脑卒中偏瘫患者步态参数与平衡功能的关系北大核心CSCD

目的探讨脑卒中偏瘫患者步态参数与平衡功能的关系。方法2018年9月至2020年3月,北京博爱医院住院脑卒中偏瘫患者76例(BrunnstromⅣ、Ⅴ期各38例),采用平衡检测仪、星状伸展平衡测试(SEBT)进行评定,采用三维步态分析系统测量步速、步频,计算双侧步长比、支撑期时间比、摆动期时间比、髋关节最大屈曲角度比、膝关节最大屈曲角度比。步态参数和平衡功能测试结果行相关性分析。结果BrunnstromⅤ期患者平衡和步态参数均优于Ⅳ期患者(|t|>2.268,P<0.05)。所有患者步速、步频与平衡功能多数参数相关(|r|>0.335,P<0.05)。BrunnstromⅣ期患者步长比与SEBT测量结果负相关(r=-0.467~-0.613,P<0.01),BrunnstromⅤ期患者步长比与平衡仪内外稳定极限负相关(r=-0.356,P=0.028)。BrunnstromⅣ期患者摆动期时间比与平衡仪前后稳定极限(r=-0.335,P=0.040)、内/外极限比(r=0.510,P=0.001)、星状伸展平衡测试多数结果(r=-0.330~-0.445,P<0.05)相关。BrunnstromⅣ期患者髋、膝关节屈曲比与平衡功能测试结果相关(|r|>0.326,P<0.05),BrunnstromⅤ期患者膝关节屈曲比与多数平衡功能测试结果相关(r>0.329,P<0.05),髋关节屈曲比仅与平衡仪前后稳定极限相关(r=0.369,P=0.023)。结论步速和步频可较好反映脑卒中偏瘫患者的平衡功能;步态的时空对称性在功能较低的患者中与平衡功能相关。     

Correlation of knee proprioception with muscle strength and spasticity in stroke patients

[Purpose] The purpose of this study was to investigate the relationship of knee proprioception with muscle strength and spasticity in stroke patients. [Subjects and Methods] The subjects were 31 stroke patients. The subjects received an explanation of the procedures and methods and provided informed consent before the experiment. A measurement board was used to determine the the proprioception deficit of the knee as a proprioception test. The proprioception test consisted of a passive and active angle reproduction test. A manual muscle test and modified Ashworth scale were used to evaluate knee muscle strength and spasticity level. The data were analyzed using an independent t-test and Spearman correlation. [Results] The results of this study revealed a significant difference between the affected side and non-affected side in the passive angle reproduction test and a significant difference in the correlation of the proprioception level with muscle strength and spasticity level. [Conclusion] This study indicates that the knee proprioception level is associated with spasticity and muscle strength in stroke patients.Key words: Proprioception, Spasticity, Stroke     

Effect of the use of a body weight-supported walker on gait parameters in hemiplegic stroke patients

[Purpose] This study investigated gait parameter changes in hemiplegic stroke patients who walked with a body weight-supported (BWS) walker and evaluated the usefulness of using the BWS walker in a walking exercise. [Participants and Methods] Nineteen hemiplegic stroke patients hospitalized in a convalescent rehabilitation ward were enrolled in the study. Trunk acceleration was used to evaluate walking with and without a BWS walker. Gait speed, cadence, stride length, step time symmetry, stride time variability, and stride time regularity were calculated from the accelerometer waveform. [Results] Hemiplegic stroke patients had a faster gait speed, walked more symmetrically, and had less variation in their gait cycle when using the BWS walker than when not using it. [Conclusion] Using a BWS walker may help hemiplegic stroke patients learn to walk more efficiently in terms of their gait speed.Key words: Stroke, Hemiplegia, Body weight-supported walker     

Effects of stationary cycling exercise on the balance and gait abilities of chronic stroke patients

[Purpose] The objective of this study was to investigate the effects of stationary cycling exercise on the balance and gait abilities of chronic stroke patients. [Subjects] Thirty-two chronic stroke patients were randomly assigned to an experimental group (n=16) or a control group (n=16). [Methods] All of the subjects received the standard rehabilitation program for 30 minutes, while the experimental group additionally participated in a daily session of stationary cycling exercise for 30 minutes, 5 times per week for 6 weeks. To assess balance function, the Berg Balance Scale and timed up-and-go test were used. The 10-m walking test was conducted to assess gait function. [Results] Both groups showed significant improvements in balance and gait abilities. The improvements in the Berg Balance Scale and timed up-and-go test scores (balance), and 10-m walking test score (gait) in the stationary cycling exercise group were significantly greater than those in the control group. [Conclusion] This study demonstrated that stationary cycling exercise training is an effective intervention for increasing the balance and gait abilities of chronic stroke patients. Therefore, we suggest that stationary cycling training is suitable for stroke rehabilitation and may be used in clinical practice.Key words: Gait, Balance, Stationary cycling     

