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。     

强化髋外展肌群对脑卒中偏瘫患者平衡功能和步行安全性的影响

目的：探讨强化髋外展肌群对脑卒中偏瘫患者平衡功能和步行安全性的影响。方法：将符合入选标准的脑卒中偏瘫患者随机分为观察组（20例）和对照组（20例），两组患者均采用以Bobath为主的现代康复技术进行平衡训练和步行训练，在此基础上，观察组加入强化髋外展肌群的训练方法，在治疗前和6周治疗结束后，分别用Berg平衡评分量表和Holden功能步行分类对两组患者进行平衡功能和步行能力的评定，随访并统计治疗结束后半年期间两组患者的跌倒发生率。结果：6周治疗后，两组的BBS和Holden功能步行分类的级别均较治疗前有明显提高（P＜0.01）。观察组的BBS和Holden功能步行分类的级别均优于对照组，差异具有显著性意义（P＜0.05，P＜0.01）。通过随访，治疗结束半年内观察组的跌倒发生率比对照组低，差异有非常显著性意义（P＜0.01）。结论：在常规平衡训练的基础上，强化患侧髋外展肌群的训练，能更有效地提高脑卒中偏瘫患者的平衡功能，增加步行的安全性。     

早期康复对脑卒中患者日常功能和生存质量的长期影响

目的：研究早期康复治疗对患者的功能障碍、生存质量及社会融入的长期影响。方法：选择64例脑卒中患者随机分为康复组和对照组，各32例。两组患者均接受西医常规治疗和中医针灸治疗，康复组待生命体征稳定48h后进行康复治疗。分别于入选时、康复结束和发病后6个月时评估FIM、NIHSS和汉化版SF-36健康调查量表。结果：康复结束后即刻评估发现，除FIM的认知功能和SF-36的躯体疼痛外，康复组在其他各项目的得分均优于对照组，差异具有显著性意义（P〈0．05）。在发病后6个月，两组在各方面的得分继续提高，康复组在SF-36的情感职能、社会功能和精神健康方面的得分显著高于对照组（P〈0．05），在NIHSS、FIM的运动和认知、SF-36的其他各项目得分，两组间差异均无显著性意义（P〉0．05）。结论：早期康复能够快速提高卒中患者躯体的、心理的和社会功能。     

Posturographic description of the regaining of postural stability following stroke

BACKGROUND: Failing balance and increased liability to falling are common complaints among hemiplegic subjects. During rehabilitation much effort is put into regaining postural stability. Purpose: To describe the regaining of postural stability during rehabilitation for the first year following stroke in hemiplegic patients MATERIALS AND METHODS: Twenty-six patients were included within 5 days of suffering a stroke resulting from a CT-verified clearly defined thromboembolic lesion, localized in the vascular bed of middle cerebral artery on either side. Posturographic evaluation of sway was performed on a commercially available force plate system (Balance Master Pro). Measured parameters included per cent maximum stability (PMS), per cent ankle strategy (AST), and average angular velocity (AVE). An additional parameter was derived by calculating the slope (SLP) of the linear relationship between stability and ankle strategy. SLP reflects the predisposition of the stroke patient to keep using ankle strategy when faced with increasingly difficult balance tasks. The presence of familiarization to the measurement method was examined by including a preliminary measurement not otherwise included in the analysis of changes during the first year of follow-up. The temporal evolvement of sway was described by measuring sway parameters 1, 2, 4, 8 and 52 weeks following stroke. The proportions of the variation in sway caused by measurement error and between patients were compared. RESULTS: All parameters improved over time, as demonstrated by significant improvements from each of week 1, 2, 4 and 8 to week 52. There was evidence of familiarisation for PMS, AST and AVE, but not for SLP. Estimation of variance components showed that between patient variation accounts for between two-thirds and four-fifths of the total variation. A considerable part of this variation was caused by individual differences in the temporal improvement of sway over time. Patients considered the evaluation of postural sway demanding and time consuming resulting in a relatively large loss to follow-up: 15 patients completed the 8-week visit while seven completed the 1 year visit. CONCLUSION: Postural stability increases for the first year following stroke. There is evidence of familiarization towards the measurements process for the traditional posturographic parameters PMS, AST and AVE, but not for the derived parameter SLP, which might make the latter a candidate for a sway parameter reflecting basic mechanisms of upholding upright stance in hemiplegic patients. The estimated variance components stress the considerable between-patient variation and question the ability of the force plate method to monitor individual sway performance of such patients during the rehabilitation process.     

