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。     

智能能量消耗和日常活动记录仪对腰部活动执行能力定量评估的信度研究

目的：探讨智能能量消耗和日常活动记录仪（IDEEA）的信度和敏感性,为临床应用提供客观评估依据。方法：30例正常人和30例腰椎间盘突出症患者,1周内采用IDEEA对每例测试对象进行2次测试。结果：两次测试结果各指标高度相关(ICC=0.914—0.997),病例组与对照组各个测试指标中前屈运动时间(TFF)、前屈最大角度(MFA),前屈运动速度(FAV)差异有显著性(P<0.01)。结论：IDEEA用于评定正常人和腰椎间盘突出症状患者的腰部活动执行功能具有较高的信度和敏感性。     

平衡测试仪的信度研究

目的 探讨平衡测试仪的信度和敏感性，为临床应用提供客观依据。方法 20例正常人和20例神经疾患患者，1周内采用平衡测试仪对每位测试对象进行2次测试，每次测试时，分别在睁眼和闭眼状态下重复测试两次。结果 两次结果各指标高度相关（ICC＝0．85－0．98），病例组与对照组各个测试指标差异有显著性（P＜0．01）。结论 平衡测试仪用于评定政党人和神经疾患患者的平衡功能具有较高的信度和敏感性。     

改良Ashworth量表用于痉挛评定的信度研究

目的:检验改良的Ashworth量表(MAS)评定肌痉挛患者肌张力时的信度。方法:共收集了23例肌张力增高的患者,其中16例为偏瘫患者,5例为截瘫患者,2例为四肢瘫患者。由两名医生用MAS分别测量偏瘫患者患肢的屈肘肌、屈腕肌和股四头肌的肌张力,而对截瘫患者只测股四头肌,以检验MAS的评定者间和评定者内信度。结果:屈肘、屈腕肌和股四头肌的评定者间和评定者内信度较高(Kendall′s tau-b为0.621-0.862),符合率也较高(≥50%)。结论:MAS是一种可靠的评估肌痉挛的方法,具有临床应用价值。     

Berg平衡量表应用于帕金森病患者的信度分析

目的对Berg平衡量表(BBS)在帕金森病患者中进行信度检验。方法 2011年3~12月帕金森病住院患者121例,由2名治疗师同时对患者采用BBS进行评定,评定过程记录为视频资料;4周后其中1名治疗师观看视频再次进行BBS评定。计算不同评定者间和同一评定者两次测试间的组内相关系数(ICC)及Kappa系数。结果 BBS总分的评定者间ICC为1.00,各单项κ=0.66~0.93;BBS总分的重测ICC为0.99,各单项κ=0.69~0.99。结论 BBS用于评定帕金森病患者的平衡功能有良好的评定者间信度和重测信度。     

12条简明健康状况调查问卷评价脑卒中患者的信度研究

目的:测试12条简明健康状况调查问卷(SF-12量表)用于评价脑卒中后偏瘫患者的信度,为其在国内的临床应用提供临床依据。方法:46例脑卒中后偏瘫患者,每次由2名评估者使用SF-12量表进行独立的评定,第1次评定后,隔1周再评定第2次,采用等级相关系数(ICC)检验SF-12量表的重测信度,并获得Crobachα信度系数检验其内部一致性。结果:SF-12量表的Crobachα信度系数为0.903,组内信度ICC为0.726—0.912,组间信度为0.805—0.912。结论:SF-12量表内部一致性良好,用于评价脑卒中后偏瘫患者具有良好的重测信度。     

脑卒中偏瘫患者非瘫痪侧下肢与正常人下肢本体感觉比较

目的:定量分析脑卒中偏瘫患者非瘫痪侧下肢与正常人下肢本体感觉之间的差异。方法:选用意大利Tecnobody公司Pro-Kin254P型本体感觉定量测试系统,采集28例脑卒中偏瘫患者非瘫痪侧下肢和30例正常人双下肢的本体感觉测试参数,主要观察指标为平均轨迹误差(ATE)、测试执行时间(TTE)和稳定指数(SI)。结果:①脑卒中偏瘫患者患侧下肢平均轨迹误差、测试执行时间及稳定指数与正常组相应侧下肢比较,差异具有显著性(P<0.01);②右半球损伤患者同侧下肢本体感觉差于左半球损伤者,除测试执行时间指标外差异具有显著性意义(P<0.05);③正常组左下肢本体感觉参数优于右下肢,但差异无显著性意义(P>0.05);④平均轨迹误差与测试执行时间呈中度负相关(r=-0.550,P=0.002)。结论:脑卒中偏瘫患者不仅患侧下肢存在功能障碍,其非瘫痪侧下肢与正常人相比也存在差异,且右半球损伤患者下肢本体感觉差于左半球损伤者,因此脑卒中后健侧下肢功能状况不容忽视。     

