Comparison of walking quality variables between incomplete spinal cord injury patients and healthy subjects by using a footscan plantar pressure system
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摘要
The main goal of spinal cord rehabilitation is to restore walking ability and improve walking quality after spinal cord injury(SCI). The spatiotemporal parameters of walking and the parameters of plantar pressure can be obtained using a plantar pressure analysis system. Previous studies have reported step asymmetry in patients with bilateral SCI. However, the asymmetry of other parameters in patients with SCI has not been reported. This was a prospective, cross-sectional study, which included 23 patients with SCI, aged 48.1 ± 14.5 years, and 28 healthy subjects, aged 47.1 ± 9.8 years. All subjects underwent bare foot walking on a plantar pressure measurement device to measure walking speed and spatiotemporal parameters. Compared with healthy subjects, SCI patients had slower walking speed, longer stride time and stance time, larger stance phase percentage, and shorter stride length. The peak pressures under the metatarsal heads and toe were lower in SCI patients than in healthy subjects. In the heel, regional impulse and the contact area percentage in SCI patients were higher than those in healthy subjects. The symmetry indexes of stance time, step length, maximum force, impulse and contact area were increased in SCI patients, indicating a decline in symmetry. The results confirm that the gait quality, including spatiotemporal variables and plantar pressure parameters, and symmetry index were lower in SCI patients compared with healthy subjects. Plantar pressure parameters and symmetry index could be sensitive quantitative parameters to improve gait quality of SCI patients. The protocols were approved by the Clinical Research Ethics Committee of Shengjing Hospital of China Medical University(approval No. 2015 PS54 J) on August 13, 2015. This trial was registered in the ISRCTN Registry(ISRCTN42544587) on August 22, 2018. Protocol version: 1.0.
The main goal of spinal cord rehabilitation is to restore walking ability and improve walking quality after spinal cord injury(SCI). The spatiotemporal parameters of walking and the parameters of plantar pressure can be obtained using a plantar pressure analysis system. Previous studies have reported step asymmetry in patients with bilateral SCI. However, the asymmetry of other parameters in patients with SCI has not been reported. This was a prospective, cross-sectional study, which included 23 patients with SCI, aged 48.1 ± 14.5 years, and 28 healthy subjects, aged 47.1 ± 9.8 years. All subjects underwent bare foot walking on a plantar pressure measurement device to measure walking speed and spatiotemporal parameters. Compared with healthy subjects, SCI patients had slower walking speed, longer stride time and stance time, larger stance phase percentage, and shorter stride length. The peak pressures under the metatarsal heads and toe were lower in SCI patients than in healthy subjects. In the heel, regional impulse and the contact area percentage in SCI patients were higher than those in healthy subjects. The symmetry indexes of stance time, step length, maximum force, impulse and contact area were increased in SCI patients, indicating a decline in symmetry. The results confirm that the gait quality, including spatiotemporal variables and plantar pressure parameters, and symmetry index were lower in SCI patients compared with healthy subjects. Plantar pressure parameters and symmetry index could be sensitive quantitative parameters to improve gait quality of SCI patients. The protocols were approved by the Clinical Research Ethics Committee of Shengjing Hospital of China Medical University(approval No. 2015 PS54 J) on August 13, 2015. This trial was registered in the ISRCTN Registry(ISRCTN42544587) on August 22, 2018. Protocol version: 1.0.