The effect of knee joint Mulligan taping on balance and gait in subacute stroke patients

[Purpose] This study aimed to determine the effects of Mulligan taping on balance and gait in subacute stroke patients. [Subjects] Thirty patients with subacute stroke were randomly divided into two groups: the experimental group (n = 15) and the control group (n = 15). Mulligan taping was applied to the knee joints of participants in the experimental group while placebo taping was applied to knee joints of subjects in the control group. Biodex was used to assess their balance ability and the GAITRite System was used to test gait. All measurements were performed before and after the intervention. [Results] Dynamic standing balance of the experimental group significantly improved after taping. Gait, gait cadence, velocity, step length, and stride length also improved significantly. However, no significant differences in standing balance or gait were observed for the control group. Furthermore, significant differences in dynamic standing balance, cadence, and velocity were found between the two groups after the intervention. [Conclusion] Our results demonstrate that Mulligan taping is effective for improving balance and gait in subacute stroke patients. Thus, this technique is a potential method for actively facilitating rehabilitation programs for hemiplegia patients.Key words: Stroke, Mulligan taping, Balance     

Effects of robot-assisted gait training on the balance and gait of chronic stroke patients: focus on dependent ambulators

[Purpose] The purpose of this study was to confirm the effect of robot-assisted gait training on the balance and gait ability of stroke patients who were dependent ambulators. [Subjects and Methods] Twenty stroke patients participated in this study. The participants were allocated to either group 1, which received robot-assisted gait training for 4 weeks followed by conventional physical therapy for 4 weeks, or group 2, which received the same treatments in the reverse order. Robot-assisted gait training was conducted for 30 min, 3 times a week for 4 weeks. The Berg Balance Scale, Modified Functional Reach Test, Functional Ambulation Category, Modified Ashworth Scale, Fugl-Meyer Assessment, Motricity Index, and Modified Barthel Index were assessed before and after treatment. To confirm the characteristics of patients who showed a significant increase in Berg Balance Scale after robot-assisted gait training as compared with physical therapy, subgroup analysis was conducted. [Results] Only lateral reaching and the Functional Ambulation Category were significantly increased following robot-assisted gait training. Subscale analyses identified 3 patient subgroups that responded well to robot-assisted gait training: a subgroup with hemiplegia, a subgroup in which the guidance force needed to be decreased to needed to be decreased to ≤45%, and a subgroup in which weight bearing was decreased to ≤21%. [Conclusion] The present study showed that robot-assisted gait training is not only effective in improving balance and gait performance but also improves trunk balance and motor skills required by high-severity stroke patients to perform activities daily living. Moreover, subscale analyses identified subgroups that responded well to robot-assisted gait training.Key words: Stroke, Robotics, Gait     

Effect of coordination movement using the PNF pattern underwater on the balance and gait of stroke patients

[Purpose] To investigate the effect of coordination movement using the Proprioceptive Neuromuscular Facilitation pattern underwater on the balance and gait of stroke patients. [Subjects and Methods] Twenty stroke patients were randomly assigned to an experimental group that performed coordination movement using the Proprioceptive Neuromuscular Facilitation pattern underwater and a control group (n =10 each). Both the groups underwent neurodevelopmental treatment, and the experimental group performed coordination movement using the Proprioceptive neuromuscular facilitation pattern underwater. Balance was measured using the Berg Balance Scale and Functional Reach Test, and gait was measured using the 10-Meter Walk Test and Timed Up and Go Test. To compare in-group data before and after the intervention, paired t-test was used. Independent t-test was used to compare differences in the results of the Berg Balance Scale, Functional Reach Test, 10-Meter Walk Test, and Timed Up and Go Test before and after the intervention between the groups. [Results] Comparison within the groups showed significant differences in the results of the Berg Balance Scale, Functional Reach Test, 10-Meter Walk Test, and Timed Up and Go Test before and after the experimental intervention. On comparison between the groups, there were greater improvements in the scores of the Berg Balance Scale, Functional Reach Test, 10-Meter Walk Test, and Timed Up and Go Test in the experimental group. [Conclusion] The findings demonstrate that coordination movement using the Proprioceptive Neuromuscular Facilitation pattern under water has a significant effect on the balance and gait of stroke patients.Key words: Coordination movement using the PNF pattern, Balance, Gait     

