肌电传感器加速度计在良性阵发性位置性眩晕患者平衡功能检测中的应用
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摘要
目的用肌电传感器加速度计评估良性阵发性位置性眩晕(BPPV)患者平衡功能。方法选择2017年11月至2018年11月确诊的单侧原发性BPPV患者25例(病例组)和健康者18例(对照组);病例组再按病变部位分为后半规管-BPPV(PC-BPPV)亚组(20例)和水平半规管-BPPV(HC-BPPV)亚组(5例)。采用可穿戴式嵌入肌电传感器的加速度计观察动静态平衡功能。肌电传感器分别固定在患者左脚、右脚、头部和腰部,加速度计采集模块有前后、左右和垂直方向3个轴,采集站立和运动过程中的加速度信号,采样频率148 Hz。静态平衡试验包括睁眼静止站立和闭眼静止站立(用时各30 s),动态平衡试验为自然状态往返行走2次(距离20 m)。主要采集站立时的静态平衡参数:加速度的均方根(RMS)、平均速度(MV)、姿势摆动平滑度指标(Jerk);行走时的动态平衡参数:步态周期、步频、单步时、支撑相所占百分率(%)等数据。结果 PC-BPPV亚组和HC-BPPV亚组睁眼、闭眼时静态平衡参数与对照组比较均有差异。PC-BPPV亚组睁眼和闭眼站立期间摆动的RMS、MV和Jerk参数均显著大于对照组(P <0. 05),且闭眼站立期间的差异更大(P <0. 01)。HC-BPPV亚组睁眼站立期间摆动的RMS、MV和Jerk参数与对照组比较差异无显著性,闭眼站立期间摆动的Jerk参数显著大于对照组(P <0. 05)。与对照组比较,PC-BPPV和HC-BPPV亚组的步态周期和单步时间显著延长(P <0. 05),步频显著较小(P <0. 05),而左脚、右脚支撑相所占百分率以及双脚支撑相所占百分率差异无显著性(P> 0. 05)。结论 BPPV患者的静态和动态平衡功能均存在缺陷,BPPV也许并不良性。平衡功能检查可为BPPV的诊断、治疗和康复提供客观依据。
Aim To observe the difference of balance in patients with benign paroxysmal positional vertigo( BPPV) and that of the normal people by using accelerometers. Methods Individuals who were diagnosed as idiopathic unilateral semicircular canal BPPV from November 2017 to November 2018 in our dizziness outpatient department and healthy subjects were included in this study. The patients' group was divided into two subgroups according to the location of heterotopic otolith: posterior semicircular canals( PC-BPPV) and horizontal semicircular canals( HC-BPPV). Acceleration patterns at the head and lower trunk were measured during standing and walking at self-selected speed. Temporospatial parameters,root mean square( RMS), mean velocity( MV), Jerkinesssway( JERK), gait cycle, stride frequency,percentage of stand phase were calculated to indicate standing and walking stability. Standing and gait patterns derived parameters were evaluated between the two groups. Results The temporospatial parameters of standing were different between BPPV patients and the healthy individuals. The RMS,MV and JERK in patients with PC-BPPV are much higher than those of the healthy individuals( P < 0. 05),specially when eyes closing( P < 0. 01). The RMS,MV and JERK in patients with HC-BPPV are similar with those of healthy individuals when eyes opening,but the JERK is much higher in the patients group when eyes closing( P < 0. 05). The gait cycle in BPPV patients is much longer than the healthy individuals( P < 0. 05) and the stride frequency is much lower( P < 0. 05). However,there was no difference of the percentage of stand phase between the two feet in BPPV patients( P > 0. 05). Conclusion The balance in patients with benign paroxysmal positional vertigo is impaired,so the benign paroxysmal positional vertigo may be not so benign. Aaccelerometers are good way to observe the balance of the patients with BPPV.
Aim To observe the difference of balance in patients with benign paroxysmal positional vertigo( BPPV) and that of the normal people by using accelerometers. Methods Individuals who were diagnosed as idiopathic unilateral semicircular canal BPPV from November 2017 to November 2018 in our dizziness outpatient department and healthy subjects were included in this study. The patients' group was divided into two subgroups according to the location of heterotopic otolith: posterior semicircular canals( PC-BPPV) and horizontal semicircular canals( HC-BPPV). Acceleration patterns at the head and lower trunk were measured during standing and walking at self-selected speed. Temporospatial parameters,root mean square( RMS), mean velocity( MV), Jerkinesssway( JERK), gait cycle, stride frequency,percentage of stand phase were calculated to indicate standing and walking stability. Standing and gait patterns derived parameters were evaluated between the two groups. Results The temporospatial parameters of standing were different between BPPV patients and the healthy individuals. The RMS,MV and JERK in patients with PC-BPPV are much higher than those of the healthy individuals( P < 0. 05),specially when eyes closing( P < 0. 01). The RMS,MV and JERK in patients with HC-BPPV are similar with those of healthy individuals when eyes opening,but the JERK is much higher in the patients group when eyes closing( P < 0. 05). The gait cycle in BPPV patients is much longer than the healthy individuals( P < 0. 05) and the stride frequency is much lower( P < 0. 05). However,there was no difference of the percentage of stand phase between the two feet in BPPV patients( P > 0. 05). Conclusion The balance in patients with benign paroxysmal positional vertigo is impaired,so the benign paroxysmal positional vertigo may be not so benign. Aaccelerometers are good way to observe the balance of the patients with BPPV.