The main goal of spinal cord rehabilitation is to restore walking ability and improve walking quality after spinal cord injury(SCI). The spatiotemporal parameters of walking and the parameters of plantar pressure can be obtained using a plantar pressure analysis system. Previous studies have reported step asymmetry in patients with bilateral SCI. However, the asymmetry of other parameters in patients with SCI has not been reported. This was a prospective, cross-sectional study, which included 23 patients with SCI, aged 48.1 ± 14.5 years, and 28 healthy subjects, aged 47.1 ± 9.8 years. All subjects underwent bare foot walking on a plantar pressure measurement device to measure walking speed and spatiotemporal parameters. Compared with healthy subjects, SCI patients had slower walking speed, longer stride time and stance time, larger stance phase percentage, and shorter stride length. The peak pressures under the metatarsal heads and toe were lower in SCI patients than in healthy subjects. In the heel, regional impulse and the contact area percentage in SCI patients were higher than those in healthy subjects. The symmetry indexes of stance time, step length, maximum force, impulse and contact area were increased in SCI patients, indicating a decline in symmetry. The results confirm that the gait quality, including spatiotemporal variables and plantar pressure parameters, and symmetry index were lower in SCI patients compared with healthy subjects. Plantar pressure parameters and symmetry index could be sensitive quantitative parameters to improve gait quality of SCI patients. The protocols were approved by the Clinical Research Ethics Committee of Shengjing Hospital of China Medical University(approval No. 2015 PS54 J) on August 13, 2015. This trial was registered in the ISRCTN Registry(ISRCTN42544587) on August 22, 2018. Protocol version: 1.0.
引文
Aguirre-Guemez AV,Perez-Sanpablo AI,Quinzanos-Fresnedo J,Perez-Zavala R,Barrera-Ortiz A(2017)Walking speed is not the best outcome to evaluate the effect of robotic assisted gait training in people with motor incomplete spinal cord injury:a systematic review with meta-analysis.J Spinal Cord Med 1-13.
Amatachaya S,Amatachaya P,Keawsutthi M,Siritaratiwat W(2013)External cues benefit walking ability of ambulatory patients with spinal cord injury.J Spinal Cord Med 36:638-644.
Arazpour M,Gholami M,Bahramizadeh M,Sharifi G,Bani MA(2017)Influence of reciprocating link when using an isocentric reciprocating gait orthosis(IRGO)on walking in patients with spinal cord injury:a pilot study.Top Spinal Cord Inj Rehabil 23:256-262.
Arazpour M,Mehrpour SR,Bani MA,Hutchins SW,Bahramizadeh M,Rahgozar M(2014)Comparison of gait between healthy participants and persons with spinal cord injury when using a powered gait orthosis-a pilot study.Spinal Cord 52:44-48.
Armstrong AJ,Clark JM,Ho DT,Payne CJ,Nolan S,Goodes LM,Harvey LA,Marshall R,Galea MP,Dunlop SA(2017)Achieving assessor accuracy on the international standards for neurological classification of spinal cord injury.Spinal Cord 55:994-1001.
Awad LN,Palmer JA,Pohlig RT,Binder-Macleod SA,Reisman DS(2015)Walking speed and step length asymmetry modify the energy cost of walking after stroke.Neurorehabil Neural Repair 29:416-423.
Beseler MR,Grao CM,Gil A,Martinez Lozano MD(2012)Walking assessment with instrumented insoles in patients with lower limb spasticity after botulinum toxin infiltration.Neurologia(Barcelona,Spain)27:519-530.
Brown S,Boulton A,Bowling F,Reeves N(2016)Benefits,challenges,and potential utility of a gait database for diabetes patients.J Diabet Sci Tech 10:1065-1072.
Chiu MC,Wu HC,Chang LY(2013)Gait speed and gender effects on center of pressure progression during normal walking.Gait Posture 37:43-48.
Fernandez-Seguin LM,Diaz Mancha JA,Sanchez Rodriguez R,Escamilla Martinez E,Gomez Martin B,Ramos Ortega J(2014)Comparison of plantar pressures and contact area between normal and cavus foot.Gait Posture 39:789-792.
Gollie JM(2018)Fatigability during volitional walking in incomplete spinal cord injury:cardiorespiratory and motor performance considerations.Neural Regen Res 13:786-790.
Greenhalgh A,Taylor PJ,Sinclair J(2014)The influence of different force and pressure measuring transducers on lower extremity kinematics measured during walking.Gait Posture 40:476-479.
Guan X,Kuai S,Ji L,Wang R,Ji R(2017)Trunk muscle activity patterns and motion patterns of patients with motor complete spinal cord injury at T8 and T10 walking with different un-powered exoskeletons.J Spinal Cord Med 40:463-470.
Guo SM,Li JM,Wu QW,Shen HT(2012)Effect of gait training and assessment system of Lokomat automatic robot on walking ability of patients with incomplete spinal cord injury.Zhongguo Zuzhi Gongcheng Yanjiu 16:2324-2327.