The effect of modified trampoline training on balance,gait, and falls efficacy of stroke patients

[Purpose] This research was conducted to investigate the effects of modified trampoline training on the balance, gait, and falls efficacy of stroke patients. [Subjects] Twenty-four stroke patients participated in this study. The subjects were randomly allocated to one of two groups: the trampoline group (n=12) or the control group (n=12). [Methods] Both groups participated in conventional physical therapy for thirty minutes per day, three times a week for six weeks. The trampoline group also took part in trampoline training for thirty minutes per day, three times a week for six weeks. We evaluated balance (Berg balance scale, timed up and go test), gait (dynamic gait index), and falls efficacy (falls efficacy scale-K) to confirm the effects of the intervention. [Results] Both the trampoline and the control group showed significant improvements in balance, gait, and falls efficacy compared to before the intervention, and the improvements were significantly greater in the trampoline group than in the control group. [Conclusion] Modified trampoline training resulted in significantly improved balance, dynamic gait, and falls efficacy of stroke patients compared to the control group. These results suggest that modified trampoline training is feasible and effective at improving balance, dynamic gait, and falls efficacy after stroke.Key words: Trampoline, Stroke, Rehabilitation     

Effects of horse-riding exercise on balance,gait, and activities of daily living in stroke patients

[Purpose] This study aimed to investigate the effects of horse-riding exercise on balance, gait, and activities of daily living (ADLs) in stroke patients. [Subjects] Among 20 participants with stroke, 10 were randomly assigned to the experimental group, and 10 were randomly assigned to the control group. The experimental group participated in horse-riding exercise for 30 minutes per day, 5 days a week for 6 weeks. Balance was tested with the Berg Balance Scale (BBS). Gait was measured using the 10-Meter Walk Test (10MWT). ADLs were tested with the Modified Barthel Index (MBI). Differences between pre- and post-experiment values within the two groups were compared using paired t-tests. Between-group differences were compared using independent t-tests. [Results] The experimental group showed significant improvements in balance, gait, and ADLs following horse-riding exercise. Additionally, the experimental group showed significant differences in balance, gait, and ADLs compared with in the control group. [Conclusion] These results support that horse-riding exercise enhances balance, gait, and ADLs in stroke patients. This study supports the need for further research on horse-riding exercise programs.Key words: Horse-riding exercise, Balance, Activities of daily living     

The effects of symmetric center of pressure displacement training with feedback on the gait of stroke patients

[Purpose] This study investigated the effects of COP displacement training using visual feedback had on the gait of patients with hemiplegia due to stroke. [Subjects and Methods] This study was conducted with 20 patients with hemiplegia due to stroke. The training consisted of five training sets repeated 10 times and the activity was conducted for 15 minutes each session, three times per week for six weeks immediately after completion of central nervous system developmental treatment. [Results] A comparison of the results of before and after the experiment found that the COP displacement training group showed significant improvements in step length, stride length, gait velocity, and the functional reach test, while the control group showed significant improvement only in the functional reach test. In the intergroup comparison, the COP displacement training group showed significant improvements in paretic side step length, paretic side stride length, gait velocity, and the functional reach test compared to the control group. [Conclusion] In conclusion, according to the results of this study, visual feedback training for COP displacement is more effective at enhancing the gait and balance of hemiplegic patients due to stroke than only performing feedback training for even weight distribution.Key words: Stroke, Center of pressure, Feedback     

The effect of non-elastic taping on balance and gait function in patients with stroke

[Purpose] This study investigated the influence of exercise on balance ability and gait function in stroke patients after applying non-elastic tape, which can stabilize muscles and joints, to the lower extremities of the affected side. [Subjects and Methods] The subjects were 30 patients diagnosed with stroke. They were divided into an experimental group (n = 15) and a control group (n = 15). The experimental group performed mat and treadmill exercises three times a week for six weeks with non-elastic tape applied to the lower extremities of the affected side. The control group performed the same exercises but without taping. [Results] The intervention significantly improved Berg balance scale scores and timed up and go (TUG) test scores as well as reduced stance duration and stride duration in the experimental group. In the control group, statistically significant improvements were observed in TUG test scores. [Conclusion] Although some differences did not reach the level of statistical significance, the application of non-elastic tape stabilized the joints of the lower extremities, thereby increasing balance and reducing stance duration and one step duration, which resulted in a reduction of overall gait duration.Key words: Stroke, Non-elastic taping, Balance     

Effect of gait training with constrained-induced movement therapy (CIMT) on the balance of stroke patients

