中国的机器人外科学杂志 | ISSN 2096-7721 | CN 10-1650/R

不同平衡训练策略对脑卒中患者下肢运动功能恢复的影响

Effects of different balance training strategies on recovery of lower limb motor function in stroke patients

作者:易江,李文茂,关宁,张添奇,张枫悦,刘威,段晓琴

Vol. 4 No. 6 Dec. 2023 DOI: 10.12180/j.issn.2096-7721.2023.06.004 发布日期:2023-10-19
关键词:平衡训练;脑卒中;下肢;运动功能

作者简介:

目的:观察两种平衡训练策略对脑卒中患者下肢运动功能恢复的影响。方法:选取脑卒中患者 63 例, 采用随机数字表法将其随机分为对照组和观察组,其中对照组 31 例,观察组 32 例。对照组在常规康复治疗的基础上, 接受姿势矫正镜下的平衡训练;观察组患者在常规康复治疗的基础上,接受平衡训练仪下的平衡训练。两组患者的 平衡训练时间均为 4 周。于治疗前和治疗 4 周后采用部分静态平衡仪测试参数(轨迹总长度、轨迹面积图和速度图)、 Berg 平衡量表(Berg Balance Scale,BBS)、10 m 最大步行速度(Maximum Walking Speed,MWS)和计时起立 - 行 走测试(Timed Up and Go Test,TUGT),分别评估患者的静态平衡能力、步行速度和移动能力。结果:治疗 4 周后, 行组内比较,两组患者的部分静态平衡仪测试参数、BBS、MWS 和 TUGT 结果较治疗前均显著改善,差异有统计学 意义(P<0.05);组间比较,两组患者的部分静态平衡仪测试参数、BBS 和 MWS 相比,差异有统计学意义(P<0.05); 而两组的 TUGT 结果相比,差别无统计学意义(P>0.05)。结论:与姿势矫正镜下进行平衡训练相比,采用平衡训 练仪能够有效改善脑卒中患者的静态平衡下压力中心(Center of Pressure,COP)的轨迹总长度、轨迹面积图和速度图, 能提高患者的平衡能力和步行速度,加速患者下肢运动功能的恢复。

Objective: To observe the effect of two different balance training strategies on recovery of lower limb motor function in stroke patients. Methods: 63 stroke patients with hemiplegia in our hospital were selected and randomly divided into control group and study group, including 31 patients in the control group and 32 patients in the observation group. The control group was given balance training under postural mirror and routine rehabilitation treatment, and the observation group were given balance training under the balance training instrument and routine rehabilitation treatment. All patients were trained for 4 weeks. Using part of the static balance test parameters (including total path length, path area and velocity diagram), Berg Balance Scale (BBS), 10-meter Maximum Walking Speed (MWS) and Timed Up & Go Test (TUGT) to evaluate static balance ability, balance function, walking speed and mobility of patients respectively before and 4 weeks after treatment. Result: After 4 weeks of treatment, the results of static balance test, BBS, MWS and TUGT in the two groups were significantly improved compared with those before treatment (P<0.05). Static balance test, BBS and MWS results between the two groups showed statistically significant differences (P<0.05), while TUGT results showed no statistically significant differences between the two groups (P> 0.05). Conclusion: Compared with the balance training under postural mirror, the balance training with balance instrument could effectively improve the total path length, path area and velocity diagram on the speed of center of pressure (COP) of stroke patients, as well as improve the balance ability and walking speed of patients and accelerate their recovery of lower limb motor function.

稿件信息

收稿日期:2022-03-11  录用日期:2023-02-07 

Received Date: 2022-03-11  Accepted Date: 2023-02-07 

基金项目:吉林省自然科学基金学科布局项目(202512JC010472429);吉林大学白求恩计划项目(2020B41) 

Foundation Item: Disciplinary Layout Project of the Natural Science Foundation of Jilin Province (202512JC010472429); Jilin University Bethune Project (2020B41) 

通讯作者:段晓琴,Email:15204309769@163.com 

Corresponding Author: DUAN Xiaoqin, Email: 15204309769@163.com 

引用格式:易江,李文茂,关宁,等 . 不同平衡训练策略对脑卒中患者下肢运动功能恢复的影响 [J]. 机器人外科学杂志(中英文), 2023,4(6):517-524. 