Hardin EC,Kobetic R,Triolo RJ(2013)Ambulation and spinal cord injury.Phys Med Rehabil Clin N Am 24:355-370.
Hasegawa T,Uchiyama Y,Uemura K,Harada Y,Sugiyama M,Tanaka H(2014)Physical impairment and walking function required for community ambulation in patients with cervical incomplete spinal cord injury.Spinal Cord 52:396-399.
Hsu AL,Tang PF,Jan MH(2003)Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke.Arch Phys Med Rehabil 84:1185-1193.
Kamibayashi K,Nakajima T,Fujita M,Takahashi M,Ogawa T,Akai M,Nakazawa K(2010)Effect of sensory inputs on the soleus H-reflex amplitude during robotic passive stepping in humans.Exp Brain Res 202:385-395.
Kawashima N,Yano H,Ohta Y,Nakazawa K(2006)Stretch reflex modulation during imposed static and dynamic hip movements in standing humans.Exp Brain Res 174:342-350.
Knippenberg E,Verbrugghe J,Lamers I,Palmaers S,Timmermans A,Spooren A(2017)Markerless motion capture systems as training device in neurological rehabilitation:a systematic review of their use,application,target population and efficacy.Arch Phys Med Rehabil 14:61.
Krizsan-Agbas D,Winter MK,Eggimann LS,Meriwether J,Berman NE,Smith PG,McCarson KE(2014)Gait analysis at multiple speeds reveals differential functional and structural outcomes in response to graded spinal cord injury.J Neurotrauma 31:846-856.
Kumprou M,Amatachaya P,Sooknuan T,Thaweewannakij T,Mato L,Amatachaya S(2017)Do ambulatory patients with spinal cord injury walk symmetrically?Spinal Cord 55:204-207.
Lapointe R,Lajoie Y,Serresse O,Barbeau H(2001)Functional community ambulation requirements in incomplete spinal cord injured subjects.Spinal Cord 39:327-335.
Li X,Huang H,Wang J,Yu Y,Ao Y(2016)The analysis of plantar pressure data based on multimodel method in patients with anterior cruciate ligament deficiency during walking.Biomed Res Int2016:7891407.
Lim BO,O’Sullivan D,Choi BG,Kim MY(2016)Comparative gait analysis between children with autism and age-matched controls:analysis with temporal-spatial and foot pressure variables.J Phys Ther Sci 28:286-292.
Lucareli PR,Lima MO,Lima FP,de Almeida JG,Brech GC,D’Andrea Greve JM(2011)Gait analysis following treadmill training with body weight support versus conventional physical therapy:a prospective randomized controlled single blind study.Spinal Cord49:1001-1007.
Mohd Said A,Justine M,Manaf H(2016)Plantar pressure distribution among older persons with different types of foot and its correlation with functional reach distance.Scientifica 2016:8564020.
Narin F,Hanalioglu S,Ustun H,Kilinc K,Bilginer B(2017)Topiramate as a neuroprotective agent in a rat model of spinal cord injury.Neural Regen Res 12:2071-2076.
Neamtu MC,Rusu L,Marin M,Avramescu T,Rusu PF,Neamtu OM,Iancau M(2012)Morphofunctional aspects of lower limb in multiple sclerosis.Rom J Morphol Embryol 53:117-120.
Nsenga Leunkeu A,Lelard T,Shephard RJ,Doutrellot PL,Ahmaidi S(2014)Gait cycle and plantar pressure distribution in children with cerebral palsy:clinically useful outcome measures for a management and rehabilitation.NeuroRehabilitation 35:657-663.
Ogawa T,Kawashima N,Obata H,Kanosue K,Nakazawa K(2015)Mode-dependent control of human walking and running as revealed by split-belt locomotor adaptation.J Exp Biol 218:3192-3198.
Plotnik M,Bartsch RP,Zeev A,Giladi N,Hausdorff JM(2013)Effects of walking speed on asymmetry and bilateral coordination of gait.Gait Posture 38:864-869.
