胸段脊髓损伤患者应用截瘫步行矫形器对下肢康复的影响
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摘要
背景:胸段脊髓损伤常导致双下肢截瘫,截瘫步行矫形器能帮助截瘫患者改善下肢功能障碍,提高日常生活活动能力,重获站立和行走能力。目的:探讨截瘫步行矫形器对胸段脊髓损伤患者下肢肌肉痉挛及功能恢复的影响。方法:将20例胸段脊髓(T5-12)损伤患者根据损伤平面按美国脊髓损伤协会(American Spinal Injury Association,ASIA)标准分为完全损伤组和不完全损伤组,各10例,均装配截瘫步行矫形器。分别于装配前进行残余肌力训练、坐位平衡训练、转移训练;装配后平行杆内站立训练、平衡及转移训练;室内、户外助行器、肘拐步行训练。结果与结论:与治疗前相比,胸髓完全性损伤患者装配截瘫步行器治疗12周后ASIA评分增加,感觉无明显变化,痉挛随病程的延长而加重;不完全性损伤患者治疗12周后ASIA评分增加,感觉明显改善,痉挛随病程的延长无改变;两组患者日常生活活动能力(改良Barthel指数、功能独立性评测)有显著改善。与治疗2周时相比,治疗12周时2组患者10 m行走时间显著减少,6 min步行距离延长。说明胸段脊髓损伤患者装配截瘫步行器,能显著改善患者的运动功能、日常生活活动能力和步行能力,对肌痉挛控制也有一定的影响。
BACKGROUND:Thoracic spinal cord injury often leads to double lower limb paralysis.Paraplegia walking orthosis can improve lower limb dysfunction,improve the daily living activity,and regain the ability to stand and walk in patients with paraplegia.OBJECTIVE:To discuss the effects of paraplegia walking orthosis on muscle spasticity and recovery of function of the affected lower extremity in patients with thoracic spinal cord injury.METHODS:The 20 patients with thoracic spinal cord injury(T5-12),according to the damage plane by AmericanSpinal Injury Association standard,were divided into complete damage group and incomplete damage group(n=10).All patients were fitted out paraplegia walking orthosis.They received residual muscle strength training,sitting balance training,and transfer training prior to assembly,and then subjected to standing exercise within parallel bar,balance and transfer training,and walking aid devices training indoor and outdoor,and elbow crutch training on foot after the assembly.RESULTS AND CONCLUSION:Compared with pre-treatment,American Spinal Injury Association score increased at 12 weeks after treatment with paraplegia walking orthosis,and sensation did not obviously alter.Spasm worsened with prolonged course of disease in the complete damage group.At 12 weeks after treatment,American Spinal Injury Association score increased,sensation apparently improved,and the spasm did not change with time in the incomplete damage group.Activities of daily living(modified Barthel index,and functional independence evaluation) evidently improved in both groups.Compared with 2 weeks,the 10-m walking time was noticeably reduced and the 6-minute walking distance was prolonged at 12 weeks in both groups.These results confirm that paraplegia walking orthosis fitted out in patients with thoracic spinal cord injury significantly improves the patient's motor function,activities of daily living and walking ability,and also has certain influence on muscle spasm control.
BACKGROUND:Thoracic spinal cord injury often leads to double lower limb paralysis.Paraplegia walking orthosis can improve lower limb dysfunction,improve the daily living activity,and regain the ability to stand and walk in patients with paraplegia.OBJECTIVE:To discuss the effects of paraplegia walking orthosis on muscle spasticity and recovery of function of the affected lower extremity in patients with thoracic spinal cord injury.METHODS:The 20 patients with thoracic spinal cord injury(T5-12),according to the damage plane by AmericanSpinal Injury Association standard,were divided into complete damage group and incomplete damage group(n=10).All patients were fitted out paraplegia walking orthosis.They received residual muscle strength training,sitting balance training,and transfer training prior to assembly,and then subjected to standing exercise within parallel bar,balance and transfer training,and walking aid devices training indoor and outdoor,and elbow crutch training on foot after the assembly.RESULTS AND CONCLUSION:Compared with pre-treatment,American Spinal Injury Association score increased at 12 weeks after treatment with paraplegia walking orthosis,and sensation did not obviously alter.Spasm worsened with prolonged course of disease in the complete damage group.At 12 weeks after treatment,American Spinal Injury Association score increased,sensation apparently improved,and the spasm did not change with time in the incomplete damage group.Activities of daily living(modified Barthel index,and functional independence evaluation) evidently improved in both groups.Compared with 2 weeks,the 10-m walking time was noticeably reduced and the 6-minute walking distance was prolonged at 12 weeks in both groups.These results confirm that paraplegia walking orthosis fitted out in patients with thoracic spinal cord injury significantly improves the patient's motor function,activities of daily living and walking ability,and also has certain influence on muscle spasm control.
