计时起立行走与最大步行速度评估脑卒中步行功能的对比分析

目的 探讨脑卒中患者计时起立行走测试（TUGT）、最大步行速度测试（MWST）与步态时-空参数之间的相关性。 方法 选取脑卒中患者22例,由同一名专业人员分别对其进行TUGT、MWST和步态时-空参数评测,并采用Pearson相关系数分析TUGT和MWST测试与步态时-空参数的相关性。 结果 22例患者的TUGT和MWST测试结果分别为(18.57±7.41)s和（1.59±0.53）m/s。MWST与步长、步速和步宽呈显著正相关性（P<0.05）,TUGT与步长、步速呈显著的相关性（P<0.05）;同时,TUGT与MWST呈显著负相关（r＝-0.712,P<0.05）。 结论 TUGT和MWST均能够有效地评估脑卒中患者的步行运动能力。     

计时“起立-行走”测验评估脑卒中患者功能性步行能力的信度和同时效度

目的：评估脑卒中患者的移动能力是康复医学重要内容。研究脑卒中患者计时“起立-行走”测试的信度和同时效度，为临床评定提供客观依据。方法：解放军总医院康复医学科收治47例脑卒中偏瘫患者，均符合第四届全国脑血管病会议通过的诊断标准，意识清晰，可接受动作行指令，可独立或在监视下步行20m以上，排除下肢全关节置换术后、严重关节炎而影响步行者以及存在其他限制下肢活动的合并症者。有5位医师参与，其中2位医师评估47例脑卒中偏瘫患者的计时“起立-行走”的测试作为评测者间信度研究，患者在同一时间段内被同一医师再评估1次，以作为评测者内信度研究。由另3位医师共同利用Berg平衡量表(BBS)，FIM和最大步行速度测量评估患者的平衡功能、日常生活能力和步行速度作为效标尺度，进行同时效度的研究。结果：在信度方面，在同一评定者的两次评定结果之间高度相关ICC=0.982(95％CI:0.901—0．992)；不同评定者的同一次评定结果之间也高度相关ICC=0．984(95％ CI：0．889～0．995)，同时在效度方面．计时“起立-行走”测试与BBS，FIM和最大步行速度之间有较好的相关性(r=-0．914～-0.646，P&;lt;0．001)。结论：计时“起立-行走”测试方法用于评定脑卒中患者的功能性步行能力方面具有良好的信度和效度，可供国内同行在进行功能性步行定量评定时选用。     

计时"起立-行走"测试在评价脑卒中患者日常生活活动能力中的价值

目的：研究脑卒中患者计时“起立-行走”测试（TUGT）与ADL的关系,为临床提供一种简单易行的评价方法。方法：对46例治疗后恢复步行能力的脑卒中偏瘫患者进行TUGT测试,同时用Barther（BI）指数测定其ADL能力,并对各变量间进行相关统计分析,ROC曲线确定敏感性和特异性均较高的临界值。结果：TUGT与BI呈负相关（-0．534,P〈0．005）。TUGT值判断脑卒中偏瘫患者ADL完全自立的ROC曲线下面积为0．827,P=0．0026,95％可信区间为0．654-1．05,判断步行自立的最佳TUGT临界值为14．9s,其相应敏感性为88．4％,特异性为90．5％。结论：TUGT作为一个筛查和评价工具与BI结合可以更加充分地描述脑卒中患者功能性移动的能力。为临床评定提供客观依据。     

"起立-行走"计时测试在评定脑卒中患者功能性移动能力中的价值

目的探讨“起立 -行走”计时测试 (TUGT)在评定脑卒中患者功能移动能力中的价值。方法 90例脑卒中患者参与本研究。采用Berg平衡量表 (BBS)、步行速度和功能独立性测量 (FIM )评定患者的平衡、步行速度和功能独立性 ,作为TUGT的效标尺度 ;用受试者工作特征曲线构图法求出判断患者独立步行与否的最佳TUGT临界值。结果TUGT与BBS、FIM和步行速度之间有明显相关性 (r =-0 .92 6— -0 .674,P <0 .0 0 1) ;TUGT值 <10s的患者全部步行独立 ,TUGT值 >2 0s的患者中步行自立群只占 8.3(G ;判断独立步行最佳临界值为 15 .2s ,其敏感性为 89.4% ,特异性为 79.1%。结论TUGT具有良好的信度和效度 ,可反应功能性活动变化的过程。     