Pramodhyakul N,Amatachaya P,Sooknuan T,Arayawichanon P,Amatachaya S(2014)Effects of a visuotemporal cue on walking ability of independent ambulatory subjects with spinal cord injury as compared with healthy subjects.Spinal Cord 52:220-224.
Quarrington RD,Costi JJ,Freeman BJC,Jones CF(2018)Quantitative evaluation of facet deflection,stiffness,strain and failure load during simulated cervical spine trauma.J Biomech 72:116-124.
Razak AH,Zayegh A,Begg RK,Wahab Y(2012)Foot plantar pressure measurement system:a review.Sensors 12:9884-9912.
Rusu L,Neamtu MC,Rosulescu E,Cosma G,Dragomir M,Marin MI(2014)Analysis of foot and ankle disorders and prediction of gait in multiple sclerosis rehabilitation.Eur J Med Res 19:73.
Safayi S,Jeffery ND,Shivapour SK,Zamanighomi M,Zylstra TJ,Bratsch-Prince J,Wilson S,Reddy CG,Fredericks DC,Gillies GT,Howard MA,3rd(2015)Kinematic analysis of the gait of adult sheep during treadmill locomotion:parameter values,allowable total error,and potential for use in evaluating spinal cord injury.JNeurol Sci 358:107-112.
Savin DN,Morton SM,Whitall J(2014)Generalization of improved step length symmetry from treadmill to overground walking in persons with stroke and hemiparesis.Clin Neurophysiol 125:1012-1020.
Shank CD,Walters BC,Hadley MN(2018)Current topics in the management of acute traumatic spinal cord injury.Neurocrit Care DOI:10.1007/s12028-018-0537-5.
Soames RW(1985)Foot pressure patterns during gait.J Biomed Eng7:120-126.
Sohn WJ,Tan AQ,Hayes HB,Pochiraju S,Deffeyes J,Trumbower RD(2018)Variability of leg kinematics during overground walking in persons with chronic incomplete spinal cord injury.J Neurotrauma DOI:10.1089/neu.2017.5538.
Song-Hua Y,Lu W,Kuan Z(2017)Effects of different movement modes on plantar pressure distribution patterns in obese and nonobese Chinese children.Gait Posture 57:28-34.
Takazawa A,Kamei N,Adachi N,Ochi M(2018)Endoplasmic reticulum stress transducer old astrocyte specifically induced substance contributes to astrogliosis after spinal cord injury.Neural Regen Res 13:536-540.
Tamburella F,Scivoletto G,Cosentino E,Molinari M(2013)Walking in water and on land after an incomplete spinal cord injury.Am JPhys Med Rehabil 92:e4-e15.
Thijs Y,Van Tiggelen D,Roosen P,De Clercq D,Witvrouw E(2007)A prospective study on gait-related intrinsic risk factors for patellofemoral pain.Clin J Sport Med 17:437-445.
Tyrell CM,Roos MA,Rudolph KS,Reisman DS(2011)Influence of systematic increases in treadmill walking speed on gait kinematics after stroke.Phys Ther 91:392-403.
Wang P,Low KH,McGregor AH,Tow A(2013)Detection of abnormal muscle activations during walking following spinal cord injury(SCI).Res Dev Disabil 34:1226-1235.
Wu MF,Zhang SQ,Liu JB,Li Y,Zhu QS,Gu R(2015)Neuroprotective effects of electroacupuncture on early-and late-stage spinal cord injury.Neural Regen Res 10:1628-1634.
Yan SH,Zhang K,Tan GQ,Yang J,Liu ZC(2013)Effects of obesity on dynamic plantar pressure distribution in Chinese prepubescent children during walking.Gait Posture 37:37-42.
Yang A,Asselin P,Knezevic S,Kornfeld S,Spungen AM(2015)Assessment of in-hospital walking velocity and level of assistance in a powered exoskeleton in persons with spinal cord injury.Top Spinal Cord Inj Rehabil 21:100-109.
Yu CH,Hung YC,Lin YH,Chen GX,Wei SH,Huang CH,Chen CS(2014)A 3D mathematical model to predict spinal joint and hip joint force for trans-tibial amputees with different SACH foot pylon adjustments.Gait Posture 40:545-548.