引文
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[3]王俊,杨振辉,刘四文,等.C6-T6脊髓损伤患者应用往复式步行矫形器的疗效分析[J].中国康复医学杂志,2008,23(2):126-129.
[4]唐丹,裴国献,李奎成,等.重心移动式截瘫步行矫形器对脊髓损伤患者日常生活活动能力及生存质量的影响[J].中国康复医学杂志,2009,24(11):985-988.
[5]Johnson WB,Fatone S,Gard SA.Modeling the walking patterns of Reciprocating Gait Orthosis users with a novel Lower Limb Paralysis Simulator.Conf Proc IEEE Eng Med Biol Soc.2011;2011:7841-7844.
[6]Arazpour M,Hutchins SW,Ahmadi Bani M,et al.The influence of a rocker sole adaptation on gait parameters in spinal cord injury patients ambulating with the advanced reciprocating gait orthosis-a pilot study.Disabil Rehabil Assist Technol.2015;10(1):89-92.
[7]Arazpour M,Bani MA,Chitsazan A,et al.The effect of an isocentric reciprocating gait orthosis incorporating an active knee mechanism on the gait of a spinal cord injury patient:a single case study.Disabil Rehabil Assist Technol.2013;8(3):261-266.
[8]帅浪,冯珍.截瘫步行矫形器在胸腰椎脊髓损伤患者中的应用[J].中华物理医学与康复杂志,2012,34(8):612-614.
[9]孙嘉利,唐丹,欧阳亚涛,等.重心移动式步行矫形器对截瘫患者步行功能的影响[J].中国组织工程研究与临床康复,2007,11(13):2437-2440.
[10]美国脊髓损伤协会,国际脊髓损伤学会,李建军,等.脊髓损伤神经学分类国际标准(2011年修订)[J].中国康复理论与实践,2011,17(10):963-972.
[11]Haas BM,Bergstr?m E,Jamous A,et al.The inter rater reliability of the original and of the modified Ashworth scale for the assessment of spasticity in patients with spinal cord injury.Spinal Cord.1996;34(9):560-564.
[12]Mishra C,Ganesh GS.Inter-rater reliability of modified modified Ashworth scale in the assessment of plantar flexor muscle spasticity in patients with spinal cord injury.Physiother Res Int.2014;19(4):231-237.
[13]Furlan JC,Noonan V,Singh A,et al.Assessment of disability in patients with acute traumatic spinal cord injury:a systematic review of the literature.J Neurotrauma.2011;28(8):1413-1430.
[14]Ploypetch T,Dajpratham P.Change in quality of life of disabled patients after intensive inpatient rehabilitation at Siriraj Hospital.J Med Assoc Thai.2011;94(10):1245-1251.
[15]Cohen JT,Marino RJ,Sacco P,et al.Association between the functional independence measure following spinal cord injury and long-term outcomes.Spinal Cord.2012;50(10):728-733.
[16]Barbetta DC,Cassemiro LC,Assis MR.The experience of using the scale of functional independence measure in individuals undergoing spinal cord injury rehabilitation in Brazil.Spinal Cord.2014;52(4):276-281.
[17]van Hedel HJ,Wirz M,Curt A.Improving walking assessment in subjects with an incomplete spinal cord injury:responsiveness.Spinal Cord.2006;44(6):352-356.
[18]Enright PL.The six-minute walk test.Respir Care.2003;48(8):783-785.
[19]李志君,郭小志,王凯斌,等.胸腰段椎体骨折脊髓损伤65例康复效果观察[J].中国康复理论与实践,2011,17(2):176-177.
