人体平衡功能检测系列研究(1):正常人静态姿势平衡的定量评定及性别、年龄的差异

目的检测正常人群的静态姿势平衡功能 ,了解不同性别和各年龄段的差异。方法采用国产PH A型平衡功能检测训练系统测定 44 5名正常人的坐位、睁眼和闭眼双脚站立、单脚站立的共 40个指标 ,将男女、睁闭眼、左右脚、7个年龄段分别作对比观察。结果睁眼和闭眼双脚站立时分别有 96 4%和 98%的被试重心分布在A区 ,只有 1人在C区。男女、睁闭眼和左右脚比较多个指标有显著性差异 ,闭眼双脚站位的稳定性要较睁眼时好 ,右脚单脚站位的稳定性较左脚好 ,各年龄段比较 ,除睁眼双脚站立左侧内外偏移幅度外 ,其他指标均有显著性差异 ,2 0— 3 9岁的平衡功能最佳 ,60岁以后出现衰退。结论静态姿势平衡检测仪能客观和定量地评价人体平衡功能 ,人体平衡功能与年龄、性别相关 ,临床应用时要考虑不同患者性别和年龄段各指标的正常值范围有差异     

社区老年人在不同双重任务下静态平衡能力的比较研究

[目的]研究社区老年人在单姿势任务和不同认知-姿势双重任务下的静态平衡能力。[方法]采用目的抽样,选取上海市浦东新区某社区70名老年人为研究对象,每人测试3次,分别为单姿势任务平衡测试、语义-姿势双任务平衡测试和数字-姿势双任务平衡测试,每次测试时间间隔30min。均采用Tetrax平衡测试系统进行平衡功能的测试。[结果]单姿势任务和姿势-认知双任务稳定性系数(睁眼、闭眼站立)和跌倒风险系数差异均有统计学意义(P0.05);两两比较结果显示稳定性系数(睁眼、闭眼站立)和跌倒风险系数两项指标均值上语义-姿势双任务高于数字-姿势双任务,但两者仅在闭眼站立稳定性系数指标比较差异有统计学意义(P0.05)。[结论]认知任务对社区老年人静态平衡的维持具有负面影响;被试者在语义-姿势双任务范式下静态平衡能力在一定程度上低于数字-姿势双任务。     

直立海绵垫姿势描记在评定正常人和眩晕患者平衡功能中的重测信度研究

目的:研究直立海绵垫姿势描记方法在分析人体姿势稳定性、评价正常人和眩晕患者姿势平衡能力时的信度。方法:25例正常人和34例病情处于稳定期的眩晕患者在3d内重复进行2次海绵垫姿势描记。测试4种不同站立条件下的静态姿势,依次为T1:睁眼站立于坚硬平板;T2:闭眼站立于坚硬平板;T3:睁眼站立海绵垫上;T4:闭眼站立海绵垫上。每种站立条件下各站立30s。记录测试中发生倾倒的情况;对于未倾倒者,姿势描记仪记录人体直立时足底压力中心晃动的平均速度(SV),作为姿势稳定性的参数。结果:健康对照组在各测试条件下未发生倾倒,而眩晕组有10例受试者在至少一次海绵垫姿势描记中发生倾倒,这部分患者结果不纳入信度分析。①49例受试者3d内重测的SV具有高度相关性(T1-T4四种测试条件下的ICC为0.973、0.931、0.932、0.887);②健康对照组和眩晕组在第一次测试中的SV比较,T2(P=0.049)和T4(P<0.001)条件下差异有显著性意义;第二次测试中的SV比较,T4条件下差异极显著性意义(P=0.001);③比较眩晕组中两次测试中倾倒发生的例数,差异无显著性意义(P=0.787)。结论:在评价正常人和病情处于稳定期的眩晕患者的平衡功能时,直立海绵垫时姿势描记具有较好的信度,提示该方法可用于评价前庭康复治疗对眩晕患者平衡功能的影响。     

