姿势控制训练对脑卒中偏瘫患者足底压力、平衡功能和步行功能改善的影响
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摘要
目的观察姿势控制训练对脑卒中偏瘫患者足底压力、平衡功能及步行改善的影响。方法选取脑卒中偏瘫患者120例,随机分为研究组和对照组,每组60例。对照组接受常规康复治疗,研究组在对照组基础上进行姿势控制训练。2组均接受20次康复治疗,每周3次,每次90 min。比较2组患者治疗后足底压力,平衡功能以及治疗前后步行功能。结果治疗后,研究组患者健足前半足和后半足峰值压力显著低于对照组[前半足:(158.52±56.71)N、(218.83±73.35)N,t=5.04,P<0.05;后半足:(257.36±85.45)N、(311.47±97.33)N,t=3.24,P<0.05],患足前半足和后半足峰值压力显著低于对照组[前半足:(85.35±37.62)N、(133.49±66.23)N,t=4.90,P<0.05;后半足:(159.84±59.16)N、(186.52±74.37)N,t=2.17,P<0.05];研究组健足前半足和后半足平均压力显著低于对照组[前半足:(54.13±14.58)%、(73.57±18.25)%,t=6.45,P<0.05;后半足:(67.46±17.36)%、(88.75±20.87)%,t=6.07,P<0.05],患足前半足和后半足平均压力显著高于对照组[前半足:(49.51±16.98)%、(37.72±20.34)%,t=3.45,P<0.05;后半足:(53.37±12.38)%、(44.63±15.47)%,t=3.42,P<0.05]。研究组PASS显著高于对照组[(33.9±2.6)分、(31.2±2.7)分,t=5.58,P<0.05],压力中心偏移的椭圆轨迹长度显著低于对照组[(160.5±65.5)mm、(241.2±71.3)mm,t=6.46,P<0.05],包络椭圆面积显著低于对照组[(169.5±34.5)mm~2、(184.3±42.7)mm~2,t=2.09,P<0.05],比值显著低于对照组[(0.9±0.2)、(1.3±0.2),t=10.95,P<0.05]。2组患者治疗后TUGT均显著降低[研究组:(20.6±4.5)s、(14.7±3.4)s,对照组:(21.8±3.7)s、(18.3±4.2)s,t值分别为6.27,1.08,P<0.05],且研究组TUGT显著低于对照组(t=5.16,P<0.05)。2组患者治疗后的6 min步行测试分值均显著升高[研究组:(216.98±99.99)m、(291.76±96.70)m,对照组:(207.53±114.06)m、(241.84±90.29)m,t值分别为3.95,2.34,P<0.05];且研究组显著高于对照组(t=2.92,P<0.05)。结论姿势控制训练可显著提高脑卒中偏瘫患者的平衡及步行功能。
Objective To observe the effects of postural control training on plantar pressure,balance function and walking improvement in patients with cerebral stroke complicated by hemiplegia. Methods A total of 120 patients with cerebral stroke complicated by hemiplegia were randomly divided into observation group and control group,with 60 patients in each group. The patients in control group were treated by conventional rehabilitation therapy,however,the patients in observation group,on the basis of control group,were treated by postural control training,90 min once,three times a week,a total of 20 times treament for both groups. Then the foot sole pressure,balance function and walking function were observed and compared between two groups. Results After treatment,the peak pressure of front half foot and back half foot in unaffected side in observation group was significantly lower than that in control group[front half foot:( 158. 52 ± 56. 71) N vs( 218. 83 ± 73. 35) N,P < 0. 05: back half foot:( 257. 36 ± 85. 45) N vs( 311. 47 ± 97. 33) N,P < 0. 05]. The peak pressure of front half foot and back half foot in affected side in observation group was significantly lower than that in control group[front half foot:( 85. 35 ± 37. 62) N vs( 133. 49 ± 66. 23) N,P < 0. 05; back half foot:( 159. 84 ± 59. 16) N vs( 186. 52 ± 74. 37) N,P < 0. 05]. Moreover the average pressure of the front half foot and back half foot in unaffected side in observation group was significantly lower than that in control group[front half foot:( 54. 13 ± 14. 58) % vs( 73. 57 ± 18. 25) %,P < 0. 05; back half foot:( 67. 46 ± 17. 36) % vs( 88. 75 ± 20. 87) %,P <0. 05]. However the average pressure of the front half foot and back half foot of in affected side in observation group was significantly higher than that in control group[front half foot:( 49. 51 ± 16. 98) % vs( 37. 72 ± 20. 34) %,P < 0. 05; back half foot:( 53. 37 ± 12. 38) % vs( 44. 63 ± 15. 47) %,P <0. 05]. In addition the PASS scores in observation group were significantly higher than those in control group[( 33. 9 ± 2. 6) vs( 31. 2 ± 2. 7),P < 0. 05],but the elliptic trajectory length in observation group was significantly shorter than that in control group[( 160. 5 ± 65. 5) mm vs( 241. 2 ± 71. 3) mm,P < 0. 05 ],and the elliptical area in observation group was significantly less than that in control group [( 169. 5 ± 34. 5) mm~2 vs( 184. 3 ± 42. 7) mm~2,P < 0. 05]. The ratio of elliptic trajectory length/elliptical area in observation group was significantly lower than that in control group[( 0. 9 ± 0. 2) vs( 1. 3 ± 0. 2),P <0. 05]. The TUGT was decreased significantly in both groups[observation group:( 20. 6 ± 4. 5) s vs( 14. 7 ± 3. 