[20]郑宏,张建奎,马丙祥.踝足矫形器材料学特点及其临床应用[J].中国组织工程研究与临床康复,2010,14(51):9643-9646.
[21]孙嘉利.重心移动式步行矫形器的基础与临床应用研究[D].广州:南方医科大学博士学位论文,2008.
[22]吴宗耀.机器人与截瘫患者的行走康复[J].中华物理医学与康复杂志,2011,33(8):624-629.
[23]陈文远.截瘫步行器的仿生效果[J].中国组织工程研究与临床康复,2011,15(30):5650-5652.
[24]唐丹,刘四文,刘海兵,等.不同步行矫形器在下胸段脊髓损伤中的应用探讨[J].中国康复医学杂志,2004,19(8):572-574.
[25]石芝喜,唐丹,欧阳庆军,等.往复式步行矫形器对改善脊髓损伤患者步行能力及日常生活活动能力的作用[J].中国康复理论与实践,2009,15(2):117-119.
[26]唐丹,裴国献,刘浩,等.往复式截瘫步行器及其在脊髓损伤患者中的应用[J].中国脊柱脊髓杂志,2010,20(1):75-78.
[27]杨俊玲,魏毅,张建国,等.下肢矫形器对脊髓损伤患者日常生活活动能力和步行能力恢复的辅助作用[J].中国临床康复,2005,9(42):68-69.
[28]高峰,弥振刚,李强,等.E-mag电磁控制膝关节矫形器在截瘫患者中的应用[J].中国康复,2013,28(4):270-271.
[29]黄杰,黄晓琳,陈勇,等.康复治疗对脊髓损伤患者功能恢复的影响[J].中华物理医学与康复杂志,2003,25(11):679-682.
[30]Chen WL,Chang WH,Chen CC,et al.Ambulation study of a woman with paraplegia using a reciprocating gait orthosis with functional electrical stimulation in Taiwan:a case report.Disabil Rehabil Assist Technol.2009;4(6):429-438.
[31]Arazpour M,Gharib M,Hutchins SW,et al.The influence of trunk extension in using advanced reciprocating gait orthosis on walking in spinal cord injury patients:A pilot study.Prosthet Orthot Int.2014.in press.
[32]孙嘉利,欧阳亚涛,唐丹,等.截瘫步行器对截瘫患者日常生活活动能力的影响[J].中国康复医学杂志,2007,22(7):609-611.
[2]孙嘉利,钟世镇,欧阳亚涛,等.重心移动式步行矫形器对截瘫患者膀胱和肠道功能的影响[J].南方医科大学学报,2008,28(6):1019-1021.
[3]王俊,杨振辉,刘四文,等.C6-T6脊髓损伤患者应用往复式步行矫形器的疗效分析[J].中国康复医学杂志,2008,23(2):126-129.
[4]唐丹,裴国献,李奎成,等.重心移动式截瘫步行矫形器对脊髓损伤患者日常生活活动能力及生存质量的影响[J].中国康复医学杂志,2009,24(11):985-988.
[5]Johnson WB,Fatone S,Gard SA.Modeling the walking patterns of Reciprocating Gait Orthosis users with a novel Lower Limb Paralysis Simulator.Conf Proc IEEE Eng Med Biol Soc.2011;2011:7841-7844.
[6]Arazpour M,Hutchins SW,Ahmadi Bani M,et al.The influence of a rocker sole adaptation on gait parameters in spinal cord injury patients ambulating with the advanced reciprocating gait orthosis-a pilot study.Disabil Rehabil Assist Technol.2015;10(1):89-92.
[7]Arazpour M,Bani MA,Chitsazan A,et al.The effect of an isocentric reciprocating gait orthosis incorporating an active knee mechanism on the gait of a spinal cord injury patient:a single case study.Disabil Rehabil Assist Technol.2013;8(3):261-266.
[8]帅浪,冯珍.截瘫步行矫形器在胸腰椎脊髓损伤患者中的应用[J].中华物理医学与康复杂志,2012,34(8):612-614.
[9]孙嘉利,唐丹,欧阳亚涛,等.重心移动式步行矫形器对截瘫患者步行功能的影响[J].中国组织工程研究与临床康复,2007,11(13):2437-2440.