Reliability of postural measures in elite badminton players using Posture Pro 8

The Posture Pro software is used for photogrammetry assessment of posture and has been commercially available for several years. Along with symmetry-related measures, a Posture Number® is calculated to reflect the sum of postural deviations. Our aim was to investigate the intra- and inter-rater reliability of measures extracted using the Posture Pro 8 software without using reference markers on subjects. Four raters assessed the standing posture of 40 badminton players (20 males, 20 females) from anterior, lateral, and posterior photographs. Thirty-three postural measures were extracted using visual landmarks as guide. Reliability was quantified using intra-class correlation coefficient (ICC) and typical error of measurement (TEM). Overall, the intra-rater reliability was considered good to excellent for nearly all measures. However, only two measures had excellent inter-rater reliability, with 13 and 18 measures exhibiting good and fair inter-rater reliability, respectively. Posture Pro specific measures (n = 9) exhibited good-to-excellent intra-rater and fair-to-excellent inter-rater reliability, with small-to-moderate and small-to-large TEM, respectively. Overall, the Posture Pro 8 software can be considered a reliable tool for assessing a range of posture-relevant measures from photographs, particularly when performed by the same examiner. The Posture Number® demonstrated generally acceptable intra- and inter-rater reliability. Nonetheless, investigations on the validity, sensitivity, and interpretation of this measure are essential to confirm its clinical relevance.     

A cross-sectional observational study comparing foot and ankle characteristics in people with stroke and healthy controls

Purpose: The purpose of this study was to explore and compare foot and ankle characteristics in people with stroke and healthy controls; and between stroke fallers and non-fallers.

Methods: Participants were recruited from community groups and completed standardized tests assessing sensation, foot posture, foot function, ankle dorsiflexion and first metatarsal phalangeal joint range of motion (1st MPJ ROM), hallux valgus presence and severity.

Results: Twenty-three stroke participants (mean age 75.09?±?7.57 years; 12 fallers) and 16 controls (mean age 73.44?±?8.35 years) took part. Within the stroke group, reduced 1st MPJ sensation (p?=?0.016) and 1st MPJ ROM (p?=?0.025) were observed in the affected foot in comparison to the non-affected foot; no other differences were apparent. Pooled data (for both feet) was used to explore between stroke/control (n?=?78 feet) and stroke faller/non-faller (n?=?46 feet) group differences. In comparison to the control group, stroke participants exhibited reduced sensation of the 1st MPJ (p?=?0.020), higher Foot Posture Index scores (indicating greater foot pronation, p?=?0.008) and reduced foot function (p?=?0.003). Stroke fallers exhibited significantly greater foot pronation in comparison to non-fallers (p?=?0.027).

Conclusions: Results indicated differences in foot and ankle characteristics post stroke in comparison to healthy controls. These changes may negatively impact functional ability and the ability to preserve balance. Further research is warranted to explore the influence of foot problems on balance ability and falls in people with stroke.

• Implications for Rehabilitation

• Foot problems are common post stroke.

• As foot problems have been linked to increased fall risk among the general population we recommend that it would be beneficial to include foot and ankle assessments or a referral to a podiatrist for people with stroke who report foot problems.

• Further research is needed to explore if we can improve functional performance post stroke and reduce fall risk if treatment or prevention of foot problems can be included in stroke rehabilitation.