引文
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[12]郝冬琳,吴波娜,毛伦林,等.耳石复位对主观性良性阵发性位置性眩晕的疗效观察[J].中国临床神经科学,2016,24:641~644,653
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[19]Parham K,Kuchel GA.A geriatric perspective on Benign Paroxysmal Positional Vertigo[J].J Am Geriatr Soc,2016,64:378-385
[20]Tang H,Li W.Advances in the diagnosis and treatment of benign paroxysmal positional vertigo[J].Exp Ther Med,2017,14:2424-2430
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[22]BergK.Measuring balance in the elderly:Preliminary development of an instrument[J].Physiother Canada,2009,41:304-311
[23]Mathias S,Nayak U,Isaacs B.Balance in elderly patients:theget-up and gotest[J].Arch Phys Med Rehabil,1986,67:387-389
[24]Podsiadlo D,Richardson S.The timedUp&Go:a test of basic functional mobility for frail elderly persons[J].J Am Geriatr Soc,1991,39:142-148
[25]Pickering RM,Grimbergen YA,,Rigney U,et al.A metaanalysis of six prospective studies of falling in Parkinson's disease[J].Mov Disord,2007,22:1892-1900
[26]Panzer VP,Wakefield DB,Hall CB,et al.Mobility assessment:sensitivity and specificity of measurement sets in older adults[J].Arch Phys Med Rehabil,2011,92:905-912
[27]Visser JE,Carpenter MG,Van der Kooij H,et al.The clinical utility of posturography[J].Clin Neurophysiol,2008,119:2424-2436
[28]Shull PB,Jirattigalachote W,Hunt MA,et al.Quantified self and human movement:a review on the clinical impact of wearable sensing and feedback for gait analysis and intervention[J].Gait Posture,2014,40:11-19
[29]Adelsberger R,Valko Y,Straumann D,et al.Automated Romberg testing in patients with benign paroxysmal positional vertigo and healthy subjects[J].IEEE Trans Biomed Eng,2015,62:373-381
[30]Cohen HS,Mulavara AP,Peters BT,et al.Test of walking balance for screening vestibulare disorders[J].J Vestib Res,2012,22:95-104
[31]Mulavara AP,Cohen HS,Peters BT,et al.Newanalyses of the sensory organization test compared to the clinical test of sensory integration and balance in patients with benign paroxysmal positional vertigo[J].Laryngoscope,2013,123:2276-2280
[32]Cohen HS,Mulavara AP,Peters BT,et al.Standingbalance tests for screening people with vestibular impairments[J].Laryngoscope,2014,124:545-550
[33]Kim SC,Kim JY,Lee HN,et al.A quantitative analysis of gait patterns in vestibular neuritis patients using gyroscope sensor and a continuous walking protocol[J].J Neuroeng Rehabil,2014,11:58
[34]Celebisoy N,Bayam E,Güle9 F,et al.Balance in posterior and horizontal canal type benign paroxysmal positional vertigo before and after canalith repositioning maneuvers[J].Gait Posture,2009,29:520-523
[35]Cohen HS,Stitz J,Sangi-Haghpeykar H,et al.Tandem walking as a quick screening test for vestibular disorders[J].Laryngoscope,2018,128:1687-1691
[36]Aoki M,Tokita T,Kuze B,et al.A characteristic pattern in the postural sway of unilateral vestibular impaired patients[J].Gait Posture,2014,40:435-440
[2]Furman JM,Cass SP.Benign paroxysmal positional vertigo[J].N Engl J Med,1999,341:1590-1596
[3]Shan X,Peng X,Wang E.Efficacy of computer-controlled repositioning procedure for benign paroxysmal positional vertigo[J].Laryngoscope,2015,125:715-719
[4]Kim JS,Zee DS.Clinical practice.Benign paroxysmal positional vertigo[J].N Engl J Med,2014,370:1138-1147
[5]Oghalai JS,Manolidis S,Barth JL,et al.Unrecognized benign paroxysmal positional vertigo in elderly patients[J].Otolaryngology Head Neck Surg,2000,122:630-634
[6]Ganan9a FF,Gazzola JM,Ganan9a CF,et al.Elderly falls associated with benign paroxysmal positional vertigo[J].Braz JOtorhinolaryngol,2010,76:113-120
[7]Adamo DE,Pociask FD,Goldberg A.The contribution of head position,standing surface and vision to postural control in young adults[J].J Vestib Res,2013,23:33-40
[8]Schniepp R,M9hwald K,Wuehr M.Gait ataxia in humans:vestibular and cerebellar control of dynamic stability[J].JNeurol,2017,264:87-92
[9]Nashner LM,Black FO,Wall C 3rd.Adaptation to altered support and visual conditions during stance:patients with vestibular deficits[J].J Neurosci,1982,2:536-544