平衡姿势控制训练联合核心稳定性训练治疗慢性非特异性下背痛的临床疗效

目的:观察平衡姿势控制训练联合核心稳定性训练(CST)对慢性非特异性下背痛(CNLBP)患者的疼痛及静动态平衡控制能力的影响。方法:共有40例CNLBP患者纳入本研究,其中男性18例,女性22例,采用随机数字表法将其分为试验组(19例)及对照组(21例)。两组患者均接受常规理疗,试验组在此基础上进行核心稳定性训练和姿势控制训练,对照组进行核心稳定性训练。对照组核心稳定性训练30min/次,每天2次,每周5天,试验组核心稳定训练和姿势控制训练每天各1次,30min/次,每周5天,连续6周。分别在治疗前、治疗3周、治疗6周时对患者进行功能评定。使用视觉模拟量表(VAS)评价患者疼痛程度,使用Oswestry功能障碍指数(ODI)评价患者功能障碍程度,使用三维平衡测试仪进行静动态平衡评估来评价患者的姿势控制能力。静态平衡指标为三种体位下的重心摆动速度;动态平衡指标为稳定时间。结果:治疗3周两组VAS、ODI评分较治疗前显著降低(P0.05),试验组闭眼站立和脚前后站立平衡得分较治疗前有显著差异(P0.05)。治疗6周两组VAS、ODI评分较治疗前有显著性差异(P0.01),对照组睁眼站立和闭眼站立平衡能力较治疗前显著改善(P0.05),试验组静动态平衡指标较治疗前有显著性差异(P0.01,P0.05)。治疗6周试验组VAS、ODI、睁眼站立、闭眼站立、稳定时间得分较对照组显著改善(P0.05),脚前后站立与对照组相比有显著差异(P0.01)。结论:平衡姿势控制训练联合核心稳定性训练可以显著减轻CNLBP患者的疼痛及改善静动态的姿势控制能力。     

平衡反馈训练仪用于脑损伤偏瘫患者静态平衡测试的信度与效度研究

目的:探讨Pro-Kine Line平衡反馈仪测试静态平衡的信度和效度,为临床应用提供客观依据。方法:24名健康人和24例脑损伤偏瘫患者,每位受试者分别在前后两天的同一时间使用Pro-Kine Line平衡反馈仪进行坐位和站立位平衡测试,检测压力中心前后及左右方向的摆动幅度标准差和摆动速度,以及压力中心的摆动长度和摆动面积。结果:①信度检验:坐位下,除压力中心前后方向摆动幅度标准差外,其他5个参数重测信度均较高(ICC=0.66—0.92);站立位下6个参数的重测信度也均较高(ICC=0.57—0.93)。②区分效度检验:偏瘫组与对照组比较,各个测试指标的差异均有显著性意义(P<0.01)。③标准效度检验:站立位下各测试指标与Berg量表之间呈良好的负相关(-0.41—-0.64)。结论:Pro-Kine Line平衡反馈训练仪在静态平衡功能的评定中具有较高的信度和效度。     

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

目的评价前庭感觉、本体感觉及视觉功能对老年人跌倒风险的影响。方法56例60岁以上老年患者采用Tetrax平衡测试系统分别检测受试者在自然站立（NO）、闭眼自然站立（NC）、脚垫站立（PO）、脚垫闭眼站立（PC）4种不同测试状态下的一般稳定性指数（ST）、体重分布指数（WDI）和跌倒指数（FI）。结果平均FI（48.21±26.47）;ST：PC组＞PO组＞NC组＞NO组（P=0.000）,但NC组与PO组无显著性差异（P=0.705）;WDI各组间无显著性差异（P=0.057）。FI与不同姿势ST相关（P<0.05）;与不同姿势WDI的无相关性（P>0.05）。结论视觉、本体感觉和前庭感觉在姿势控制和跌倒预测方面均有重要作用;稳定性指数不仅能精确反映静态平衡功能状态和姿势控制能力,而且能初步反映感觉因素对平衡调控和跌倒风险的影响;体重分布指数评估跌倒风险不敏感。     

帕金森病患者姿势平衡障碍的定量评定

目的：客观、定量评价帕金森病患姿势平衡障碍。方法;采用日本经玛公司生产的重心平衡检测仪对１００例正常人１００例帕金森病患进行检测,分析比较其表态姿势图。结果：正常人各组平衡参数指标与年龄呈曲线关系。重心摆动类型以中心型为主,帕金森病患重心摆动类型以弥散型为主,静立稳定性下降,重心摆动速度明显增快,在４～６Ｈｚ摆动明显增高。结论：人体平衡功能与年龄相关;帕金森病患静立平衡功能下降,重心摆动面     