[10]美国脊髓损伤协会,国际脊髓损伤学会,李建军,等.脊髓损伤神经学分类国际标准(2011年修订)[J].中国康复理论与实践,2011,17(10):963-972.
[11]Haas BM,Bergstr?m E,Jamous A,et al.The inter rater reliability of the original and of the modified Ashworth scale for the assessment of spasticity in patients with spinal cord injury.Spinal Cord.1996;34(9):560-564.
[12]Mishra C,Ganesh GS.Inter-rater reliability of modified modified Ashworth scale in the assessment of plantar flexor muscle spasticity in patients with spinal cord injury.Physiother Res Int.2014;19(4):231-237.
[13]Furlan JC,Noonan V,Singh A,et al.Assessment of disability in patients with acute traumatic spinal cord injury:a systematic review of the literature.J Neurotrauma.2011;28(8):1413-1430.
[14]Ploypetch T,Dajpratham P.Change in quality of life of disabled patients after intensive inpatient rehabilitation at Siriraj Hospital.J Med Assoc Thai.2011;94(10):1245-1251.
[15]Cohen JT,Marino RJ,Sacco P,et al.Association between the functional independence measure following spinal cord injury and long-term outcomes.Spinal Cord.2012;50(10):728-733.
[16]Barbetta DC,Cassemiro LC,Assis MR.The experience of using the scale of functional independence measure in individuals undergoing spinal cord injury rehabilitation in Brazil.Spinal Cord.2014;52(4):276-281.
[17]van Hedel HJ,Wirz M,Curt A.Improving walking assessment in subjects with an incomplete spinal cord injury:responsiveness.Spinal Cord.2006;44(6):352-356.
[18]Enright PL.The six-minute walk test.Respir Care.2003;48(8):783-785.
[19]李志君,郭小志,王凯斌,等.胸腰段椎体骨折脊髓损伤65例康复效果观察[J].中国康复理论与实践,2011,17(2):176-177.
[20]郑宏,张建奎,马丙祥.踝足矫形器材料学特点及其临床应用[J].中国组织工程研究与临床康复,2010,14(51):9643-9646.
[21]孙嘉利.重心移动式步行矫形器的基础与临床应用研究[D].广州:南方医科大学博士学位论文,2008.
[22]吴宗耀.机器人与截瘫患者的行走康复[J].中华物理医学与康复杂志,2011,33(8):624-629.
[23]陈文远.截瘫步行器的仿生效果[J].中国组织工程研究与临床康复,2011,15(30):5650-5652.
[24]唐丹,刘四文,刘海兵,等.不同步行矫形器在下胸段脊髓损伤中的应用探讨[J].中国康复医学杂志,2004,19(8):572-574.
[25]石芝喜,唐丹,欧阳庆军,等.往复式步行矫形器对改善脊髓损伤患者步行能力及日常生活活动能力的作用[J].中国康复理论与实践,2009,15(2):117-119.
[26]唐丹,裴国献,刘浩,等.往复式截瘫步行器及其在脊髓损伤患者中的应用[J].中国脊柱脊髓杂志,2010,20(1):75-78.
[27]杨俊玲,魏毅,张建国,等.下肢矫形器对脊髓损伤患者日常生活活动能力和步行能力恢复的辅助作用[J].中国临床康复,2005,9(42):68-69.
[28]高峰,弥振刚,李强,等.E-mag电磁控制膝关节矫形器在截瘫患者中的应用[J].中国康复,2013,28(4):270-271.
[29]黄杰,黄晓琳,陈勇,等.康复治疗对脊髓损伤患者功能恢复的影响[J].中华物理医学与康复杂志,2003,25(11):679-682.
[30]Chen WL,Chang WH,Chen CC,et al.Ambulation study of a woman with paraplegia using a reciprocating gait orthosis with functional electrical stimulation in Taiwan:a case report.Disabil Rehabil Assist Technol.2009;4(6):429-438.
[31]Arazpour M,Gharib M,Hutchins SW,et al.The influence of trunk extension in using advanced reciprocating gait orthosis on walking in spinal cord injury patients:A pilot study.Prosthet Orthot Int.2014.in press.
[32]孙嘉利,欧阳亚涛,唐丹,等.截瘫步行器对截瘫患者日常生活活动能力的影响[J].中国康复医学杂志,2007,22(7):609-611.