4) s,control group:( 21. 8 ± 3. 7) s vs( 18. 3 ± 4. 2) s,P < 0. 05],moreover,which in observation group was significantly lower than that in control group( P < 0. 05). Besides the 6-minute walk test scores were increased significantly in both groups[observation group:( 216. 98 ± 99. 99) m vs( 291. 76 ± 96. 70) m,control group:( 207. 53 ± 114. 06) m vs( 241. 84 ± 90. 29) m,P <0. 05],moreover,which in observation group were significantly higher than those in control group( P < 0. 05). Conclusion The postural control training can obviously improve balance function and walking function in patients with cerebral stroke complicated by hemiplegia.
Objective To observe the effects of postural control training on plantar pressure,balance function and walking improvement in patients with cerebral stroke complicated by hemiplegia. Methods A total of 120 patients with cerebral stroke complicated by hemiplegia were randomly divided into observation group and control group,with 60 patients in each group. The patients in control group were treated by conventional rehabilitation therapy,however,the patients in observation group,on the basis of control group,were treated by postural control training,90 min once,three times a week,a total of 20 times treament for both groups. Then the foot sole pressure,balance function and walking function were observed and compared between two groups. Results After treatment,the peak pressure of front half foot and back half foot in unaffected side in observation group was significantly lower than that in control group[front half foot:( 158. 52 ± 56. 71) N vs( 218. 83 ± 73. 35) N,P < 0. 05: back half foot:( 257. 36 ± 85. 45) N vs( 311. 47 ± 97. 33) N,P < 0. 05]. The peak pressure of front half foot and back half foot in affected side in observation group was significantly lower than that in control group[front half foot:( 85. 35 ± 37. 62) N vs( 133. 49 ± 66. 23) N,P < 0. 05; back half foot:( 159. 84 ± 59. 16) N vs( 186. 52 ± 74. 37) N,P < 0. 05]. Moreover the average pressure of the front half foot and back half foot in unaffected side in observation group was significantly lower than that in control group[front half foot:( 54. 13 ± 14. 58) % vs( 73. 57 ± 18. 25) %,P < 0. 05; back half foot:( 67. 46 ± 17. 36) % vs( 88. 75 ± 20. 87) %,P <0. 05]. However the average pressure of the front half foot and back half foot of in affected side in observation group was significantly higher than that in control group[front half foot:( 49. 51 ± 16. 98) % vs( 37. 72 ± 20. 34) %,P < 0. 05; back half foot:( 53. 37 ± 12. 38) % vs( 44. 63 ± 15. 47) %,P <0. 05]. In addition the PASS scores in observation group were significantly higher than those in control group[( 33. 9 ± 2. 6) vs( 31. 2 ± 2. 7),P < 0. 05],but the elliptic trajectory length in observation group was significantly shorter than that in control group[( 160. 5 ± 65. 5) mm vs( 241. 2 ± 71. 3) mm,P < 0. 05 ],and the elliptical area in observation group was significantly less than that in control group [( 169. 5 ± 34. 5) mm~2 vs( 184. 3 ± 42. 7) mm~2,P < 0. 05]. The ratio of elliptic trajectory length/elliptical area in observation group was significantly lower than that in control group[( 0. 9 ± 0. 2) vs( 1. 3 ± 0. 2),P <0. 05]. The TUGT was decreased significantly in both groups[observation group:( 20. 6 ± 4. 5) s vs( 14. 7 ± 3. 4) s,control group:( 21. 8 ± 3. 7) s vs( 18. 3 ± 4. 2) s,P < 0. 05],moreover,which in observation group was significantly lower than that in control group( P < 0. 05). Besides the 6-minute walk test scores were increased significantly in both groups[observation group:( 216. 98 ± 99. 99) m vs( 291. 76 ± 96. 70) m,control group:( 207. 53 ± 114. 06) m vs( 241. 84 ± 90. 29) m,P <0. 05],moreover,which in observation group were significantly higher than those in control group( P < 0. 05). Conclusion The postural control training can obviously improve balance function and walking function in patients with cerebral stroke complicated by hemiplegia.