国产PJ-I型电脑型人体平衡功能检测仪的应用

目的：客观、定量了解正常及多种疾病患者的静立平衡功能；检验国际上常用指标及新增指标的敏感性。方法：运用国产电脑型人体平衡功能检测仪对５０４例正常人及２４６例神经科、五官科、骨伤科患者进行检测，分析比较其静态姿势图。结果：该仪器大部分指标与年龄呈曲线关系，脑卒中、共济失调、颈椎病及非颈椎肱眩晖患者静立明显下降，帕金森病在０．０１￣０．１Ｈｚ摆相对功率增加。四肢骨骼疾病患者静立稳定性较小。结论：该仪器     

重视国人平衡功能的研究

人类对自身平衡功能的研究至少有100多年的历史。从1851年Romberg提出通过观察站立位睁眼、闭眼时的姿势稳定性来判断有无平衡障碍,到20世纪70年代Nashner根据生物力学和生理学原理发明的定量研究姿势控制系统的动态姿势图(dynamicposturagraphy),显示了人类对自身平衡功能由知之甚少到深入研究的漫长过程以及锲而不舍的探索精神。国内平衡研究发展缓慢原因剖析:与国外平衡研究的发展相比,国内对平衡功能的研究起步较晚,初期发展比较缓慢,究其原因有多方面。①对平衡缺乏基本的认识,或者说对这方面的认识甚为肤浅。查阅国内20世纪出版的教…     

老年脑卒中患者平衡功能障碍特征分析

目的分析老年脑卒中患者平衡功能损害的特征。方法回顾性对照研究。分为患者组和正常对照组。采用Tetrax平衡仪分别检测两组睁眼站立状态下的一般稳定性、体重分布及体重分布指数、跌倒风险指数、同步性及姿势摆动频谱分析。结果 患者组除低频段外,其余频段姿势摆动强度均高于对照组(P<0.05);患者组健侧足跟和足趾部位的体重百分比及体重分布指数均高于对照组(P<0.05);患者组稳定性、"四点"同步性指标(CD、AC、BD、BC)均较对照组差(P<0.05);患者组跌倒风险指数与稳定性、中低频、中高频、高频摆动强度、同侧脚的足跟与足趾以及双脚足跟/足趾对角线同步性(AB、CD、AD、BC)呈正相关(P<0.05),与双侧脚足跟与足趾同步性(AC、BD)呈负相关(P<0.05)。结论老年脑卒中患者平衡功能障碍时身体的稳定性、体重分布及体重分布指数、同步性及姿势摆动频谱均显示异常,跌倒风险与多种因素相关。     

人体平衡功能定量测评

建立国产平衡仪的正常值范围，探讨各指标的敏感性及可靠性，运用国产人体平衡仪对202例相对正常人群及某些疾病患者进行测评，并分组进行比较。结果：该仪器大部分指标与年龄相关，但并非线性关系，动摇径、动摇轨迹、包络面积、单位面积轨迹长、动摇角度及能耗等指标在正常与疾病组间有差异。提示人体平衡功能与年龄相关，该平衡仪有助于客观和定量地评价人体平衡功能。     

Reliability and validity of functional balance tests post stroke

OBJECTIVE: To contribute to the reliability and validity of a series of functional balance tests for use post stroke. DESIGN: Within-session, test-retest and intertester reliability was tested using the kappa coefficient and intraclass correlations. The tests were performed three times and the first and third attempts compared to test the within-session reliability. The tests were repeated a few days later to assess test-retest reliability and were scored simultaneously by two physiotherapists to assess the intertester reliability. To test criterion-related validity the tests were compared with the sitting section of the Motor Assessment Scale, Berg Balance Scale and Rivermead Mobility Index using Spearman's rho. SETTING: Stroke physiotherapy services of six National Health Service hospitals. PARTICIPANTS: People with a post stroke hemiplegia attending physiotherapy who had no other pathology affecting their balance took part. Thirty-five people participated in the reliability testing and 48 people took part in the validity testing. MAIN OUTCOME MEASURES: The following functional balance tests were used: supported sitting balance, sitting arm raise, sitting forward reach, supported standing balance, standing arm raise, standing forward reach, static tandem standing, weight shift, timed 5-m walk with and without an aid, tap and step-up tests. RESULTS: The ordinal level tests (supported sitting and standing balance and static tandem standing tests) showed 100% agreement in all aspects of reliability. Intraclass correlations for the other tests ranged from 0.93 to 0.99. All the tests showed significant correlations with the appropriate comparator tests (r = 0.32-0.74 p < 0.05), except the weight shift test and step-up tests which did not form significant relationship with Berg Balance Scale (r = 0.26 and 0.19 respectively). CONCLUSION: These functional balance tests are reliable and valid measures of balance disability post stroke.     