Citation: YI J, LI W M, GUAN N, et al. Effects of different balance training strategies on recovery of lower limb motor function in stroke patients[J]. Chinese Journal of Robotic Surgery, 2023, 4 (6): 517-524.

参考文献

[1] Ekker M S, Boot E M, Singhal A B, et al. Epidemiology, aetiology, and management of ischaemic stroke in young adults [J]. Lancet Neurol, 2018, 17(9): 790-801. [2] Valery L F, Michael B, Norrving B, et al. World Stroke Organization (WSO): Global Stroke Fact Sheet 2022 [J]. International Journal of Stroke, 2022, 17(1): 18-29. [3] WU S M, WU B, LIU M, et al. Stroke in China: advances and challenges in epidemiology, prevention, and management [J]. Lancet Neurol, 2019, 18(4): 394-405. [4] Lord S E, McPherson K, McNaughton H K, et al. Community ambulation after stroke: how important and obtainable is it and what measures appear predictive? [J]. Arch Phys Med Rehabil, 2004, 85(2): 234-239. [5] Nadeau S E, Wu S S, Dobkin B H, et al. Effects of taskspecific and impairment-based training compared with usual care on functional walking ability after inpatient stroke rehabilitation: LEAPS Trial [J]. Neurorehabil Neural Repair, 2013, 27(4): 370-380. [6] Nichols-Larsen D S, Clark P C, Zeringue A, et al. Factors influencing stroke survivors’ quality of life during subacute recovery [J]. Stroke, 2005, 36(7): 1480-1484. [7] 卓大宏 . 中国康复医学 [M]. 2版 . 北京 : 华夏出版社 , 2003: 757-808. [8] de Oliveira C B, de Medeiros I R, Frota N A, et al. Balance control in hemiparetic stroke patients: main tools for evaluation [J]. J Rehabil Res Dev, 2008, 45(8): 1215-1226. [9] Vistamehr A, Kautz S A, Bowden M G, et al. Correlations between measures of dynamic balance in individuals with post-stroke hemiparesis [J]. J Biomech, 2016, 49(3): 396-400. [10] 宋利娜 , 张洪斌 . 脑卒中偏瘫患者平衡功能康复 方法研究进展 [J]. 中国康复医学杂志 , 2012, 27(8): 781-783. [11] 庄霁雯 , 郑洁皎 , 陈秀恩 , 等 . 脑卒中平衡功能障 碍治疗的研究进展 [J]. 中国康复理论与实践 , 2016, 22(10): 1127-1131. [12] 中华医学会全国第四届脑血管疾病学术会议 . 各类 脑血管疾病诊断要点[J]. 中华神经科杂志 , 1996, (6): 60-61. [13] Blum L, Korner-Bitensky N. Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review[J]. Phys Ther, 2008, 88(5): 559-566. [14] Persson C U, Hansson P O, Sunnerhagen K S. Clinical tests performed in acute stroke identify the risk of falling during the first year: postural Stroke Study in Gothenburg (POSTGOT) [J]. J Re-habil Med, 2011, 43(4): 348-353. [15] Podsiadlo D, Richardson S. The Timed “Up & Go”: a test of basic functional mobility for frail elderly persons [J]. J Am Geriatr Soc, 1991, 39(2): 142-148. [16] Faria C D, Teixeira-Salmela L F, Nadeau S. Predicting levels of basic functional mobility, as assessed by the Timed “Up and Go” Test, for individuals with stroke: discriminant analyses[J]. Disabil Rehabil, 2013, 35(2): 146-152. [17] Sibley K M, Straus S E, Inness E L, et al. Balance assessment practices and use of standardized balance measures among Ontario physical therapists[J]. Phys Ther, 2011, 91(11): 1583-1591. [18] 张丽 , 瓮长水 , 王秋华 , 等 . 前庭感觉、本体感觉 及视觉功能对老年人跌倒风险影响的因素分析 [J]. 