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物理治療
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Background and Purpose: Inadequate ankle dorsiflexion at initial contact is a common ankle impairment that affects locomotion after stroke. An increase in ankle dorsiflexion at initial contact has been reported while walking on the inclined treadmill in stroke subjects. The purpose of this study was to investigate the accumulative effects of inclined treadmill training on ankle control in chronic stroke participants with inadequate ankle control. Methods: Eighteen stroke subjects with inadequate ankle control were randomly assigned to the experimental group (n = 9) or control group (n = 9). Subjects in the experimental group received two 15-min of inclined treadmill training followed by 5 mins of over-ground walking for 12 sessions, and two 15-min of regular treadmill training followed by 5 mins of over-ground walking in the control group. All patients were assessed for ankle control during walking and walking performance before and after 12 training sessions. Results: The results on ankle control showed that increased ankle dorsiflexion angle at initial contact (p = 0.002), increased activation of tabialis anterior at initial contact (p = 0.003) and during swing (p = 0.006), and decreased dynamic spasticity of plantar flexors (p = 0.027) in the experimental group when compared to control. Although there was no significant improvement in gait velocity in the two groups, the cadence significantly decreased in the experimental group compared with the control group (p = 0.015). Conclusion: Our results suggested that the inclined treadmill training seems to be effective for ankle control by increasing angle and muscle activation of dorsiflexion and decreasing plantarflexion spasticity during walking. Clinical Relevance: Inclined treadmill training is suggested to be a beneficial addition into stroke rehabilitation program for ankle impairment.