引文
1 Whitall J.Stroke rehabilitation research:time to answer more specific questions?Neurorehabilitation and Neural Repair,2004,18:3-8.
2 康海燕,许光旭.虚拟现实技术对脑卒中患者平衡及步行能力康复效果的meta分析.中国康复医学杂志,2016,31:554-557.
3 李静艳,孙宁,马宝英,等.优质护理对老年脑梗死患者生活质量护理满意度及预后的改善作用.河北医药,2016,38:1898-1900.
4 Schwesig R,Goldich Y,Hahn A,et al.Postural control in subjects with visual impairment.Eur J Ophthalmol,2011,21:303-309.
5 Forster A,Brown L,Smith J,et al.Information provision for stroke patients and their caregivers.Cochrane Database Syst Rev,2012,14:11.
6 Cho KH,Lee WH.Effect of treadmill training based realworld video recording on balance and gait in chronic stroke patients:a randomized controlled trial.Gait Posture,2014,39:523-528.
7 中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点.中华神经科杂志,1996,29:379-380.
8 瓮长水.脑卒中患者姿势控制量表(PASS)介绍.中国康复理论与实践,2003,9:724-725.
9 燕铁斌.“起立-行走”计时测试简介--功能性步行能力快速定量评定法.中国康复理论与实践,2000,6:115-117.
10 张萍.6分钟步行试验.临床心电学杂志,2007,16:236-237.
11 刘蓓蓓,丁勤能,王岩,等.姿势控制训练对偏瘫患者足底压力及平衡功能的影响.东南国防医药,2014,16:367-369,390.
12 谢凌锋,林志峰,黄杰,等.动态人体重心和支撑面积监测下平衡训练对脑卒中偏瘫患者平衡能力的影响.中国康复医学杂志,2016,31:1094-1098.
13 Management of Stroke Rehabilitation Working G.VA/DOD Clinical practice guideline for the management of stroke re-habilitation.JRehabil Res Dev,2010,47:1-43.
14 蒋文华,刘才栋主编.神经解剖学.第1版.上海:复旦大学出版社,2002.409-411.
15 Massion J,Alexandrov A,Frolov A.Why and how are posture and movement coordinated?Prog Brain Res,2004,143:13-27.
16 Hsieh CL,Sheu CF,Hsueh IP.Trunk control as an early predictor of comprehensive activities of daily living function in stroke patients.Stroke,2002,33:2626-2630.
17 Verheyden G,Nieuwboer A,De Wit L,et al.Trunk performance after stroke:an eye-catching predictor of functional outcome.J Neurol Neurosurg Psychiatry,2007,78:694-698.
18 林源,钮美娥,王丽,等.脑卒中患者平衡功能评定方法的应用进展.中国康复理论与实践,2016,22:667-671.
19 瓮长水,王娜,刘立明,等.三种功能性移动能力测试工具对预测老年人跌倒危险有效性的比较.中国康复医学杂志,2013,28:109-113.
