脑瘫青少年异常步态的柔韧性训练干预研究
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摘要
目的:脑瘫青少年下肢的柔韧性差,导致其步态出现异常,拟通过下肢柔韧性训练改善脑瘫青少年的异常步态。方法:选取5名脑瘫青少年作为干预对象,以1名正常青少年作为参考对象,对5名脑瘫青少年进行12周的下肢分关节柔韧性训练,采用三维录像解析和足底压力分布测试以对比脑瘫青少年柔韧性训练前、后的测试数据。结果:脑瘫青少年重患侧下肢训练后的摆动期、单支撑期与训练前均具有显著性差异(P<0.05),与正常青少年无显著性差异(P>0.05);训练前重患侧下肢膝角—大腿角、膝角—小腿角在形状上与正常青少年相差很大,在训练后均朝着正常青少年的角—角图形状靠近;训练前重患侧下肢足底7个分区压强雷达图形状与正常青少年相差很大,在训练后与正常青少年的雷达图相近似,且Kendall’s W协同系数经训练后得到较大提高。结论:对髋、膝关节的柔韧性训练可提高脑瘫青少年重患侧下肢摆动的协调性,对踝关节的柔韧性训练可促进重患侧下肢足底压力分布的合理性,分关节柔韧性训练可提高整个步态的稳定性和连续性。
Objective:Because less flexible lower limbs of cerebral palsy adolescents lead to the gait abnormalities,the flexibility of lower limbs of cerebral palsy adolescents was trained to improve abnormal gait.Methods:Five adolescents with cerebral palsy were selected as intervention with 1 normal adolescent as reference,and the flexibility of lower limb joint of 5 adolescents with cerebral palsy were trained for 12 weeks.The data before training and after the above tests were compared by 3-D video analyzing and plantar pressure distribution test.Results:The phases of single supporting and swing of more injured lower limb of cerebral palsy adolescents have significant difference(p<0.05)between after training and before,and there was no significant difference(p>0.05) =between cerebral palsy adolescents after training and normal adolescents;the shapes of knee angle-thigh angle and knee angle-leg angle of cerebral palsy adolescents before training were not like them of the normal adolescent,and were more alike after training.The radar map of seven-partition of plantar pressure of more injured side before training were not like them of normal adolescent,and were more alike after training,and Kendall's W coordination coefficients were elevated obviously after training.Conclusions:The coordination of gait of cerebral palsy adolescents was improved by training the flexibility of the hip and knee of more injured lower limb oscillation,the rationality of the plantar pressure distribution was improved by training flexibility of the ankle,and the whole gait stability and continuity was improved by training flexibility of the joints of the whole more injured lower limb.
Objective:Because less flexible lower limbs of cerebral palsy adolescents lead to the gait abnormalities,the flexibility of lower limbs of cerebral palsy adolescents was trained to improve abnormal gait.Methods:Five adolescents with cerebral palsy were selected as intervention with 1 normal adolescent as reference,and the flexibility of lower limb joint of 5 adolescents with cerebral palsy were trained for 12 weeks.The data before training and after the above tests were compared by 3-D video analyzing and plantar pressure distribution test.Results:The phases of single supporting and swing of more injured lower limb of cerebral palsy adolescents have significant difference(p<0.05)between after training and before,and there was no significant difference(p>0.05) =between cerebral palsy adolescents after training and normal adolescents;the shapes of knee angle-thigh angle and knee angle-leg angle of cerebral palsy adolescents before training were not like them of the normal adolescent,and were more alike after training.The radar map of seven-partition of plantar pressure of more injured side before training were not like them of normal adolescent,and were more alike after training,and Kendall's W coordination coefficients were elevated obviously after training.Conclusions:The coordination of gait of cerebral palsy adolescents was improved by training the flexibility of the hip and knee of more injured lower limb oscillation,the rationality of the plantar pressure distribution was improved by training flexibility of the ankle,and the whole gait stability and continuity was improved by training flexibility of the joints of the whole more injured lower limb.
引文
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[2]原林,高粱斌.髋关节的解剖和生物力学[J].中华创伤骨科杂志,2001,3(2):146-147.
[3]孙泊,刘宇,李海鹏,等.跑台与地面上步态比较研究[J].上海体育学院学报,2012,36(2):47-51
[4]MORTON R E,SCOTT B,MCCLELLAND V,et al.Dislocation of the hips in children with bilateral spastic cerebral palsy[J].Dev Med Child Neurol,2006,48:555-558.
[5]BRUNNER R,BAUMANN J U.Clinical benefit of reconstruction of dislo-cated or subluxated hip joints in patients with spastic cerebral palsy[J].J Pediatr Orthop,1994,14:290-294.
[6]LESPARGOT A,RENAUDIN E,KHOURI N,et al.Extensibility of hip ad-ductors in children with cerebral palsy[J].Dev Med Child Neurol,1994,36(11):980-988.
[7]OUNPUU S,GAGE J R,DAVIS R B.Three-dimensional lower extremity joint kinetics in normal pediatric gait[J].Pediatric Orthopaedics,1991,10:433-442.
[8]朱梅,尚清等.脑瘫合并足内翻的康复治疗[J].中国实用神经杂志,2008,11(10):79-80.
[9]江晓峰,荣湘江.踝足矫形器对脑瘫患儿异常步态的影响[J].中国康复医学杂志,2005,20(11):836-837.
[10]陈龙伟,王钰.痉挛型脑瘫患儿步态的膝-踝关节运动协调性的分析[J].西安交通大学学报:医学版,2011,32(4):508-511.
[11]KAY R M,RETHLEFSEN S,REED M,et al.Changes in pelvic rotation after soft tissue and bony surgery in ambulatory children with cerebral palsy[J].J Pediatr Orthop,2004,24(3):278-82.
[12]TRUEBLOOD P R.Partial body weigh treadmill training in persons with chronic stroke[J].Neurorehabilitation,2001,16:141-153.
[13]吴成风,余蜀翔.弹性绷带矫治脑瘫儿步态异常临床观察[J].现代临床医学,2010,36(1):52-53.
[14]万蓓,昝飞.脑瘫儿童综合康复训练的个案研究[J].中国特殊教育,2007(1):21.
[15]PALISANO ROBERT,ROSENBAUM PETER,WALTER STEPHEN,et al.Gross Motor Function Classification System[J].Dev Med Child Neurol,1997,39:214-223.
[16]王新,安丰洋.1到5岁健康幼儿步态特征分析[C]//中国体育科学学会:第三届中国体育博士高层论坛论文集,2010:405.
[17]伍勰,陆爱云,庞军.健康老年人常速行走的步态分析[J].上海体育学院学报,2000,24(2):52-55.