[Purpose] The purpose of the present study was to examine the effect of intensive gait training using a constrained induced movement therapy (CIMT) technique applied to the non-paretic upper extremity on the balance ability of stroke patients. [Subjects and Methods] Twenty stroke patients were randomly assigned to an experimental group or a control group. The experimental group received gait training with CIMT for 30 minutes per session, three sessions per week for four weeks, and the control group received gait training alone. [Results] The experimental group showed improvements in dynamic balance and the degree of improvement in this group was greater than that observed in the control group. Furthermore, the experimental group showed improvements in movement distances to the paretic side. On the other hand, the control group showed no significant improvements in balance indices after the intervention. [Conclusion] Gait training of stroke patients using CIMT techniques should be regarded as a treatment that can improve the balance of stroke patients.Key words: Constrained-induced movement therapy, Gait training, Balance     

The effects of action observation gait training on the static balance and walking ability of stroke patients

[Purpose] The purpose of the study was to investigate the effects of action observation training on the static balance and walking ability of patients who had suffered a stroke. [Subjects] Forty patients with hemiplegia resulting from a stroke were divided into an action observation gait training group (AOGT group, n=20) and a general gait training group (GGT group, n=20). [Methods] The AOGT group watched a training video on flatland gait, slope gait, and stair gait. The GGT group watched a video on nature. Both groups watched their respective video for 10 minutes and then had gait training for 20 minutes per day, five times per week, for eight weeks. [Results] The static balance and gait ability of both groups significantly improved. Although there were significant differences between the groups, the AOTG group showed greater improvements in sway speed, limit of stability, and gait ability. [Conclusion] We recommend action observation training over general gait training for patients with hemiplegia. Action observational training had a positive effect on static balance and gait ability in stroke patients’ static balance and gait ability. Further research is needed to generalize the results of this study.Key words: Hemiplegia, Action observation training, Gait     

Effects of neuromuscular electrical stimulation on masticatory muscles in elderly stroke patients

[Purpose] This study aimed to examine the effects of neuromuscular electrical stimulation on masticatory muscle activation in elderly stroke patients. [Subjects and Methods] The subjects included 20 elderly patients diagnosed with stroke and 10 healthy elderly individuals. The neuromuscular electrical stimulation group received stimulation on the masseter muscle in the affected side for 30 min each day, 3 times per week for 8 weeks. In all the subjects, surface electromyography was used to measure activity of the masseter and temporal muscles in both sides under resting and clenching conditions. [Results] In the neuromuscular electrical stimulation group, after the intervention, an increase in the activity of all of the masticatory muscles was observed during clenching, with a significant increase in the activity of the masseter muscle in the affected side. Significant differences between the groups were not observed after the interventions. [Conclusion] The results of this study suggest that application of neuromuscular electrical stimulation effectively improves muscle activity in elderly stroke patients during clenching, and that this technique can be applied particularly for the improvement of the clenching activity of the masseter muscle in the affected side.Key words: Stroke, Masticatory muscle, Neuromuscular electrical stimulation     

Electromyography of symmetrical trunk movements and trunk position sense in chronic stroke patients

[Purpose] To explore the differences in bilateral trunk muscle activation between chronic stroke patients and healthy controls, this study investigated the symmetry index and cross-correlation of trunk muscles during trunk flexion and extension movements. This study also assessed the differences in trunk reposition error between groups and the association between trunk reposition error and bilateral trunk muscle activation. [Subjects and Methods] Fifteen stroke patients and 15 age- and gender-matched healthy subjects participated. Bilateral trunk muscle activations were collected by electromyography during trunk flexion and extension. Trunk reposition errors in trunk flexion and extension directions were recorded by a Qualisys motion capture system. [Results] Compared with the healthy controls, the stroke patients presented lower symmetrical muscle activation of the bilateral internal oblique and lower cross-correlation of abdominal muscles during trunk flexion, and lower symmetry index and cross-correlation of erector spinae in trunk extension. They also showed a larger trunk extension reposition error. A smaller trunk reposition error was associated with higher cross-correlation of bilateral trunk muscles during trunk movements in all subjects. [Conclusion] Trunk muscle function during symmetrical trunk movements and trunk reposition sense were impaired in the chronic stroke patients, and trunk position sense was associated with trunk muscle functions. Future studies should pay attention to symmetrical trunk movements as well as trunk extension position sense for patients with chronic stroke.Key words: Stroke, Electromyography, Trunk reposition sense     

Effects of gait training with horizontal impeding force on gait and balance of stroke patients