20 Kollen BJ,Lennon S,Lyons B,et al.The effectiveness of the Bobath concept in stroke rehabilitation:what is the evidence.Stroke,2009,40:e89-97.
21 Chae J,Johnston M,Kim H,et al.Admission motor impairment as a predictor of physical disability after stroke rehabilitation.Am J Phys Med Rehabil,1995,74:218.
22 谢羽婕,张驰,胥方元,等.核心稳定性训练结合神经发育疗法对脑卒中患者下肢运动功能的影响.中国康复医学杂志,2014,29:773-775.
23 古澤正道,何静杰,常冬梅,等.Synergy:从Bobath法出发的认识.中国康复理论与实践,2011,17:810-812.
2 康海燕,许光旭.虚拟现实技术对脑卒中患者平衡及步行能力康复效果的meta分析.中国康复医学杂志,2016,31:554-557.
3 李静艳,孙宁,马宝英,等.优质护理对老年脑梗死患者生活质量护理满意度及预后的改善作用.河北医药,2016,38:1898-1900.
4 Schwesig R,Goldich Y,Hahn A,et al.Postural control in subjects with visual impairment.Eur J Ophthalmol,2011,21:303-309.
5 Forster A,Brown L,Smith J,et al.Information provision for stroke patients and their caregivers.Cochrane Database Syst Rev,2012,14:11.
6 Cho KH,Lee WH.Effect of treadmill training based realworld video recording on balance and gait in chronic stroke patients:a randomized controlled trial.Gait Posture,2014,39:523-528.
7 中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点.中华神经科杂志,1996,29:379-380.
8 瓮长水.脑卒中患者姿势控制量表(PASS)介绍.中国康复理论与实践,2003,9:724-725.
9 燕铁斌.“起立-行走”计时测试简介--功能性步行能力快速定量评定法.中国康复理论与实践,2000,6:115-117.
10 张萍.6分钟步行试验.临床心电学杂志,2007,16:236-237.
11 刘蓓蓓,丁勤能,王岩,等.姿势控制训练对偏瘫患者足底压力及平衡功能的影响.东南国防医药,2014,16:367-369,390.
12 谢凌锋,林志峰,黄杰,等.动态人体重心和支撑面积监测下平衡训练对脑卒中偏瘫患者平衡能力的影响.中国康复医学杂志,2016,31:1094-1098.
13 Management of Stroke Rehabilitation Working G.VA/DOD Clinical practice guideline for the management of stroke re-habilitation.JRehabil Res Dev,2010,47:1-43.
14 蒋文华,刘才栋主编.神经解剖学.第1版.上海:复旦大学出版社,2002.409-411.
15 Massion J,Alexandrov A,Frolov A.Why and how are posture and movement coordinated?Prog Brain Res,2004,143:13-27.
16 Hsieh CL,Sheu CF,Hsueh IP.Trunk control as an early predictor of comprehensive activities of daily living function in stroke patients.Stroke,2002,33:2626-2630.
17 Verheyden G,Nieuwboer A,De Wit L,et al.Trunk performance after stroke:an eye-catching predictor of functional outcome.J Neurol Neurosurg Psychiatry,2007,78:694-698.
18 林源,钮美娥,王丽,等.脑卒中患者平衡功能评定方法的应用进展.中国康复理论与实践,2016,22:667-671.
19 瓮长水,王娜,刘立明,等.三种功能性移动能力测试工具对预测老年人跌倒危险有效性的比较.中国康复医学杂志,2013,28:109-113.
20 Kollen BJ,Lennon S,Lyons B,et al.The effectiveness of the Bobath concept in stroke rehabilitation:what is the evidence.Stroke,2009,40:e89-97.
21 Chae J,Johnston M,Kim H,et al.Admission motor impairment as a predictor of physical disability after stroke rehabilitation.Am J Phys Med Rehabil,1995,74:218.
22 谢羽婕,张驰,胥方元,等.核心稳定性训练结合神经发育疗法对脑卒中患者下肢运动功能的影响.中国康复医学杂志,2014,29:773-775.
23 古澤正道,何静杰,常冬梅,等.Synergy:从Bobath法出发的认识.中国康复理论与实践,2011,17:810-812.