     

Recruitment of the plantar intrinsic foot muscles with increasing postural demand

Background

The aim of this study was to determine the difference in activation patterns of the plantar intrinsic foot muscles during two quiet standing tasks with increasing postural difficulty. We hypothesised that activation of these muscles would increase with increasing postural demand and be correlated with postural sway.

Methods

Intra-muscular electromyographic (EMG) activity was recorded from abductor hallucis, flexor digitorum brevis and quadratus plantae in 10 healthy participants while performing two balance tasks of graded difficulty (double leg stance and single leg stance). These two standing postures were used to appraise any relationship between postural sway and intrinsic foot muscle activity.

Findings

Single leg stance compared to double leg stance resulted in greater mean centre of pressure speed (0.24 m s^− 1 versus 0.06 m s^− 1, respectively, P ≤ 0.05) and greater mean EMG amplitude for abductor hallucis (P ≥ 0.001, ES = 0.83), flexor digitorum brevis (P ≤ 0.001, ES = 0.79) and quadratus plantae (P ≤ 0.05, ES = 0.4). EMG amplitude waveforms for all muscles were moderate to strongly correlated to centre of pressure (CoP) medio-lateral waveforms (all r ≥ 0.4), with muscle activity amplitude increasing with medial deviations of the CoP. Intra-muscular EMG waveforms were all strongly correlated with each other (all r ≥ 0.85).

Interpretations

Activation of the plantar intrinsic foot muscles increases with increasing postural demand. These muscles are clearly important in postural control and are recruited in a highly co-ordinated manner to stabilise the foot and maintain balance in the medio-lateral direction, particularly during single leg stance.     

踝足矫形器对足下垂患者下肢功能影响的分析

目的观察和分析足下垂患者穿戴踝足支具(AFO)前后对下肢稳定性、负重能力、步行中膝、踝关节活动的影响.方法20例足下垂患者(男14例,女6例),其中右侧足下垂者9例,左侧足下垂者13例.患者中有6例需在辅助下行走,14例已具备独立行走的条件.对所有患者分别在穿戴和不穿戴踝支具状态下进行步行能力、下肢活动能力、身体平衡功能测定.其中5例患者在穿戴支具1个月左右进行步态分析.结果穿戴AFO后即刻患者的步行速度和步幅影响与穿戴支具前比较无显著差异(P＞0.05);踏车时间和上楼的速度比不戴支具有明显提高(P＜0.05),而起蹲、下楼时间、足抬高距离无显著差异(P＞0.05);穿戴AFO对患肢负重无明显改善(P＞0.05),但可使患者身体左右的稳定性及患腿前后的稳定性有明显改善(P＜0.05);步态分析结果发现,5例患者穿戴支具前后患侧下肢垂直峰力矩、步速无明显影响(P＞0.05);穿戴AFO后患侧膝关节在步行周期中最大伸膝度数较不穿支具明显减少(P＜0.05);患侧踝关节在步态周期中最大趾屈度数较不穿支具明显减少(P＜0.01).结论AFO对下肢功能的影响主要表现在改善足下垂和膝过伸程度;增强身体稳定性及患侧下肢稳定性;穿戴AFO对患者下肢日常功能活动无明显影响;对患者即刻和1个月以后的步速、步幅、患腿负重能力的改善不明显.     

Vestibular rehabilitation with computerised dynamic posturography in patients with Parkinson's disease: Improving balance impairment

Purpose.?In patients with Parkinson's disease (PD), balance impairment involves considerable morbi-mortality from the numerous falls that may result. In an earlier postural study, we detected that a deteriorated processing of vestibular input is implicated. The aim of the present study is to assess the effectiveness of vestibular rehabilitation in improving overall stability in patients with PD.

Method.?Out of an initial group of 45 patients with PD, we chose those presenting a high risk of falls, based on their score on the timed up and go test (TUG). Rehabilitation was performed on 10 patients using computerised dynamic posturography (CDP). Improvement was assessed using the dizziness handicap inventory (DHI), the TUG and the CDP.