便携式人体平衡测试仪的信度及敏感性研究

目的：研究便携式人体平衡测试仪评定人体站姿平衡功能的信度及敏感性,以指导其临床应用。方法：20例脑外伤及脑卒中患者作为病例组,20例健康人作为正常组,由同一名测试者使用便携式平衡测试仪在2周内对2组受试者的站姿平衡功能进行2次测试,每次测试分别在睁眼和闭眼状态下各1次。结果：2组内相关系数进行信度分析,结果显示2次测试间有较好的重测信度（ICC=0.84～0.92）;病例组与正常组各测试指标间差异有统计学意义（P〈0.01）。结论：便携式平衡测试仪具有很好的重测信度和敏感性,是定量评定人体站姿平衡功能的理想工具,并且还可用于评定人体坐姿平衡功能,其信度和敏感性有待进一步研究。     

The Measurement of Balance Post-Stroke. Part 3: Instrumented Measurement Tools

Abstract

The restoration of balance skills is an important aspect of stroke physiotherapy, but the lack of appropriate outcome measures has been identified as a factor hampering development of the evidence base. In recent years instrumented measurement tools such as those measuring postural sway have become popular for research and clinical use. A systematic review of ways to measure balance using instrumented measurement tools was undertaken. CINAHL, MEDLINE, and EMBASE databases were searched for tests which measured balance post-stroke and could be used in clinical settings. They were assessed for reliability, validity, sensitivity to change, suitability for use in clinical settings and with a wide range of stroke severity. Forty-three papers were identified. For clarity and ease of presentation, these were divided into tests of postural sway, weight distribution, and responses to external perturbations. All had some information about their psychometric properties but none had been comprehensively tested and none fulfilled the criteria for an outcome measure for stroke physiotherapy interventions. Platform measures of postural sway had limited reliability and validity as a measure of balance disability, while responses to external perturbations had been insufficiently tested. Measurement of weight distribution showed more promise however. Here, there was reasonable evidence of reliability and validity, the equipment was simple to use although it could be expensive and difficult to move, but simple 'low-tech' methods (for standing balance) have been suggested which merit further investigation.     

A new clinical test of dynamic standing balance in the frontal plane: the side-step test

OBJECTIVE: To confirm retest reliability for the side-step test and to investigate the validity of the side-step test by correlating performance on this test with that on other commonly used measures of balance and mobility. SETTING: Katta Public Hospital, Miyagi, Japan. DESIGN: Cross-sectional study. Intraclass correlation coefficient was examined by calculating the intra-rater reliability of the side-step test. Moreover, the validity of the test was examined by correlating maximum side-step length with gait parameters. SUBJECTS: This study recruited 28 hemiplegic subjects (17 with left-sided hemiplegia and 11 with right-sided hemiplegia). MEASURES: We measured balance ability and walking ability as follows: dynamic balance ability was assessed from maximum side-step length from the side-step test, static balance ability from one-footed standing duration, and walking ability from maximum walking speed, stride length and cadence. Balance ability was measured on both the affected and unaffected side. Maximum side-step length was standardized in terms of lower extremity length. RESULTS: Intraclass correlation coefficient of maximum side-step length was 0.97 bilaterally. There was a high linear correlation between maximum side-step length and both maximum walking speed and stride length; Pearson's product-moment correlation coefficient ranged from 0.84 to 0.89. One-footed standing duration was significantly correlated with maximum side-step length, maximum walking speed and stride length, and these relationships were non-linear. CONCLUSION: The reliability and validity of the side-step test was confirmed.     

Validation of the Chinese translated Activities-Specific Balance Confidence scale

OBJECTIVES: To translate contents of the Activities-Specific Balance Confidence (ABC) scale into Chinese (Cantonese), to examine the psychometric properties (internal reliability and validity) of this scale for use with Chinese older adults in Hong Kong, and to determine the level of self-perceived balance confidence of this population. DESIGN: A 2-phase exploratory study: formative qualitative research and a cross-sectional survey to establish the psychometric properties of the Chinese translated ABC (ABC-C) scale. SETTING: Community based. PARTICIPANTS: One hundred older community-dwelling subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Measurement of perceived level of confidence in maintaining balance using the ABC-C scale. This instrument contains 16 items on indoor and outdoor activities requiring different levels of balance function. RESULTS: Four of the 16 ABC-C scale items had to be modified to achieve content equivalence and cultural relevance to Hong Kong. Final test items of this scale showed high internal consistency with a Cronbach alpha coefficient of .97. The instrument was found to have excellent test-retest and very good interrater reliability with intraclass coefficients of .99 and .85, respectively. Results of a factor analysis conducted on the scale showed evidence of a coherent 1-domain structure. The mean perceived balance confidence level +/- standard deviation of 100 community-dwelling older adults in Hong Kong, performed by using the ABC-C scale, was 71.6+/-23.7. CONCLUSIONS: Results of the present study verified that the ABC-C scale is a culturally relevant, valid, and reliable tool for measuring self-perceived balance confidence in Chinese older adults. These were reflected in very good to excellent internal consistency of items, test-retest and interrater reliability, and construct validity shown.     