起立步行试验生物力学策略评估在脑卒中患者运动功能评估中的应用

摘要目的：探讨起立步行试验生物力学策略评估（TUG-ABS）在脑卒中患者运动功能评估中的作用,为临床应用提供理论基础。方法：脑卒中患者34例,应用TUG-ABS、平衡仪（PRO-KIN）和功能评估（TUG）、单腿支撑时间、Brunnstrom分期、Fugl-Meyer运动功能评估和10m最大步行速度对其进行评估,并对结果进行分析比较。结果：①TUG-ABS中的“站到坐”分项与平衡仪评估静态站立平衡结果有着显著的相关性（P<0.05）;②TUG-ABS和TUG评估与常规功能评估间均有显著的相关性（P<0.05）。结论：TUG-ABS可以较好的评价脑卒中患者的运动功能,较TUG更能代表患者的静态站立平衡功能。     

"起立-行走"计时测试评价全膝关节置换术近期行走功能

目的:使用"起立-行走"计时测试评价全膝关节置换术后近期行走功能.方法:选用我院2008-2010年治疗的42例膝关节骨性关节炎行全膝关节置换术患者,其中男14例,女28例,年龄62 ～ 72岁,平均60.6岁,随访2 ～ 9个月,平均6.3个月,使用"起立-行走"计时测试评价患者术后的行走功能.结果:术前"起立-行走"计时测试为(54.40 ± 4.63)s,术后为(29.93 ± 2.96)s;术前JOA膝关节治疗效果评分为47.36 ± 6.61,术后为73.33 ± 3.21,通过配对t检验提示,两种评价方法评定行全膝关节置换手术后,可以明显改善膝关节功能.结论:"起立-行走"计时测试可有效评价全膝关节置换术后的行走功能,而且操作简便,值得推广.     

脑卒中患者功能恢复的测定:自由步行与最大步行速度的比较

目的比较脑卒中患者自由与最大步行速度在评定功能恢复结果中的价值。方法对 3 2例恢复步行能力的脑卒中偏瘫患者 ,测定自然舒适状态下的 10m步行速度和 10m最大步行速度 ,用Fugl Meyer评定法评定下肢运动功能 ,用Berg平衡量表评定平衡功能 ,用功能独立性测量中的移动类项目测量综合移动能力。对自由步行和最大步行速度与临床评定变量间进行Pearson相关分析。结果自由步行和最大步行速度之间呈高度正相关 (r =0 95 3 ,P <0 0 0 1) ;自由步行和最大步行速度与平衡功能、下肢运动功能和综合移动能力之间呈高度正相关 (r =0 742— 0 83 4,P <0 0 0 1) ;但自由步行速度与功能恢复的相关性更高 (r =0 787— 0 83 4,P <0 0 0 1)。结论自由步行和最大步行速度都能够反映功能恢复结果 ,但是自由步行速度测定方法更实用、更安全和更敏感。     

脑卒中患者步行功能恢复的客观依据：自由和最大步行速度测量的信度和同时效度研究

目的：步行速度是反映脑卒中患者功能恢复的重要指标。研究采用自由和最大步行速度测量法进行脑卒中患者步行能力评定时的信度和同时效度，为临床评定提供客观依据。方法：解放军总医院康复医学科收治脑卒中偏瘫患者55例，符合第四届全国脑血管病会议通过的诊断标准，意识清晰，可接受动作行指令，患者可独立或在监视下步行20m以上，排除下肢全关节置换术后、严重关节炎而影响步行者，以及存在其他限制下肢活动的并发症者。有5位医师参与，其中2位医师评估55例脑卒中偏瘫患者的10m自由和最大步行速度，作为评测者间信度研究，患者在同一时间段内被同一医师再评估1次，以作为评测者内信度研究。由另3位医师共同利用下肢Fugl-Meyer评价、Berg平衡量表和功能独立性测量作效标尺度进行同时效度的研究。结果：在信度方面，10m自由和最大步行速度的测量在同一评定者的两次评定结果之间高度相关(ICC=0．912—0．937)，不同评定者的同一次评定结果之间也高度相关(ICC=0．961～0．972)，在同时效度方面，自由和最大步行速度与Fugl-Meyer评价，Berg平衡量表和功能独立性测量有较好的相关性(r=0．595～0．693，P&;lt;0．001)。结论：自由和最大步行速度测量法评定具有良好的信度与同时效度．推荐在临床结局评价中使用。     

