强化躯干核心肌群对脑卒中患者躯干控制 平衡步行及日常生活能力的康复效果
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摘要
目的探讨躯干核心肌群训练的强度对脑卒中患者躯干控制、平衡步行及日常生活能力的康复效果。方法选择2017年4月至2018年3月在华中科技大学同济医学院附属协和医院康复医学科住院治疗的90例脑卒中偏瘫患者为研究对象,按照随机数字表法将患者分为A、B、C组,每组各30例,3组患者均在常规治疗基础上联合不同强度的躯干核心肌群训练,其中A组每天训练1次,B组每天训练2次,C组每天训练3次,每次训练30 min,每周5天,共训练3个月。3组患者治疗1个月、2个月和3个月时采用躯干控制能力测试(TCT)、Berg平衡量表(BBS)评价躯干控制能力,采用步行功能评级(FAC)评定平衡步行功能、采用日常生活能力(MBI)评定日常生活能力。比较3组患者上述评分差异。结果治疗前3组患者躯干控制能力、平衡步行功能和生活能力评分比较差异无统计学意义(P> 0. 05),3组患者治疗1个月、2个月、3个月后躯干控制、平衡步行和日常生活能力评分均逐渐提高,差异均有统计学意义(P均<0. 05);且在1～3个月期间躯干控制和平衡能力评分C组高于B组,B组高于A组,差异均有统计学意义(P均<0. 05),但3个月时差异无统计学意义(P> 0. 05)。3组患者步行和日常生活能力在1个月期间组间差异无统计学意义(P> 0. 05),但1个月后C组较B组,B组较A组均有统计学意义(P均<0. 05)。结论强化躯干核心肌力量可以显著提高患者躯干控制、平衡步行和日常生活能力,缩短康复时间。
Objective To investigate the rehabilitation effect of training intensity of trunk core muscle group on trunk control,balanced walking and daily living ability of stroke patients. Methods Ninety stroke hemiplegic patients hospitalized in the Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from April 2017 to March 2018 were randomly divided into group A,B and C according to random numerical table method,with 30 cases in each group. On the basis of routine treatment,the patients in the three groups were trained with different intensities of trunk core muscle group training,including group A once/day,group B twice/day,and group C 3 times/day,30 min for each training,for 5 days every week and for altogether three months. (TCT), (BBS), (FAC), (MBI) test were used respectively to assess the balance,trunk control function,walking and daily living ability of the three groups in 1 month,2 months and 3 months before and after treatment. Results There was no significant difference in trunk control ability,balanced walking function and living ability score among three groups before treatment (P > 0. 05). The scores of trunk control,balanced walking and ability of daily living in three groups increased gradually after 1 month,2 months and 3 months of treatment (P < 0. 05). After 3 months and 2 months,and after 2 months and 1 month,the score of trunk control and balanced ability in group C was higher than that in group B,that in group B was higher than that in group A,and the differences were statistically significant (all P < 0. 05). There was no significant difference in walking and daily living ability among three groups during one month (P > 0. 05),but one month later,there was significant difference between group C and group B (P > 0. 05),and between group B and group A after one month (all P < 0. 05). Conclusions Strengthening the core muscle strength of the trunk can significantly improve the patients' ability of trunk control,balanced walking and daily living ability,and shorten the recovery time.
Objective To investigate the rehabilitation effect of training intensity of trunk core muscle group on trunk control,balanced walking and daily living ability of stroke patients. Methods Ninety stroke hemiplegic patients hospitalized in the Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from April 2017 to March 2018 were randomly divided into group A,B and C according to random numerical table method,with 30 cases in each group. On the basis of routine treatment,the patients in the three groups were trained with different intensities of trunk core muscle group training,including group A once/day,group B twice/day,and group C 3 times/day,30 min for each training,for 5 days every week and for altogether three months. (TCT), (BBS), (FAC), (MBI) test were used respectively to assess the balance,trunk control function,walking and daily living ability of the three groups in 1 month,2 months and 3 months before and after treatment. Results There was no significant difference in trunk control ability,balanced walking function and living ability score among three groups before treatment (P > 0. 05). The scores of trunk control,balanced walking and ability of daily living in three groups increased gradually after 1 month,2 months and 3 months of treatment (P < 0. 05). After 3 months and 2 months,and after 2 months and 1 month,the score of trunk control and balanced ability in group C was higher than that in group B,that in group B was higher than that in group A,and the differences were statistically significant (all P < 0. 05). There was no significant difference in walking and daily living ability among three groups during one month (P > 0. 05),but one month later,there was significant difference between group C and group B (P > 0. 05),and between group B and group A after one month (all P < 0. 05). Conclusions Strengthening the core muscle strength of the trunk can significantly improve the patients' ability of trunk control,balanced walking and daily living ability,and shorten the recovery time.
引文
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[5]张明,高晓盟,李宁,等.踏车训练结合功能性电刺激对脑卒中患者运动功能和日常生活活动能力的影响[J].中华物理医学与康复杂志,2017,39(9):655-658.
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[12]付常喜,李平.悬吊训练对男子网球运动员平衡能力和躯干核心稳定性的实验研究[J].北京体育大学学报,2014,2(21):21-25.