Results.?We found statistically significant improvement in the sensorial organisation test (SOT) and the limits of stability and rhythmic weight shift tests measured by the CDP, the DHI and the TUG. These improvements continue to be statistically significant 1 year post-treatment.

Conclusion.?Vestibular rehabilitation in PD has shown to be effective in improving the activities of daily life, gait velocity and balance, as well as in reducing the risk of falls. Moreover, these benefits persist over time.     

扁平足患者足型及步态特征研究

目的:为探究足型及步态特征的动态压力分布,给扁平足患者的预防及治疗提供理论帮助。方法:通过三维足型扫描仪,测试80例男性在校大学生的足弓指数、拇外翻角度、后跟角度、足弓类型等指标筛选出扁平足患者,并使用Foot scan高频足底压力测试系统,检测正常足和扁平足在自然行走时的动态足底压力分布,对比分析扁平足患者足型的步态特征。结果:扁平足足底各区域冲量在第1—5趾骨、第1—2跖骨处普遍小于正常足,在第3—5跖骨、足弓(P0.05)、足跟内侧(P0.05)、足跟外侧普遍大于正常足;扁平足在第2—5趾骨(P0.05)、第1—2跖骨、第3—4跖骨(P0.05)、足跟内侧、足跟外侧足底接触面积变小,在第1趾骨、足弓处的足底接触面积大于正常足;扁平足在第1—5趾骨、第1—4跖骨、足跟内侧、足跟外侧的峰值压强均大于正常足,且在第2—5趾骨有较显著性差异(P0.05),在第5跖骨、足弓处的峰值压强均小于正常足;扁平足在整足接触阶段所占的时相比例均大于正常足,在着地阶段、离地阶段的时相比例小于正常足(P0.05)。结论:扁平足患者足底接触面积、足弓部位的冲量和峰值压强增大,足部易产生结构性损伤,对扁平足患者尽早开展矫正治疗十分必要。     

时间管理对糖尿病足患者血糖和创面的影响

目的探讨采用生物节律模式进行时间管理对糖尿病足患者血糖的影响。方法选择2011—2013年收治于上海市中西医结合医院的糖尿病足患者100例,随机分为观察组和对照组各50例。对照组采用常规护理;观察组在常规护理的基础上,按生物节律中的昼夜节律模式对糖尿病足患者实行时间管理。结果两组患者前后空腹血糖值、餐后2 h血糖值和糖化血红蛋白值比较,差异均有统计学意义(尸0.05);两组患者足部创面情况前后比较差异有统计学意义(P0.05)。结论运用时间管理能够有效改善糖尿病足患者的血糖指标,促进其足部创面的愈合,有利于患者的康复。     

综合治疗对老年糖尿病患者早期足部病变的影响

目的：探讨综合治疗对老年糖尿病患者早期足病病变的影响。方法使用远红外热像仪检测老年糖尿病患者双下肢皮肤温度,比较双下肢测温区的温度差,对出现温度差异的106例患者实施药物治疗干预、物理干预,健康指导等综合治疗,比较干预前后双下肢温度差、异常面积、患者不适症状及血糖。结果本组患者干预前双下肢温度差（1．91±1．21）℃,异常面积（9．90±5．52）cm2,干预后3个月双下肢温度差（0．21±0．12）℃,异常面积（1．90±0．52）cm2,差异均有统计学意义（t值分别为8．817,11．574;P＜0．01）;干预前患者糖化血红蛋白平均（7．90±1．32）％,干预后3个月平均（6．88±0．52）％,差异有统计学意义（t＝7．402,P＜0．01）。干预后3个月患者主诉双下肢不适症状均有改善。结论使用远红外热像技术能够及时发现老年糖尿病足部皮肤内部的温度异常影像改变,针对性实施药物治疗干预、物理干预、健康指导等综合治疗,可有效预防糖尿病足部并发症。