脑卒中偏瘫患者最大步行速度决定因子的研究

目的：根据脑卒中偏瘫患者最大步行速度的决定因子探讨脑卒中不同阶段的治疗方案。方法：测定１８例脑卒中偏瘫患者从独步开始到治疗８周后的最大步行速度和相关生物力学因子,用逐次重回归分析求出最大步行速度的决定因子。结果：独步开始最大步行速度的决定因子是健侧的大腱四头肌肌力,治疗８周后最大步行速度的决定因子是左右重心移植距离。结论：脑卒中偏瘫的不同阶段,最大步行速度的决定因子不同。     

影响脑卒中偏瘫患者自由和最大步行速度的主要功能损害因素

目的：探讨脑卒中偏瘫患者下肢运动功能、下肢肌力、平衡和痉挛等变量与自由和最大步行速度之间的相互关系，为临床优化步行训练程序提供客观依据。方法：解放军总医院康复医学科收治的脑卒中偏瘫患者85例，符合第四届全国脑血管病会议通过的诊断标准，意识清晰，可接受动作行指令，患者可独立或在监视下步行20m以上，排除下肢全关节置换术后、严重关节炎而影响步行者以及存在其他限制下肢活动的并发症者。85例恢复步行能力的脑卒中偏瘫患者，测定在自由和最大步行速度的状态下的10m步行速度，用Fugl-Meyer评价法评测下肢运动功能，用Motricity指数评测下肢肌力，用Berg平衡量表评定平衡功能，用改良Ashworth评定法评定足跖屈肌张力。分别对自由和最大步行速度与临床变量间进行Pearson相关分析，然后进行逐步回归分析。结果：患者的自由和最大步行速度与下肢运动功能、平衡和下肢肌力之间呈高度正相关(r=0.592—0．696，P&;lt;0．001)。自由步行速度与足跖屈肌痉挛呈中度的负相关(r=-0．411，P&;lt;0．05)，而最大步行速度与足跖屈肌张力痉挛无相关性(r=-0．311，P=0．064)；逐步回归分析发现，平衡、足跖屈肌痉挛和下肢肌力是自由步行速度的功能损害因素(R^2=0．55，P&;lt;0．05)，平衡和下肢运动功能是最大步行速度的功能损害因素(R^2=0．535，P&;lt;0．001)。结论：影响脑卒中偏瘫患者自由和最大步行速度的功能损害因素是有不同的，但平衡功能是决定患者自由和最大步行速度最重要的功能损害因素。     

三种功能性移动能力测试工具对预测老年人跌倒危险有效性的比较

目的:比较三种功能性移动能力测试工具在预测老年人跌倒危险方面的有效性.方法:116名老年人受试者参与本研究并分为跌倒组和非跌倒组.对受试者进行5次坐到站测试(five times sit to stand test,FTSST)、3m计时起立行走测试(timed up and go test,TUGT)和计时10m步行测试(timed 10-meter walk test,TWT).结果:跌倒组和非跌倒组的受试者在FTSST、TUGT和TWT之间的比较有显著差异(P＜ 0.001).Spearman相关分析结果均显示FTSST、TUGT和TWT与跌倒史之间显著相关(P＜ 0.001).Logistic回归分析显示FTSST、TUGT和TWT的时间与跌倒危险显著关联(OR:1.1643-1.2503).接受者操作特征(ROC)曲线下的面积比较FTSST、TUGT和TWT之间无显著性差异(P＞0.05),并且三种测试工具可以显著预测跌倒危险(AUC:0.68--0.73,P＜0.001).结论:FTSST、TUGT和TWT作为简便、快捷的功能性测试工具可以有效预测老年人跌倒危险.     