Yugue I,Okada S,Maeda T,Ueta T,Shiba K(2018)Sensitivity and specificity of the‘knee-up test’for estimation of the American Spinal Injury Association Impairment Scale in patients with acute motor incomplete cervical spinal cord injury.Spinal Cord 56:347-354.
Zhang Y,Liu H,Fu C,Ning Y,Zhang J,Zhou L,Li Z,Bai P(2016)The biomechanical effect of acupuncture for poststroke cavovarus foot:study protocol for a randomized controlled pilot trial.Trials17:146.
Amatachaya S,Amatachaya P,Keawsutthi M,Siritaratiwat W(2013)External cues benefit walking ability of ambulatory patients with spinal cord injury.J Spinal Cord Med 36:638-644.
Arazpour M,Gholami M,Bahramizadeh M,Sharifi G,Bani MA(2017)Influence of reciprocating link when using an isocentric reciprocating gait orthosis(IRGO)on walking in patients with spinal cord injury:a pilot study.Top Spinal Cord Inj Rehabil 23:256-262.
Arazpour M,Mehrpour SR,Bani MA,Hutchins SW,Bahramizadeh M,Rahgozar M(2014)Comparison of gait between healthy participants and persons with spinal cord injury when using a powered gait orthosis-a pilot study.Spinal Cord 52:44-48.
Armstrong AJ,Clark JM,Ho DT,Payne CJ,Nolan S,Goodes LM,Harvey LA,Marshall R,Galea MP,Dunlop SA(2017)Achieving assessor accuracy on the international standards for neurological classification of spinal cord injury.Spinal Cord 55:994-1001.
Awad LN,Palmer JA,Pohlig RT,Binder-Macleod SA,Reisman DS(2015)Walking speed and step length asymmetry modify the energy cost of walking after stroke.Neurorehabil Neural Repair 29:416-423.
Beseler MR,Grao CM,Gil A,Martinez Lozano MD(2012)Walking assessment with instrumented insoles in patients with lower limb spasticity after botulinum toxin infiltration.Neurologia(Barcelona,Spain)27:519-530.
Brown S,Boulton A,Bowling F,Reeves N(2016)Benefits,challenges,and potential utility of a gait database for diabetes patients.J Diabet Sci Tech 10:1065-1072.
Chiu MC,Wu HC,Chang LY(2013)Gait speed and gender effects on center of pressure progression during normal walking.Gait Posture 37:43-48.
Fernandez-Seguin LM,Diaz Mancha JA,Sanchez Rodriguez R,Escamilla Martinez E,Gomez Martin B,Ramos Ortega J(2014)Comparison of plantar pressures and contact area between normal and cavus foot.Gait Posture 39:789-792.
Gollie JM(2018)Fatigability during volitional walking in incomplete spinal cord injury:cardiorespiratory and motor performance considerations.Neural Regen Res 13:786-790.
Greenhalgh A,Taylor PJ,Sinclair J(2014)The influence of different force and pressure measuring transducers on lower extremity kinematics measured during walking.Gait Posture 40:476-479.
Guan X,Kuai S,Ji L,Wang R,Ji R(2017)Trunk muscle activity patterns and motion patterns of patients with motor complete spinal cord injury at T8 and T10 walking with different un-powered exoskeletons.J Spinal Cord Med 40:463-470.
Guo SM,Li JM,Wu QW,Shen HT(2012)Effect of gait training and assessment system of Lokomat automatic robot on walking ability of patients with incomplete spinal cord injury.Zhongguo Zuzhi Gongcheng Yanjiu 16:2324-2327.
Hardin EC,Kobetic R,Triolo RJ(2013)Ambulation and spinal cord injury.Phys Med Rehabil Clin N Am 24:355-370.
Hasegawa T,Uchiyama Y,Uemura K,Harada Y,Sugiyama M,Tanaka H(2014)Physical impairment and walking function required for community ambulation in patients with cervical incomplete spinal cord injury.Spinal Cord 52:396-399.
Hsu AL,Tang PF,Jan MH(2003)Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke.Arch Phys Med Rehabil 84:1185-1193.