Carroll上肢功能试验在痉挛型偏瘫儿童中的信度研究

目的:检验Carroll上肢功能试验(UEFT)在痉挛型偏瘫儿童中的信度,为Carroll上肢功能试验在痉挛型偏瘫儿童的临床应用提供客观依据。方法:选取30例能理解简单指令的痉挛型偏瘫儿童参加本研究,由两位熟练掌握UEFT评分标准的作业治疗师同时进行UEFT评分,评分结果由不参与评价的作者最后进行汇总统计,患侧、健侧上肢均进行UEFT测试。把UEFT抓握、捏、放置、旋转、书写五个功能区分数以及试验总分共6部分分数单独进行数据分析,使用等级间相关系数(ICC)分别检验UEFT患侧、健侧上肢的评价者间信度(组间信度)。结果:UEFT在患侧和健侧上肢水平都有较高的评价者间信度(患侧上肢的ICC值=0.921—0.976;健侧上肢的ICC值=0.926—0.973),且95%可信区间集中(P<0.001)。结论:UEFT用于评定痉挛型偏瘫儿童的上肢功能测试时具有较好的评价者间信度。同时,UEFT具有使用简便、实用、准确的优点,为痉挛型偏瘫儿童上肢功能的诊断和评价提供了一种可靠的手段。     

中文版运动功能状态量表用于评定脑卒中上肢运动功能的信度研究

目的:研究中文版运动功能状态量表(motor status scale,MSS)评定脑卒中上肢运动功能的评定者间信度及内部一致性信度。方法:2名经过MSS规范化培训的评定者使用MSS对36例脑卒中偏瘫上肢运动功能障碍患者进行评定。采用组内相关系数检验MSS的评定者间信度;采用Cronbachα系数和分半信度检验MSS的内部一致性信度。结果:MSS评定者间信度为0.998(0.997—0.999);MSS的内部一致性信度Cronbachα系数为0.910;MSS的前后分半系数为0.702,奇偶分半系数为0.972。结论:MSS具有良好的评定者间信度及内部一致性信度。     

四种上肢功能评定量表用于脑卒中患者的信度研究

目的探讨脑卒中偏瘫患者Fugl-Meyer量表上肢运动功能测试部分(U-FMA)、Wolf运动功能测试量表(WMFT)、组块测试(BBT)及九孔柱测试 (NHPT)间不同评定次数的重测信度和不同评价者间的组间信度。 方法选取18例脑卒中患者,2 h内应用上述4种量表对每例患者进行2次评定,每次评定均由2名受过专业训练的评定员分别进行。 结果U-FMA的重测信度组内相关系数（ICC）为0.988,组间信度ICC为0.959;WMFT的计时均数和计时中位数重测信度ICC分别为0.996和0.393,组间信度ICC均为1.000;WMFT的动作质量等级评分均数重测信度ICC为0.989,组间信度ICC为0.977;BBT患手计数及患手与健手差值的重测信度ICC分别为0.975和0.982;NHPT患手计时及患手与健手计时差值的重测信度ICC分别为0.937和0.936,组间信度ICC均为1.000。 结论U-FMA、WMFT、BBT及九孔柱测试均具有良好的重测信度和组间信度,适用于脑卒中患者手部功能的临床评价。     

Use of a video time display in determining general gait measures

By superimposing a video time display (VTD) onto videotapes of patients walking, and using pause-motion replay, precise measures of walking speed, cadence and stride length may be obtained. Five groups of 10 subjects were used to investigate VTD-based gait analysis under different test conditions. An additional 20 healthy subjects were retested on two occasions on average 10.2 weeks apart. These subjects demonstrated moderate reliability for cadence and poor reliability for speed and stride length. It is recommended that progress be assessed by serial testing with regular time intervals. The results from healthy subjects were comparable with results from studies using other instruments. VTD-based gait analysis is a simple, accurate and inexpensive test procedure under a variety of clinical conditions.     

