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首页> 外文期刊>Gait & posture >Muscle paresis and passive stiffness: Key determinants in limiting function in Hereditary and Sporadic Spastic Paraparesis
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Muscle paresis and passive stiffness: Key determinants in limiting function in Hereditary and Sporadic Spastic Paraparesis

机译：肌肉麻痹和被动僵硬：遗传性和散发性痉挛性轻瘫的限制功能的关键因素

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Background: People with Hereditary and Sporadic Spastic Parapresis (SP) walk with a stiff legged gait characterised by a lack of knee flexion. Objective: We investigated the relationship between lower limb strength and stiffness and knee flexion during swing phase while walking in 20 people with SP and 18 matched controls. Methods: Maximal isometric strength was measured using a dynamometer. Passive stiffness and spasticity was assessed during motor-driven slow (5°/s) and fast (60°/s) stretches at the ankle and knee while the subject was relaxed or preactivating the muscle. Walking was assessed using 3D motion analysis. Results: Isometric muscle strength was decreased in people with SP with over a 50% reduction in strength being found in the ankle dorsiflexors. Passive stiffness, assessed during slow stretches, was 35% higher in the plantarflexors in people with SP (p<0.05). Faster stretches induced large stretch evoked muscle activity and over a 110% increase in stiffness at the ankle and knee in people with SP reflecting the presence of spasticity (p<0.05). However, stretch reflex size and stiffness was similar between the groups following identical stretches of the pre-activated muscle (P>0.05). Lower knee flexion during swing phase was associated with reduced knee flexion velocity at the end of stance phase which in turn was associated with reduced plantarflexor strength and increased passive stiffness in the knee extensors. Conclusions: The relative importance of muscle paresis and passive stiffness in limiting walking in SP suggests that these impairments should be the target of future therapies.
机译：背景：遗传性和散发性痉挛性瘫痪（SP）的人步态僵硬，步态僵硬，缺乏膝盖屈曲。目的：我们调查了20名SP患者和18名相匹配的对照组在行走过程中下肢力量与刚度以及膝部屈伸之间的关系。方法：使用测力计测量最大等距强度。在受试者放松或预先激活肌肉的过程中，在踝关节和膝盖的慢速（5°/ s）和快速（60°/ s）拉伸过程中评估了被动的僵硬和痉挛。使用3D运动分析评估步行情况。结果：SP患者的等轴肌力量降低，而踝背屈肌的力量降低了50％以上。 SP患者在slow屈期间的被动刚度在slow屈肌中高35％（p <0.05）。较快的拉伸导致SP患者大幅度拉伸诱发了肌肉活动，踝关节和膝盖的僵硬度增加了110％以上，反映出痉挛的存在（p <0.05）。然而，在相同的预激活肌肉拉伸后，两组之间的拉伸反射大小和刚度相似（P> 0.05）。摆动阶段膝关节屈曲降低与站立阶段结束时膝关节屈曲速度降低有关，而膝关节屈肌速度下降与膝伸肌的被动僵硬增加有关。结论：肌肉麻痹和被动僵硬在限制SP行走中的相对重要性表明，这些损伤应成为未来治疗的目标。

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