تاثير تمرين راه رفتن با علامت‌گذاري شنيداري بر هم‌انقباضي عضلات اندام تحتاني سالمندان سالم

The Effect of Walking Training with Auditory Cueing on Co-Contraction of Lower Limb Muscles in Healthy Elderly

ﺳﺎﻟﻤﻨﺪان ﺳﻄﻮح ﺑﺎﻻﯾﯽ از ﻫﻢاﻧﻘﺒﺎﺿﯽ را در ﻋﻀﻼت اﻧﺪام ﺗﺤﺘﺎﻧﯽ ﻧﺸﺎن ﻣﯽدﻫﻨﺪ ﮐﻪ ﺑﯿﺸﺘﺮ ﺑﺮاي ﺟﺒﺮان زوال اﻧﺪامﻫﺎ و ﮐﻨﺘﺮل ﺣﺮﮐﺘﯽ ﺑﻬﺘﺮ ﻇﺎﻫﺮ ﻣﯽﺷﻮد. راه رﻓﺘﻦ ﻋﺎدي و ﺑﯽﻧﻘﺺ ﻋﻼوهﺑﺮ ﺳﻼﻣﺖ ﻋﻮاﻣﻞ ﻋﺼﺐ ﻋﻀﻠﻪ، ﺑﻪ ﺳﻼﻣﺖ ﺷﻨﺎﺧﺘﯽ و ﻧﯿﺰ ﺧﻮدﮐﺎري ﺣﺮﮐﺖ ﺑﺴﺘﮕﯽ دارد؛ ﺑﻨﺎﺑﺮاﯾﻦ ﻣﯽﺗﻮان ﺑﺎ ﺑﻪ ﭼﺎﻟﺶ ﮐﺸﯿﺪن ﻣﻨﺎﺑﻊ اﺟﺮاﯾﯽ از ﻃﺮﯾﻖ ﻋﻼﻣﺖﮔﺬاري رﯾﺘﻤﯿﮏ ﺷﻨﯿﺪاري ﺗﻮﺟﻪ ﻓﺮد را ﺑﻪ ﺑﯿﺮون ﺟﻠﺐ ﮐﺮد و ﻓﻌﺎﻟﯿﺖ روزﻣﺮهاي ﭼﻮن راه رﻓﺘﻦ را ﺑﻪ ﺧﻮدﮐﺎر و ﺑﺪون ﺗﻤﺮﮐﺰ ﺗﻐﯿﯿﺮ داد. 30 ﻣﺮد ﺳﺎﻟﻤﻨﺪ واﺟﺪ ﺷﺮاﯾﻂ 60 ﺗﺎ 75 ﺳﺎﻟﻪ ﺑﻪﻃﻮر داوﻃﻠﺒﺎﻧﻪ اﻧﺘﺨﺎب ﺷﺪﻧﺪ و در دو ﮔﺮوه ﮐﻨﺘﺮل )ﮔﺮوه ﺑﺪون ﺗﻤﺮﯾﻦ و ﮔﺮوه راه رﻓﺘﻦ ﺑﺪون ﻋﻼﻣﺖﮔﺬاري ﺷﻨﯿﺪاري( و 1 ﮔﺮوه ﺗﺠﺮﺑﯽ )راه رﻓﺘﻦ ﺑﺎ ﻋﻼﻣﺖﮔﺬاري ﺷﻨﯿﺪاري( ﻗﺮار ﮔﺮﻓﺘﻨﺪ. ﺑﺮاي ارزﯾﺎﺑﯽ ﻫﻢاﻧﻘﺒﺎﺿﯽ ﻋﻀﻠﻪ، اﻟﮕﻮي ﻓﻌﺎﻟﯿﺖ ﻋﻀﻼت اﻧﺪام ﺗﺤﺘﺎﻧﯽ از ﺟﻤﻠﻪ ﻧﻌﻠﯽ، ﺳﺎﻗﯽ ﻗﺪاﻣﯽ، ﭘﻬﻦ داﺧﻠﯽ، ﭘﻬﻦ ﺧﺎرﺟﯽ و دوﺳﺮراﻧﯽ ﻃﯽ 90 ﺛﺎﻧﯿﻪ راه رﻓﺘﻦ ﺑﺎ ﺳﺮﻋﺖ ﺗﺮﺟﯿﺤﯽ در ﭘﯿﺶ و ﭘﺲآزﻣﻮن ﺑﺮرﺳﯽ ﺷﺪ. ﺗﻤﺮﯾﻨﺎت ﺑﻪ ﻣﺪت 6 ﻫﻔﺘﻪ، 3 ﺟﻠﺴﻪ در ﻫﻔﺘﻪ و ﻫﺮ ﺟﻠﺴﻪ 20 دﻗﯿﻘﻪ اﻧﺠﺎم ﮔﺮﻓﺖ. ﺗﺤﻠﯿﻞ دادهﻫﺎ ﺑﺎ اﺳﺘﻔﺎده از ﻣﺪل آﻧﺎﻟﯿﺰ ﮐﻮوارﯾﺎﻧﺲ و آزﻣﻮن ﻧﺎﭘﺎراﻣﺘﺮﯾﮏ ﺑﻮت اﺳﺘﺮپ در ﺳﻄﺢ ﻣﻌﻨﺎداري 0/05 اﻧﺠﺎم ﮔﺮﻓﺖ. ﻧﺘﺎﯾﺞ ﻧﺸﺎن داد ﮐﻪ ﭘﺲ از 18 ﺟﻠﺴﻪ ﺗﻤﺮﯾﻦ، ﻫﻢاﻧﻘﺒﺎﺿﯽ در ﻋﻀﻼت ﻫﻤﮑﺎر ﺑﯿﺸﺘﺮ و ﻋﻀﻼت ﻣﻮاﻓﻖ و ﻣﺨﺎﻟﻒ ﮐﻤﺘﺮ ﺷﺪه، اﻣﺎ اﯾﻦ ﯾﺎﻓﺘﻪﻫﺎ از ﻧﻈﺮ آﻣﺎري، ﻣﻌﻨﺎدار ﻧﺒﻮده اﺳﺖ )0/05>P(. اﯾﻦ ﻧﺘﺎﯾﺞ ﻧﺸﺎن ﻣﯽدﻫﺪ ﮐﻪ ﻋﻼﻣﺖﮔﺬاري ﺷﻨﯿﺪاري ﺣﯿﻦ ﺗﻤﺮﯾﻦ راه رﻓﺘﻦ، ﻣﻤﮑﻦ اﺳﺖ ﺗﺄﺛﯿﺮ ﭼﻨﺪاﻧﯽ ﺑﺮ ﻓﻌﺎﻟﯿﺖ ﻫﻢاﻧﻘﺒﺎﺿﯽ ﻋﻀﻼت در ﺳﺎﻟﻤﻨﺪي اوﻟﯿﻪ ﻧﺪاﺷﺘﻪ ﺑﺎﺷﺪ ﮐﻪ اﺣﺘﻤﺎﻻً در اﺛﺮ ﻋﺪم ﺗﻐﯿﯿﺮات ﺑﺎرز ﺷﻨﺎﺧﺘﯽ در اﯾﻦ دوره اﺳﺖ.

The elderly often exhibit high levels of co-contraction in lower extremity muscles which may appear to compensate for deteriorations of organs and better motor control. Normal gait depends on both the neuromuscular system and cognitive health and motion automation. Thus, subjects’ attention can be attracted to outer environment by challenging executive resources through rhythmic auditory cueing and thus daily activity such as gait can change to automatic mode. 30 qualified elderly men (age range of 60 to 75 years old) were voluntarily selected and were divided into two control groups (detraining group and walking without auditory cueing) and one experimental group (walking with auditory cueing). The pattern of lower limb muscles activity including soleus, tibialis anterior, vastus medialis, vastus lateralis and biceps femoris during 90s walking at preferred speed was investigated in pretest and posttest to evaluate muscle co-contraction. This program was performed for 6 weeks, 3 sessions per week and 20 minutes each session. Data were analyzed using ANCOVA and nonparametric Bootstrap test at the significance level of 0.05. The results showed an increase in co-contraction in the synergic muscles but a reduction in agonist–antagonist muscles after 18 sessions of program, but these findings were not statistically significant (P˃0.05). These results indicated that auditory cueing during gait could not influence muscle co-contraction in early aging which is probably due to the lack of evident cognitive changes.