Preoperative factors related to the ambulatory status at 1 year after total knee arthroplasty

Purpose: The purpose of this study is to investigate whether preoperative factors can predict the ambulatory status at 1?year after primary total knee arthroplasty (TKA).

Methods: The subjects were 115 patients who had undergone TKA. Isometric lower limb muscle strength was measured and the Timed Up and Go (TUG) test and the 2011 knee society scoring were conducted preoperatively. Then, the patients were divided into two groups after surgery: a cane-assisted walking group (n?=?42) and independent walking group (n?=?73). Unpaired t-test, chi-square test, Mann–Whitney U-test, logistic regression analysis and the receiver-operating characteristic curve analysis were used in this study.

Results: A multiple logistic regression analysis selected age, TUG test and functional activities as significant variables estimating the use of a cane after surgery. Receiver-operating characteristic curve analyses revealed that the cut-off score for TUG test was 10.8?s (sensitivity?=?69%, specificity?=?67%, area under curve?=?0.81) and the cut-off score for functional activities was 39 points (sensitivity?=?83%, specificity?=?63%, area under curve?=?0.83) in predicting the ambulatory status.

Conclusions: Preoperative TUG test with a cut-off score of 10.8?s and functional activities with a cut-off score of 39 points are reliable assessment tools for predicting the use of walking aid following TKA.

• Implications for Rehabilitation

• An accurate prediction of the ambulatory status after total knee arthroplasty can aid patients in understanding their own goals of the activities of daily living.

• Preoperative timed up and go test of <10.8?s and a preoperative functional activities functional activities score in the 2011 knee society scoring >39 points are useful for predicting the ambulatory status after total knee arthroplasty.

     

Relevance of nerve conduction velocity in the assessment of balance performance in older adults with diabetes mellitus

Purpose This study investigated the relationship between peripheral nerve conduction velocity (NCV) and balance performance in older adults with diabetes. Methods Twenty older adults with diabetes were recruited to evaluate the NCV of their lower limbs and balance performance. The balance assessments comprised the timed up and go (TUG) test, Berg balance scale (BBS), unipedal stance test (UST), multidirectional reach test (MDRT), maximum step length (MSL) test and quiet standing with eyes open and closed. The relationship between NCV and balance performance was evaluated by Pearson’s correlation coefficients, and the balance performances of the diabetic patients with and without peripheral neuropathy were compared by using Mann–Whitney U tests. Results The NCV in the lower limbs exhibited a moderate to strong correlation with most of the balance tests including the TUG (r?=??0.435 to??0.520, p?r?=?0.406–0.554, p?r?=?0.409–0.647, p?P?p?p?p?p?p?Conclusion Our findings revealed that a decline in peripheral nerve conduction in the lower limb is not only an indication of nerve dysfunction, but may also be related to the impairment of balance performance in patients with diabetes.

• Implications for Rehabilitation

• Nerve conduction velocity in the lower limbs of diabetic older adults showed moderate to strong correlations with most of the results of balance tests, which are commonly used in clinics.

• Decline in nerve conduction velocity of the lower limbs may be related to the impairment of balance control in patients with diabetes.

• Diabetic older adults with peripheral neuropathy exhibited greater postural instability than those without peripheral neuropathy.

     

脑卒中偏瘫患者步行速度变化的研究

目的该文通过对脑卒中偏瘫患者步行速度的变化与病程关系的研究,探讨脑卒中偏瘫患者步行速度恢复的规律。方法35例发病后6周内进行步行功能训练的的脑卒中偏瘫患者,连续进行12周的步行速度评测。步行速度测量方法采用10m最大步行速度测定方法。结果脑卒中偏瘫患者最大步行速度的变化与病程呈近似双曲线函数关系Y=A-B/X(R2=0.971)。结论脑卒中偏瘫患者的步行速度恢复的变化是有规律的,而且是可以预测的。     

A longitudinal study investigating how stroke severity,disability, and physical function the first week post-stroke are associated with walking speed six months post-stroke

Objectives: To investigate to which degree stroke severity, disability, and physical function the first week post-stroke are associated with preferred walking speed (PWS) at 6 months.

