The Effect Of Task-oriented Training On Walking In Patients With Hemiplegia

Objective:How to improve the walking ability of patients with chronic hemiplegia is a focus in the field of rehabilitation.Exploring the effects of task-oriented training on waiking in patients with hemiplegia,analyzing its walking function,kinematic parameters and kinetics parameters,to seek a more effective and comprehensive clinical rehabilitation interventions.Methods:Selecting five male chronic hemiplegia patients that accorded with inclusion criteria as the research object,were left hemiplegia.Subjects received 8 weeks of task-oriented training,applying the classification of ICF,respectively,to set up the function and structure level tasks and activity level tasks,set the difficulty and the number of the task.Using neurologic music therapy technology,adopting the way of one to one in rehabilitation training.Before and after the training,conducting walking function test and three-dimensional gait analysis test.All tests were taken videos.Walking ability tests includes 10m walking speed testing and TUGT.Using Vicon motion capture system for three-dimensional gait analysis test,including kinematic parameters and kinetics parameters.Observing the changes of the parameters before and after the intervention.Results:1.After the intervention,the patient's 10 m walking speed increased(P<0.05),TUGT reduced(P<0.05);2.Spatial and temporal parameters:at posttest,the patient's affected sides step length,unaffected side length,stride length,unaffected side stride frequency,percentage of affected side's swing time increased significantly(P<0.05),the percentage of affected side's support time significantly reduced(P<0.05);Speed,unaffected side stride length,step width,the unaffected side's swing time percentage increase,the unaffected side's support time percentage,double support time percentage decreased,but there was no statistically significant difference(P>0.05);3.Joint angles(1)At posttest,ankle maximum dorsiflexion and plantarflexion and adduction angle increased significantly(P<0.05),knee maximum flexion,adduction,and internal rotation,rotation angle increased significantly(P<0.05),maximum hip extension angle increased significantly(P<0.05);Ankle valgus,abduction angle significantly reduced(P<0.05);Ankle maximum varus angle increased,knee maximum extension angle increased,hip maximum abduction angle,and internal rotation angle increased,the maximum flexion,adduction,external rotation angle decreased,but there were no statistically.(2)At posttest,the moment of toe off,ankle dorsiflexion angle significantly reduced(P<0.05),knee flexion angle increased significantly(P<0.05);Hip flexion angle decreased,but there was no statistically significant difference(P>0.05).4.Kinetics parameters(1)At posttest,the ankle,knee and hip maximum flexion,extension moment increased significantly(P<0.05),the ankle maximum varus moment,knee maximum internal rotation moment,hip maximum external rotation moment increased significantly(P<0.05);Knee maximum valgus,adduction moment increased,knee maximum adduction,external rotation moment increasd,hip maximum adduction,internal rotation moment increased,but there was no statistically significant difference(P>0.05);(2)At posttest,the peak vertical GRF increased significantly(P<0.05),forward GRF peak decreases,there was no statistically significant difference(P>0.05).Conclusion:The study confirmed that 8 weeks' task-oriented training can improve the walking ability of patients,including the following aspects:1.It can reduce the time of the 10 m walking speed and the TUG.;2.It can increase patients' step length,stride length,speed,stride length,swing time percentage,reduce support time percentage and double support time percentage;3.It can increase ankle and knee maximum flexion and extension angle,hip maximum extension angle,reduce maximum hip flexion angle;increase ankle maximum adduction angle,knee maximum adduction,internal rotation,external rotating angle;4.It can increase the ankle,knee and hip maximum flexion and extension,adduction and abduction,external rotating t and internal rotation moment and increase the peak ground reaction force of the vertical direction.