[Purpose] The purpose of this study was to investigate the effects of treadmill training with a horizontal impeding force applied to the center of upper body mass on the gait and balance of post-stroke patients. [Subjects and Methods] Twenty-four subjects with hemiplegia less than 3 months after stroke onset were randomly assigned to 2 groups: an applied horizontal impeding force on treadmill training (experimental) group (n = 12), and a control group (n = 12). Both groups walked on a treadmill at a comfortable or moderate speed for 20 minutes per day, 3 sessions per week for 8 weeks after a pre-test. The experimental group also had a horizontal impeding force applied to the center of their upper body mass. [Results] All groups demonstrated significant improvement after 8 weeks compared to baseline measurements. In intra-group comparisons, the subjects’ gait ability (CGS, MGS, cadence, and step length) and balance ability (TUG, BBS, and FRT) significantly improved. In inter-group comparisons, the experimental group’s improvement was significantly better in CGS MGS, cadence, step length, TUG, and BBS, but not in FRT. [Conclusion] Treadmill training was identified as an effective training method that improved gait and balance ability. A horizontal impeding force applied during treadmill training was more effective than treadmill walking training alone at improving the gait and dynamic balance of patients with stroke.Key words: Treadmill gait, Horizontal impeding force, Upper body     

Effects of brain-computer interface-based functional electrical stimulation on balance and gait function in patients with stroke: preliminary results

[Purpose] The purpose of this study was to determine the effects of brain-computer interface (BCI)-based functional electrical stimulation (FES) on balance and gait function in patients with stroke. [Subjects] Subjects were randomly allocated to a BCI-FES group (n=5) and a FES group (n=5). [Methods] The BCI-FES group received ankle dorsiflexion training with FES according to a BCI-based program for 30 minutes per day for 5 days. The FES group received ankle dorsiflexion training with FES for the same duration. [Results] Following the intervention, the BCI-FES group showed significant differences in Timed Up and Go test value, cadence, and step length on the affected side. The FES group showed no significant differences after the intervention. However, there were no significant differences between the 2 groups after the intervention. [Conclusion] The results of this study suggest that BCI-based FES training is a more effective exercise for balance and gait function than FES training alone in patients with stroke.Key words: Brain-computer interface, Functional electrical stimulation, Gait     

Effect of a virtual reality exercise program accompanied by cognitive tasks on the balance and gait of stroke patients

[Purpose] This study aimed to assess the effect of a virtual reality exercise program accompanied by cognitive tasks on the balance and gait of stroke patients. [Subjects] Twenty stroke patients were randomly assigned to two groups 10 to an experimental group that performed a virtual reality exercise program accompanied by cognitive tasks and 10 to a control group. The control group performed a proprioceptive neuromuscular facilitation exercise program. Balance was measured with the Berg Balance Scale. Gait was assessed using the Timed Up and Go Test. The paired t-test was used to compare groups before and after the experiment. The independent t-test was conducted to assess differences in the degree of change between the two groups before and after the experiment. [Results] Within-group comparison in the experimental group showed significant differences in the Berg Balance Scale and Timed Up and Go Test. In a comparison between groups, the differences in the Berg Balance Scale and Timed Up and Go Test in the experimental group appeared significant compared with the control group. [Conclusion] The results of the experiment indicate that a virtual reality exercise program accompanied by cognitive tasks has a positive effect on the balance and gait of stroke patients.Key words: Virtual reality exercise program accompanied by cognitive tasks, Balance, Gait     

The relationship between motor recovery and gait velocity during dual tasks in patients with chronic stroke

[Purpose] The aims of this study were to identify the relationship between motor recoveryand gait velocity during dual tasks in patients with chronic stroke and determineautomatic gait ability following stroke. [Subjects and Methods] Thirty-three outpatientsand twelve healthy subjects participated in a cross-sectional assessment. Communityambulation was assessed using a self-administered questionnaire. Outcome measures includedthe Motricity index, Berg Balance Scale, and gait speed under three conditions (self-pacedambulation for 10 m, ambulation while performing dual cognitive tasks, and ambulationwhile performing dual manual tasks). Gait automaticity was calculated. [Results] Nosignificant differences were observed for muscle strength or balance between the limitedcommunity ambulation and the community ambulation groups. However, a significantdifference in gait velocity was observed between the groups under the three conditions. Inparticular, a significant difference was detected only in the limited community ambulationgroup depending on the level of motor function recovery during cognitive and manual dualtask ambulation. Additionally, we revealed that the community ambulation group had a lowerlevel of gait automaticity compared with that in the normal group. [Conclusion] Ourresults show the influence of motor recovery on the change in gait velocity depending onthe task if a patient is limitedly ambulatory. We revealed that community ambulators didnot have a sufficient level of gait automaticity.