三维步态分析对下肢生物力学变化的重测信度研究

目的:观察健康人在步行过程中下肢运动学、动力学、地面反作用力以及表面肌电信号的重测信度。方法:采用VICON (NEXUS 1.8.5)三维步态分析系统及NORAXON无线表面肌电图测试13名健康人步行过程中下肢运动学、动力学、地面反作用力以及表面肌电信号的重测信度。采用组内相关系数(ICC)及测量标准误(SEM)比较两次测试结果的相对信度与绝对信度。结果:步行过程中步速、下肢运动学、动力学、地面反作用力以及表面肌电信号均具有良好的重测信度ICC 0.78～0.96,运动学参数测量标准误SEM%为4.18～15.6,动力学参数SEM%为3.31～21.82,地面反作用力SEM%为1.70～16.67,表面肌电信号SEM%为8.00～11.11。结论:三维步态分析系统结合表面肌电图可用于评估步行时下肢运动学、动力学、地面反作用力以及表面肌电信号,且具有良好的重测信度。     

Mechanisms of compensation in the gait of patients with drop foot

BackgroundDrop foot is a complex syndrome, with multiple interactions between joints and muscles. Abnormalities in movement patterns can be measured using motion capture techniques, but identifying compensation mechanisms remains challenging.MethodsIn order to identify compensatory mechanisms in patients with drop foot, this study evaluated a sample of 15 such patients using a computerized gait analysis system, as compared to a group of 15 healthy subjects.FindingsFour classes of parameters were distinguished, falling in differing intervals of percentage differences between the groups in the study. The first class comprised two kinematic parameters for which the values of percentage differences in the control group were more than 100% greater than for the patient group. The second class comprised two kinetic parameters falling in the interval of 100–49%. In the third class, in the 49–20% interval the main differences were observed for spatiotemporal parameters, whereas in the 20–4% interval the differences were distributed similarly for kinematic, kinetic and spatiotemporal parameters.InterpretationThese differences in gait pattern between the groups may be related to both primary motor deficits and secondary compensatory mechanisms. Generally, we conclude that drop foot affects the patients' overall kinematic and kinetic gait parameters, with compensation seen as a chain originating from a change of movement within the ankle joint.     

Spatio-temporal gait disorder and gait fatigue index in a six-minute walk test in women with fibromyalgia

BackgroundGait disorders in fibromyalgia patients affect several gait parameters and different muscle recruitment patterns. The aim of this study was to assess the gait differences observed during a six-minute walk test between fibromyalgia patients and healthy controls.MethodsForty-eight women with fibromyalgia and 15 healthy women were evaluated. Fibromyalgia patients met the American College of Rheumatology criteria for fibromyalgia selected of an ambulatory care. Both patients and controls had a negative history of musculoskeletal disease, neurological disorders, and gait abnormalities. The 15 controls were healthy women matched to the patients in age, height and body weight. Spatio-temporal gait variables and the rate of perceived exertion during the six-minute walk test (all subjects) and Fibromyalgia Impact Questionnaire (fibromyalgia subjects) were evaluated. All walking sets on the GaitRITE were collected and the gait variables were selected at three stages during the six-minute walk test: two sets at the beginning, two sets at 3 min and two sets at the end of the test. In addition, the Fibromyalgia Impact Questionnaire was used for the fibromyalgia patients.FindingsFibromyalgia patients showed a significant decrease in all spatio-temporal gait variables at each of the three stages and had a lower walk distance covered in the six-minute walk test and higher rate of perceived exertion. No correlations were found between the Fibromyalgia Impact Questionnaire and gait variables. The fibromyalgia and control subjects showed lower gait fatigue indices between the middle and last stages.InterpretationGait analysis during a six-minute walk test is a good tool to assess the fatigue and physical symptoms of patients with fibromyalgia.     

便携步态分析量化评价脊髓型颈椎病患者的步态特征

背景：步态改变是脊髓型颈椎病重要的诊断依据和手术指征;传统的三维步态实验室因操作复杂和耗时费力等原因,无法真正应用于临床前沿。近些年,基于微型传感器的便携式步态分析设备逐渐兴起和发展,部分经过了临床应用验证,使患者在病房里进行步态分析成为现实。目的：以便携式步态分析仪量化评估脊髓型颈椎病的步态特点。方法：选择2013年3至11月连续住院治疗的15例伴有步态异常的脊髓型颈椎病患者纳入患者组,同期30例健康受试者纳入对照组。受试者佩戴便携式步态分析仪在30 m的平地上来回自由行走120 m进行检测,共12个步态参数纳入研究,包括7个常用步态参数：单腿站立时间、双腿站立时间、步态周期时间、速度、步频、步长、跨步长及5个新定义的步态参数：拔腿强度、摆腿强度、地面反冲、足落地控制和摆动前期角度。3例患者接受常规颈椎减压,治疗后1周佩戴颈托下地后再次进行步态测试。结果与结论：与对照组相比,患者组患者的双腿站立时间和步态周期明显延长（P＜0.05）,速度、步频、步长、跨步长、摆腿强度、地面反冲、足落地控制和摆动前期角度明显减小（P＜0.05）,而单腿站立时间和拔腿强度差异无显著性意义（P＜0.05）。3例手术患者治疗后日本骨科学会评分改善率32.5%,摆腿强度在图形上可见明显改善。脊髓型颈椎病患者日本骨科学会评分与所有12项检测的步态参数均有不同程度的相关性。说明便携式步态分析仪能够有效检测测量伴有步态异常的脊髓型颈椎病患者的病理步态,可协助客观量化评估下肢神经功能的变化。     