Kamibayashi K,Nakajima T,Fujita M,Takahashi M,Ogawa T,Akai M,Nakazawa K(2010)Effect of sensory inputs on the soleus H-reflex amplitude during robotic passive stepping in humans.Exp Brain Res 202:385-395.
Kawashima N,Yano H,Ohta Y,Nakazawa K(2006)Stretch reflex modulation during imposed static and dynamic hip movements in standing humans.Exp Brain Res 174:342-350.
Knippenberg E,Verbrugghe J,Lamers I,Palmaers S,Timmermans A,Spooren A(2017)Markerless motion capture systems as training device in neurological rehabilitation:a systematic review of their use,application,target population and efficacy.Arch Phys Med Rehabil 14:61.
Krizsan-Agbas D,Winter MK,Eggimann LS,Meriwether J,Berman NE,Smith PG,McCarson KE(2014)Gait analysis at multiple speeds reveals differential functional and structural outcomes in response to graded spinal cord injury.J Neurotrauma 31:846-856.
Kumprou M,Amatachaya P,Sooknuan T,Thaweewannakij T,Mato L,Amatachaya S(2017)Do ambulatory patients with spinal cord injury walk symmetrically?Spinal Cord 55:204-207.
Lapointe R,Lajoie Y,Serresse O,Barbeau H(2001)Functional community ambulation requirements in incomplete spinal cord injured subjects.Spinal Cord 39:327-335.
Li X,Huang H,Wang J,Yu Y,Ao Y(2016)The analysis of plantar pressure data based on multimodel method in patients with anterior cruciate ligament deficiency during walking.Biomed Res Int2016:7891407.
Lim BO,O’Sullivan D,Choi BG,Kim MY(2016)Comparative gait analysis between children with autism and age-matched controls:analysis with temporal-spatial and foot pressure variables.J Phys Ther Sci 28:286-292.
Lucareli PR,Lima MO,Lima FP,de Almeida JG,Brech GC,D’Andrea Greve JM(2011)Gait analysis following treadmill training with body weight support versus conventional physical therapy:a prospective randomized controlled single blind study.Spinal Cord49:1001-1007.
Mohd Said A,Justine M,Manaf H(2016)Plantar pressure distribution among older persons with different types of foot and its correlation with functional reach distance.Scientifica 2016:8564020.
Narin F,Hanalioglu S,Ustun H,Kilinc K,Bilginer B(2017)Topiramate as a neuroprotective agent in a rat model of spinal cord injury.Neural Regen Res 12:2071-2076.
Neamtu MC,Rusu L,Marin M,Avramescu T,Rusu PF,Neamtu OM,Iancau M(2012)Morphofunctional aspects of lower limb in multiple sclerosis.Rom J Morphol Embryol 53:117-120.
Nsenga Leunkeu A,Lelard T,Shephard RJ,Doutrellot PL,Ahmaidi S(2014)Gait cycle and plantar pressure distribution in children with cerebral palsy:clinically useful outcome measures for a management and rehabilitation.NeuroRehabilitation 35:657-663.
Ogawa T,Kawashima N,Obata H,Kanosue K,Nakazawa K(2015)Mode-dependent control of human walking and running as revealed by split-belt locomotor adaptation.J Exp Biol 218:3192-3198.
Plotnik M,Bartsch RP,Zeev A,Giladi N,Hausdorff JM(2013)Effects of walking speed on asymmetry and bilateral coordination of gait.Gait Posture 38:864-869.
Pramodhyakul N,Amatachaya P,Sooknuan T,Arayawichanon P,Amatachaya S(2014)Effects of a visuotemporal cue on walking ability of independent ambulatory subjects with spinal cord injury as compared with healthy subjects.Spinal Cord 52:220-224.
Quarrington RD,Costi JJ,Freeman BJC,Jones CF(2018)Quantitative evaluation of facet deflection,stiffness,strain and failure load during simulated cervical spine trauma.J Biomech 72:116-124.
Razak AH,Zayegh A,Begg RK,Wahab Y(2012)Foot plantar pressure measurement system:a review.Sensors 12:9884-9912.