公众心肺复苏培训效果评价工具的研制和信效度分析

目的通过对公众心肺复苏知识测试卷和心肺复苏技能评价表的信效度分析,为公众心肺复苏培训的效果评价建立良好的评价工具。方法在大量查闻中英文文献的基础上,初步建立了公众心肺复苏知识测试卷（包含A、B两卷）和技能评价表的条目。通过专家法对试卷和评价表进行了内容效度的分析。公众心肺复苏知识测试卷和技能评价表又分别采用重测信度、复本信度和评分者间信度分析法对该工具进行了信度的检验。结果公众心肺复苏知识测试卷和心肺复苏技能评价表中每个条目的内容效度指数（CVI）均在o．9—1．0之间,抽样效度分别为91％和93％。公众心肺复苏知识测试卷的重测信度分别为r=0．824和r=0．850。试卷A和试卷B的复本信度值栅．752。2位考核员心肺复苏技能评价表评分的相关系数r=0．764;操作评分的组内相关系数分析ICC值为0．861,P〈0．001;操作合格判定的一致性Kappa值为0．807,P〈0．001。结论公众心肺复苏知识测试卷和心肺复苏技能评价表的信效度良好,可以在公众心肺复苏培训中对受训者的理论和技能做出合理的评价。     

Spanish validation of an instrument to measure the quality of nursing care in hospital emergency units

The article describes the translation and adaptation to Spanish of the Consumer Emergency Care Satisfaction Scale (CECSS), an instrument used to measure the quality of care nurses give in emergency units. Bilingual people using a translation-retrotranslation process performed the adaptation. The reliability and validity of content and construction were analyzed. The reliability study showed satisfactory indexes in all cases. Content validity (judgment of expert nurses and patients) obtained a mean item-dimension suitability valuation of 6.1 and item-scale suitability of 5.5. As the Spanish version of the CECSS is comprehensible to patients, and reliability and validity are satisfactory, it provides a useful measure of the quality of nursing care.     

Validity and Reliability of Wii Fit Balance Board for the Assessment of Balance of Healthy Young Adults and the Elderly

[Purpose] Balance is an integral part of human ability. The smart balance master system (SBM) is a balance test instrument with good reliability and validity, but it is expensive. Therefore, we modified a Wii Fit balance board, which is a convenient balance assessment tool, and analyzed its reliability and validity. [Subjects and Methods] We recruited 20 healthy young adults and 20 elderly people, and administered 3 balance tests. The correlation coefficient and intraclass correlation of both instruments were analyzed. [Results] There were no statistically significant differences in the 3 tests between the Wii Fit balance board and the SBM. The Wii Fit balance board had a good intraclass correlation (0.86–0.99) for the elderly people and positive correlations (r = 0.58–0.86) with the SBM. [Conclusions] The Wii Fit balance board is a balance assessment tool with good reliability and high validity for elderly people, and we recommend it as an alternative tool for assessing balance ability.Key words: Wii Fit balance board, Smart balance master system, Balance     

Reliability and validity of the SF-12 health survey among people with severe mental illness

OBJECTIVE: The objective of this work was to assess the reliability and validity of the Medical Outcomes Study Short-Form 12-Item Health Survey (SF-12) in a large sample of people with severe mental illness (SMI). METHODS: We examined the internal factor structure of the SF-12, compared component scores for this sample with normative levels, examined test-retest reliability, and examined convergent and divergent validity by comparing SF-12 scores to other indexes of physical and mental health. RESULTS: The SF-12 distinguished this sample of people with SMI from the general population, was stable over a 1-week interval, consisted of 2 fairly distinct factors, and was related to physical and mental health indexes in expected ways. CONCLUSIONS: The SF-12 appears to be a psychometrically sound instrument for measuring health-related quality of life for people with SMI.