一种便携式步态分析系统的信度研究

目的:探讨一种便携式步态分析系统在时空参数、多关节角度值的信度。方法:选取30例健康青年,由2名评估者进行便携式步态分析,记录步频、步幅、步速、步长等时空参数和行走时矢状面、水平面和冠状面各关节活动角度的最大值,采用相关系数进行重测信度和测量者间信度的比较,评估其测量信度。结果:时空参数、矢状面最大角度值组内相关系数(ICC)均0.75,信度良好;水平面、冠状面最大角度值ICC无显著性差异或信度差。结论:该便携式步态分析系统分析时空参数、矢状面最大角度值信度良好,可良好地反映步行功能,有较好的评估价值;水平面及冠状面关节角度值信度较低,应用时需谨慎。     

功能性步态评价应用于帕金森病患者的信度分析

目的:验证功能性步态评价(FGA)在帕金森病(PD)患者中的组间信度、重测信度、内部一致性及分半信度,为临床提供评价工具.方法:121例住院帕金森病患者(平均年龄61.9岁)入选.两名评价者同时评定PD患者的FGA表现,进行组间信度分析.评价过程同时记录为视频资料,4周后其中一名评定者对视频资料进行二次评价,进行重测信度分析.内部一致性信度采用克朗巴赫α系数来评价.分半信度:将FGA各单项以奇数项、偶数项分为两半,计算其分半信度.结果:FGA总分的组间信度和重测信度均为0.99,各单项组间信度波动于0.49-0.98之间,重测信度波动于0.91-0.99之间.FGA内部一致性Cronbach α为0.94,分半信度为0.97.结论:FGA用于评价PD患者的平衡及步态障碍,其组间信度、重测信度、内部一致性及分半信度极佳.     

Self-reported gait unsteadiness in mildly impaired neurological patients: an objective assessment through statistical gait analysis

ABSTRACT: BACKGROUND: Self-reported gait unsteadiness is often a problem in neurological patients without any clinical evidence of ataxia, because it leads to reduced activity and limitations in function. However, in the literature there are only a few papers that address this disorder. The aim of this study is to identify objectively subclinical abnormal gait strategies in these patients. METHODS: Eleven patients affected by self-reported unsteadiness during gait (4 TBI and 7 MS) and ten healthy subjects underwent gait analysis while walking back and forth on a 15-m long corridor. Time-distance parameters, ankle sagittal motion, and muscular activity during gait were acquired by a wearable gait analysis system (Step32, DemItalia, Italy) on a high number of successive strides in the same walk and statistically processed. Both self-selected gait speed and high speed were tested under relatively unconstrained conditions. Non-parametric statistical analysis (Mann--Whitney, Wilcoxon tests) was carried out on the means of the data of the two examined groups. RESULTS: The main findings, with data adjusted for velocity of progression, show that increased double support and reduced velocity of progression are the main parameters to discriminate patients with self-reported unsteadiness from healthy controls. Muscular intervals of activation showed a significant increase in the activity duration of the Rectus Femoris and Tibialis Anterior in patients with respect to the control group at high speed. CONCLUSIONS: Patients with a subjective sensation of instability, not clinically documented, walk with altered strategies, especially at high gait speed. This is thought to depend on the mechanisms of postural control and coordination. The gait anomalies detected might explain the symptoms reported by the patients and allow for a more focused treatment design. The wearable gait analysis system used for long distance statistical walking assessment was able to detect subtle differences in functional performance monitoring, otherwise not detectable by common clinical examinations.     

Postural control during sit-to stand and gait in stroke patients

OBJECTIVE: To investigate the relationship of sit-to-stand and gait performance in hemiplegic stroke patients. DESIGN: A total of 40 chronic stroke patients with hemiplegia and 22 age-matched healthy subjects were included in this study. Data of a motion analysis system and three force platforms were collected in a rehabilitation unit of a medical center. RESULTS: Laboratory sit-to-stand measurement and gait analysis were evaluated in both groups via three AMTI (Advanced Mechanical Technology Inc.) force platforms and a Vicon 370 system (six high-resolution cameras and one AMTI force plate), respectively. The sit-to-stand and gait parameters of hemiplegic patients were correlated significantly, especially in rising speed and the maximal vertical force of both legs during rising. CONCLUSIONS: Hemiplegic stroke patients, who could stand up within 4.5 sec or who had a maximal vertical force difference of less than 30% of body weight between both legs, had better gait performance than the others did.