Rusu L,Neamtu MC,Rosulescu E,Cosma G,Dragomir M,Marin MI(2014)Analysis of foot and ankle disorders and prediction of gait in multiple sclerosis rehabilitation.Eur J Med Res 19:73.
Safayi S,Jeffery ND,Shivapour SK,Zamanighomi M,Zylstra TJ,Bratsch-Prince J,Wilson S,Reddy CG,Fredericks DC,Gillies GT,Howard MA,3rd(2015)Kinematic analysis of the gait of adult sheep during treadmill locomotion:parameter values,allowable total error,and potential for use in evaluating spinal cord injury.JNeurol Sci 358:107-112.
Savin DN,Morton SM,Whitall J(2014)Generalization of improved step length symmetry from treadmill to overground walking in persons with stroke and hemiparesis.Clin Neurophysiol 125:1012-1020.
Shank CD,Walters BC,Hadley MN(2018)Current topics in the management of acute traumatic spinal cord injury.Neurocrit Care DOI:10.1007/s12028-018-0537-5.
Soames RW(1985)Foot pressure patterns during gait.J Biomed Eng7:120-126.
Sohn WJ,Tan AQ,Hayes HB,Pochiraju S,Deffeyes J,Trumbower RD(2018)Variability of leg kinematics during overground walking in persons with chronic incomplete spinal cord injury.J Neurotrauma DOI:10.1089/neu.2017.5538.
Song-Hua Y,Lu W,Kuan Z(2017)Effects of different movement modes on plantar pressure distribution patterns in obese and nonobese Chinese children.Gait Posture 57:28-34.
Takazawa A,Kamei N,Adachi N,Ochi M(2018)Endoplasmic reticulum stress transducer old astrocyte specifically induced substance contributes to astrogliosis after spinal cord injury.Neural Regen Res 13:536-540.
Tamburella F,Scivoletto G,Cosentino E,Molinari M(2013)Walking in water and on land after an incomplete spinal cord injury.Am JPhys Med Rehabil 92:e4-e15.
Thijs Y,Van Tiggelen D,Roosen P,De Clercq D,Witvrouw E(2007)A prospective study on gait-related intrinsic risk factors for patellofemoral pain.Clin J Sport Med 17:437-445.
Tyrell CM,Roos MA,Rudolph KS,Reisman DS(2011)Influence of systematic increases in treadmill walking speed on gait kinematics after stroke.Phys Ther 91:392-403.
Wang P,Low KH,McGregor AH,Tow A(2013)Detection of abnormal muscle activations during walking following spinal cord injury(SCI).Res Dev Disabil 34:1226-1235.
Wu MF,Zhang SQ,Liu JB,Li Y,Zhu QS,Gu R(2015)Neuroprotective effects of electroacupuncture on early-and late-stage spinal cord injury.Neural Regen Res 10:1628-1634.
Yan SH,Zhang K,Tan GQ,Yang J,Liu ZC(2013)Effects of obesity on dynamic plantar pressure distribution in Chinese prepubescent children during walking.Gait Posture 37:37-42.
Yang A,Asselin P,Knezevic S,Kornfeld S,Spungen AM(2015)Assessment of in-hospital walking velocity and level of assistance in a powered exoskeleton in persons with spinal cord injury.Top Spinal Cord Inj Rehabil 21:100-109.
Yu CH,Hung YC,Lin YH,Chen GX,Wei SH,Huang CH,Chen CS(2014)A 3D mathematical model to predict spinal joint and hip joint force for trans-tibial amputees with different SACH foot pylon adjustments.Gait Posture 40:545-548.
Yugue I,Okada S,Maeda T,Ueta T,Shiba K(2018)Sensitivity and specificity of the‘knee-up test’for estimation of the American Spinal Injury Association Impairment Scale in patients with acute motor incomplete cervical spinal cord injury.Spinal Cord 56:347-354.
Zhang Y,Liu H,Fu C,Ning Y,Zhang J,Zhou L,Li Z,Bai P(2016)The biomechanical effect of acupuncture for poststroke cavovarus foot:study protocol for a randomized controlled pilot trial.Trials17:146.