中国康复理论与实践 , 2010, 16(1): 16-18. [19] Horlings C G C, Kǜng U M, Van Engelen B G M, et al. Balance control in patients with distal versus proximal muscle weakness[J]. Neuroscience, 2009, 164(4): 1876-1886. [20] 黄小兵 , 刘博 . 平衡三联及中枢整合在人体平衡中 的作用 [J]. 前庭医学 , 2009, 17(6): 534-553. [21] Peterka R J. Sensorimotor integration in human postural control[J]. J Neurophys 2002, 88(3): 1097-1118. [22] Hoark F B, Hlavacka F. Somatosensory loss increases vestibulospinal sensitivity [J]. J Neurophysiol, 2001, 86 (2): 575-585. [23] Nardone A, Godi M, Artuso A, et al. Balance rehabilitation by moving platform and exercises in patients with neuropathy or vestibular deficit[J]. Arch Phys Med Rehabil, 2010, 91(12): 1869-1877. [24] Bonan I V, Colle F M, Guichard J P, et al. Reliance on visual information after stroke. Part I: balance on dynamic posturography[J]. Arch Phys Med Rehabil, 2004, 85(2): 268-273. [25] Bonan I V, Yelnilk A P, Colle F M, et al. Reliance on visual information after stroke. Part II: Effectiveness of a balance rehabilitation program with visual cue deprivation after stroke: a randomized controlles trial [J]. Arch Phys Med Rehabil, 2004, 85(2): 274-278. [26] Sullivan J E, Hedman L D. Sensory dysfunction following stroke: incidence, significance, examination, and intervention[J]. Top Stroke Rehabil, 2008, 15(3): 200-217. [27] Vuilerme N, Danion F, Marin L, et al. The effect of expertise in gymnastics on postural control [J]. Neurosci Lett, 2001, 303(2): 83-86. [28] Pellerno L, Giannoni P, Marinelli L, et al. Effects of continuous visual feedback during sitting balance training in chronic stroke survivors [J]. J Neuroeng Rehabil, 2017, 14(1): 107-121. [29] 何蕾 , 柴双双 , 陈亚平 . 平衡评估训练系统对脑卒 中后平衡功能的康复效果 [J]. 中国康复理论与实 践 , 2021, 27(7): 760-764. [30] Walker C, Brouwer B J, Culham E G. Use of visual feedback in retraining balance following acute stroke [J]. Phys Therapy Pract, 2000, 80(9): 886-895. [31] Moore S, Woollacott M. The use of biofeedback devices to improve postural stability [J]. Phys Therapy Pract, 1993, 2(1): 1-19. [32] Jung K, Kim Y, Chung Y, et al. Weight-shift training improves trunk control, proprioception, and balance in patients with chronic hemiparetic stroke [J]. Tohoku J Exp Med, 2014, 232(3): 195-199. [33] Tsaklis P V, Grooten W J, Franzen E. Effects of weight-shift training on balance control and weight distribution in chronic stroke: a pilot study [J]. Top Stroke Rehabil, 2012, 19(1): 23-31. [34] Dault M C, Haart M, Geurts A C H, et al. Effects of visual center of pressure feedback on postural control in young and elderly healthy adults and in stroke patients [J]. Hum Mov Sci, 2003, 22(3): 221-236. [35] Ahn M H, Ahn C S, Kim M C. Effect of selective-task vs set-task program on balance and weight bearing of stroke patient [J]. J Phys Ther Sci, 2011, 23(5): 707-711. [36] Srivastava A, Taly A B, Gupta A, et al. Post-stroke balance training: role of force platform with visual feedback technique [J]. J Neurol Sci, 2009, 287(1-2): 89-93. [37] 薛燕萍 , 许志强 , 梁英 . 视觉对脑卒中患者立位平 衡功能的影响 [C]. 中国康复医学会第九届全国康复 治疗学术年会论文集 , 2012: 780.

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