[13]吴婉霞,徐武华,刘文权.躯干力量及视觉反馈平衡训练对脑卒中患者平衡及步行能力的影响[J].实用医学杂志,2013,29(15):2529-2530.
[14]吴鸣,倪朝民,刘孟.Swiss球躯干功能训练对恢复早期脑卒中偏瘫患者平衡及步行功能的影响[J].中华物理医学与康复杂志,2016,38(3):183-186.
[15]李辉,李岩,顾旭东.早期诱发躯干功能训练对脑卒中患者平衡及步行能力的影响[J].中华物理医学与康复杂志,2012,34(9);689-691.
[16]孙丹乔,王强,柏广涛.神经康复机械手强化训练对脑卒中偏瘫患者上肢运动功能恢复的影响[J].华物理医学与康复杂志,2018,40(2):96-99.
[17]杨敏,余茜,何成松.运动训练对脑梗死大鼠行为学及NF200表达变化的影响[J].中国康复医学杂志.2006,13(21):21-25.
[18]KARTHIKBABU S,RAO B K,MANIKANDAN N,et al.Role of trunk rehabilitation on trunk control,balance and gait in patients with chronic stroke:a pre post design[J].Neurosci Med,2011(2):61-67.
[19]梁天佳,吴小平,尤耀斌,等.核心稳定性训练对脑卒中偏瘫患者运动功能的影响[J].中华物理医学与康复杂志,2012,34(5):353-356
[20]范红军,王艳,周国平.周围神经损伤后轴突再生微环境的研究进展[J].中国康复理论与实践,2015,21(3):288-291.
[2]凌畅泉,车革方,黄汉辉.躯干核心肌群训练对脑卒中偏瘫急性期患者平衡及行走功能的影响[J].临床医学,2017,37(5);35-36.
[3]赵雅宁,郝正纬,李建民,等.下肢康复训练机器人对缺血性脑卒中偏瘫患者平衡及步行功能的影响[J].中国康复医学杂志,2012,9(11):1015-1020.
[4]郭铁成,卫小梅.改良的Ashworth分级应用于上下肢肌张力评估时的比较[J].中国康复,2008,23(5):313-315.
[5]张明,高晓盟,李宁,等.踏车训练结合功能性电刺激对脑卒中患者运动功能和日常生活活动能力的影响[J].中华物理医学与康复杂志,2017,39(9):655-658.
[6]迪晓霞,王栋毅,李鑫铭.平衡仪训练对脑卒中患者运动功能的影响[J].卒中与神经疾病,2018,25(6):704-706.
[7]HOLD M K,GILL K M,MAGLIOZZI M R,et al.Clinical gait assessment in the neurologically impaired:reliability and meaning fulness[J].Phys There,1984,64(1):35-40
[8]戚红亮.早期强化膝关节控制训练对脑卒中偏瘫患者下肢运动功能的影响分析[J].中国当代医药,2015,22(10):63-62.
[9]韩亮,李惠琳,陈晶晶.脑卒中后躯干控制障碍康复治疗研究进展[J].中国老年保健医学,2018,16(2):51-81.
[10]程水良,厉坤鹏,李慧子.强化核心肌群训练对脑卒中偏瘫患者平衡能力的影响初探[J].按摩与康复医学,2016,7(10):36-37.
[11]孙大宏.中国康复[M].北京:华夏出版社,2002:336-337.
[12]付常喜,李平.悬吊训练对男子网球运动员平衡能力和躯干核心稳定性的实验研究[J].北京体育大学学报,2014,2(21):21-25.
[13]吴婉霞,徐武华,刘文权.躯干力量及视觉反馈平衡训练对脑卒中患者平衡及步行能力的影响[J].实用医学杂志,2013,29(15):2529-2530.
[14]吴鸣,倪朝民,刘孟.Swiss球躯干功能训练对恢复早期脑卒中偏瘫患者平衡及步行功能的影响[J].中华物理医学与康复杂志,2016,38(3):183-186.
[15]李辉,李岩,顾旭东.早期诱发躯干功能训练对脑卒中患者平衡及步行能力的影响[J].中华物理医学与康复杂志,2012,34(9);689-691.
[16]孙丹乔,王强,柏广涛.神经康复机械手强化训练对脑卒中偏瘫患者上肢运动功能恢复的影响[J].华物理医学与康复杂志,2018,40(2):96-99.
[17]杨敏,余茜,何成松.运动训练对脑梗死大鼠行为学及NF200表达变化的影响[J].中国康复医学杂志.2006,13(21):21-25.
[18]KARTHIKBABU S,RAO B K,MANIKANDAN N,et al.Role of trunk rehabilitation on trunk control,balance and gait in patients with chronic stroke:a pre post design[J].Neurosci Med,2011(2):61-67.
[19]梁天佳,吴小平,尤耀斌,等.核心稳定性训练对脑卒中偏瘫患者运动功能的影响[J].中华物理医学与康复杂志,2012,34(5):353-356
[20]范红军,王艳,周国平.周围神经损伤后轴突再生微环境的研究进展[J].中国康复理论与实践,2015,21(3):288-291.