[10]Anson E,Pineault K,Bair W,et al.Reduced vestibular function is associated with longer,slower steps in healthy adults during normal speed walking[J].Gait Posture,2019,68:340-345
[11]中华耳鼻咽喉头颈外科杂志编辑委员会,中华医学会耳鼻咽喉头颈外科学分会.良性阵发性位置性眩晕诊断和治疗指南(2017)[J].中华耳鼻咽喉头颈外科杂志,2017,52:173-177
[12]郝冬琳,吴波娜,毛伦林,等.耳石复位对主观性良性阵发性位置性眩晕的疗效观察[J].中国临床神经科学,2016,24:641~644,653
[13]WikipediaRoot mean square[EB]/[OL].https://en.wikipedia.org/wiki/Root-mean-square.13th.Mar,2019
[14]Mancini M,Salarian A,Carlson-Kuhta P,et al.ISway:a sensitive,valid and reliable measure of postural control[J].JNeuroeng Rehabil,2012,9:59
[15]周长青.步态分析及常用步态测量方法[J].百度文库,2018,https://wenku.baidu.com
[16]Gleeson M,Browning GB,Burton MJ,et al.editors.ScottBrown's Otorhinolaryngol Head Neck Surg[M].London:Edward Arnold(Publishers)Ltd,2008:3207-3244
[17]Allum JH,Honegger F.Relation between head impulse tests,rotating chair tests,and stance and gait posturography afer an acute unilateral peripheral vestibular defcit[J].Otol Neurotol,2013,34:980-989
[18]MacKinnon CD.Sensorimotor anatomy of gait,balance,and falls[J].Handb Clin Neurol,2018,159:3-26
[19]Parham K,Kuchel GA.A geriatric perspective on Benign Paroxysmal Positional Vertigo[J].J Am Geriatr Soc,2016,64:378-385
[20]Tang H,Li W.Advances in the diagnosis and treatment of benign paroxysmal positional vertigo[J].Exp Ther Med,2017,14:2424-2430
[21]Guralnik JM,Simonsick EM,Ferrucci L,et al.A short physical performance battery assessing lower extremity function:association with self-reported disability and prediction of mortality and nursing home admission[J].J Gerontol,1994,49:M85-94
[22]BergK.Measuring balance in the elderly:Preliminary development of an instrument[J].Physiother Canada,2009,41:304-311
[23]Mathias S,Nayak U,Isaacs B.Balance in elderly patients:theget-up and gotest[J].Arch Phys Med Rehabil,1986,67:387-389
[24]Podsiadlo D,Richardson S.The timedUp&Go:a test of basic functional mobility for frail elderly persons[J].J Am Geriatr Soc,1991,39:142-148
[25]Pickering RM,Grimbergen YA,,Rigney U,et al.A metaanalysis of six prospective studies of falling in Parkinson's disease[J].Mov Disord,2007,22:1892-1900
[26]Panzer VP,Wakefield DB,Hall CB,et al.Mobility assessment:sensitivity and specificity of measurement sets in older adults[J].Arch Phys Med Rehabil,2011,92:905-912
[27]Visser JE,Carpenter MG,Van der Kooij H,et al.The clinical utility of posturography[J].Clin Neurophysiol,2008,119:2424-2436
[28]Shull PB,Jirattigalachote W,Hunt MA,et al.Quantified self and human movement:a review on the clinical impact of wearable sensing and feedback for gait analysis and intervention[J].Gait Posture,2014,40:11-19
[29]Adelsberger R,Valko Y,Straumann D,et al.Automated Romberg testing in patients with benign paroxysmal positional vertigo and healthy subjects[J].IEEE Trans Biomed Eng,2015,62:373-381
[30]Cohen HS,Mulavara AP,Peters BT,et al.Test of walking balance for screening vestibulare disorders[J].J Vestib Res,2012,22:95-104
[31]Mulavara AP,Cohen HS,Peters BT,et al.Newanalyses of the sensory organization test compared to the clinical test of sensory integration and balance in patients with benign paroxysmal positional vertigo[J].Laryngoscope,2013,123:2276-2280
[32]Cohen HS,Mulavara AP,Peters BT,et al.Standingbalance tests for screening people with vestibular impairments[J].Laryngoscope,2014,124:545-550
[33]Kim SC,Kim JY,Lee HN,et al.A quantitative analysis of gait patterns in vestibular neuritis patients using gyroscope sensor and a continuous walking protocol[J].J Neuroeng Rehabil,2014,11:58
[34]Celebisoy N,Bayam E,Güle9 F,et al.Balance in posterior and horizontal canal type benign paroxysmal positional vertigo before and after canalith repositioning maneuvers[J].Gait Posture,2009,29:520-523
[35]Cohen HS,Stitz J,Sangi-Haghpeykar H,et al.Tandem walking as a quick screening test for vestibular disorders[J].Laryngoscope,2018,128:1687-1691
[36]Aoki M,Tokita T,Kuze B,et al.A characteristic pattern in the postural sway of unilateral vestibular impaired patients[J].Gait Posture,2014,40:435-440