步行训练时机选择对脑卒中偏瘫病人平衡及步行能力的影响
Effect of the timing of walking training on balance function and walking ability of hemiplegia patients with stroke
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摘要: 目的:观察步行训练的时机选择对脑卒中偏瘫病人平衡及步行能力的影响。方法:选择脑卒中偏瘫病人68例,随机分为观察组34例和对照组34例,观察组在早期肌张力不低下的条件下开始进行科学的步行训练,对照组在具备一定的条件(站立平衡等级超过3级、患肢能够支持3/4以上体质量、患肢具有主动屈/伸膝、屈/伸髋、踝关节背屈功能)后进行步行训练。2组在训练前、训练2个月后分别采用Berg平衡量表(BBS)、简式Fugl-Meyer运动功能量表(FMA)、Bathel指数(MBI)、Holden步行功能分级(FAC)评定病人平衡功能、下肢运动功能、日常生活活动能力以及步行能力。此外,通过10 m最大步行速度测定法获得病人的步行速度、步长和步频等步态参数来评价步行质量。结果:训练2个月后,观察组和对照组BBS、FMA、MBI以及FAC评分均显著优于治疗前(P<0.01),且训练后观察组的各项评分均高于对照组(P<0.01);观察组步行质量优于对照组(P<0.05~P<0.01)。结论:步行训练时机的选择,对于肌张力恢复正常的偏瘫病人来说有重要意义,尽早开始科学的步行训练能够有效提高脑卒中偏瘫病人的平衡及步行能力,进而提高病人的步行质量。Abstract: Objective:To observe the effects of the timing of ambulation training on balance function and walking ability of hemiplegia patients with stroke.Methods:Sixty-eight hemiplegia patients with stroke were randomly divided into the observation group(n=34) and control group(n=34).The observation group were treated with scientific walking training under the condition of the high muscle tension at the early stage,and the control group were treated with scientific walking training under certain conditions,which included the standing balance more than grade 3,injured limb supporting over 3/4 of self-body weight,normal flex and adduct function of the knee joint and hip joint,and normal dorsiflexion function of ankle joint.The balance function,lower limb motor function,activities of daily living and walking ability in two groups were evaluated using the Berg balance scale(BBS),simple type Fugl-Meyer motor function scale(FMA),Bathel index(MBI) and Holden walking function rating(FAC) before training and after two months of training,respectively.The walking speed,stride length and stride frequency were measured using the max walking speed of 10m.Results:After 2 months of training,the scores of the BBS,FMA,MBI and FAC in two groups were significantly better than before treatment(P<0.01),the scores of the BBS,FMA,MBI and FAC in observation group were significantly higher those in control group(P<0.01),and the walking quality in observation group was better that in control group(P<0.05 to P<0.01).Conclusions:The timing of scientific walking training has important significance in the recovery of muscle tension in hemiplegia patients.The starting scientific walking training as early as possible can effectively improve the balance function,walking ability and living quality of patients.
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Key words:
- hemiplegia /
- stroke /
- walking /
- training
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[1] 李迎光,李志君,李小军.早期部分减重步行训练联合常规康复治疗对脑卒中偏瘫患者步行功能的影响[J].郑州大学学报(医学版),2011,46(1):160. [2] 徐文玉,丁泉涌,苏玉萍,等.步行训练的时机选择对偏瘫患者康复疗效的影响[J].中华老年心脑血管病杂志,2013,15(1):64. [3] 全国第四届脑血管病学术会议.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379. [4] 刘艺,黄敬.脑卒中偏瘫患者3种步行训练方法的效果比[J].中国康复理论与实践,2014,20(3):272. [5] 王文威,王路,李凌晋,等.基于Bobath理念的步行训练在恢复期脑卒中患者中的应用[J].中国康复医学杂志,2012,27(12):1124. [6] 繆鸿石,朱镛连.脑卒中的康复评定和治疗[M].北京:华夏出版社,1996:162. [7] 潘毓健,徐国会,郑洁皎,等.本体感觉神经肌肉促进技术对脑卒中患者平衡功能的影响[J].中国康复理论与实践,2012,18(1):22. [8] 苏晓娇,鲍颂杨.减重步行训练在脑卒中后下肢运动及平衡功能康复中的价值[J].中国实用神经疾病杂志,2011,14(22):50. [9] 张丽华,赵连成.减重步行训练对脑卒中后偏瘫患者的康复疗效分析[J].中国疗养医学,2014,23(3):221. [10] 雷迈,卢斌,吴旻,等.作业疗法和运动疗法对老年脑卒中患者上肢功能及日常生活活动能力的影响[J].中国康复理论与实践,2010,16(12):1167. [11] 王芗斌,陈剑,李天骄,等.不同频率电针对脑卒中下肢痉挛患者肌电图及步行能力的影响随机对照研究[J].中国针灸,2011,31(7):580. [12] 刘翠华,张盘德,容小川,等.步态诱发功能性电刺激对脑卒中足下垂患者的疗效观察[J].中国康复医学杂志,2011,26(12):1136. [13] SOUSA CO,BARELA JA,PRADO-MEDEIROS CL,et al.Gait training with partial body weight support during over ground walking for individuals with chronic stroke:a pilot study[J].J Neuroeng Rehabil,2011,8(24):8. [14] 夏梵.早期院内行减重步行训练在脑卒中后轻中度偏瘫患者中的疗效观察[J].现代中西医结合杂志,2013,22(15):1669. [15] 罗峰,马丹,秦宏.社区康复对脑卒中后典型偏瘫步态的疗效观察[J].中国康复理论与实践,2011,17(2):81. [16] 曹莉,田维琴.强化步行训练在早期脑卒中偏瘫患者肢体康复过程中的效果分析[J].检验医学与临床,2014,11(15):2175. [17] 佟剑平,赵春艳,邓雪奇,等.脑卒中偏瘫患者早期介入减重训练对提高下肢步行能力的影响[J].中国康复理论与实践,2010,16(10):958. [18] 唐玉清,谢荣,杨文华.减重步行训练改善脑卒中患者步行能力的疗效观察[J].新疆医学,2011,41(5):83.
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