Design: Longitudinal observational study. Method: Participants were recruited from a stroke unit and tested within the first week (baseline) and at 6 months post-stroke. Outcome measures were the National Institutes of Health Stroke Scale (NIHSS), the Barthel Index (BI), modified Rankin Scale (mRS), PWS, Postural Assessment Scale for Stroke (PASS), and the Trunk Impairment Scale modified-Norwegian version. Multiple regression models were used to explore which variables best predict PWS at 6 months, and the Receiver Operating Characteristics (ROC) curves to determine the cutoffs. Results: A total of 132 participants post-stroke were included and subdivided into two groups based on the ability to produce PWS at baseline. For the participants that could produce PWS at baseline (WSB group), PASS, PWS, and age at baseline predicted PWS at 6 months with an explained variance of 0.77. For the participants that could not produce a PWS at baseline (NoWSB group), only PASS predicted PWS at 6 months with an explained variance of 0.49. For the Walking speed at baseline (WSB) group, cutoffs at baseline for walking faster than 0.8 m/s at 6 months were 30.5 points on the PASS, PWS 0.75 m/s, and age 73.5 years. For the NoWSB group, the cutoff for PASS was 20.5 points. Conclusion: PASS, PWS, and age the first week predicted PWS at 6 months post-stroke for participants with the best walking ability, and PASS alone predicted PWS at 6 months post-stroke for participants with the poorest walking ability.     

踝足矫形器对脑卒中偏瘫患者步行能力的影响

目的:从步行速度和步行效率两方面来研究踝足矫形器(AFO)对脑卒中偏瘫患者步行能力的影响。方法:选择10例年龄相匹配的健康人和30例脑卒中偏瘫患者分别在穿着AFO和不穿着AFO的情况下评测10m最大步行速度和生理消耗指数(PCI)。结果:患者的步行速度在穿着AFO情况下比不穿着AFO情况明显提高(P<0.01);患者的PCI在穿着AFO情况下比不穿着AFO情况明显降低(P<0.01),步行速度较慢的患者PCI较步行速度较快的患者降低更为明显(P<0.01)。健康人在穿着AFO情况下不但步行速度并没有得到改善(P>0.05),PCI反而明显升高(P<0.01)。结论:AFO可以提高脑卒中偏瘫患者步行速度和步行效率,改善患者的步行能力。步行速度越接近健康人的步行速度的偏瘫患者,AFO对步行效率改善程度也就越小。     

Functional measures show improvements after a home exercise program following supervised balance training in older adults with elevated fall risk

Supervised balance training shows immediate benefit for older adults at fall risk. The long-term effectiveness of such training can be enhanced by implementing a safe and simple home exercise program (HEP). We investigated the effects of a12-week unsupervised HEP following supervised clinic-based balance training on functional mobility, balance, fall risk, and gait. Six older adults with an elevated fall risk obtained an HEP and comprised the HEP group (HEPG) and five older adults who were not given an HEP comprised the no HEP group (NoHEPG). The HEP consisted of three static balance exercises: feet-together, single-leg stance, and tandem. Each exercise was to be performed twice for 30–60 s, once per day, 3 days per week for 12 weeks. Participants were educated on proper form, safety, and progression of exercises. Pre- and post-HEP testing included Berg Balance Scale (BBS), Timed Up and Go, Short Physical Performance Battery (SPPB) assessments, Activities-Balance Confidence, Late-Life Functional Disability Instrument and instrumented assessments of balance and gait (Limits of Stability, modified Clinical Test of Sensory Interaction on Balance, Gait). A healthy control group (HCG; n = 11) was also tested. For most of the measures, the HEPG improved to the level of HCG. Though task-specific improvements like BBS and SPPB components were seen, the results did not carry over to more dynamic assessments. Results provide proof of concept that a simple HEP can be independently implemented and effective for sustaining and/or improving balance in older adults at elevated fall-risk after they have undergone a clinic-based balance intervention.