简易步态训练预防老年帕金森病病人跌倒的临床研究

[目的]探讨简易步态训练对老年帕金森病病人平衡的影响及其预防跌倒的临床效果。[方法]选取60例60岁以上原发性帕金森病病人,对病人采用5m步行训练法,用步速和步长、计时"起立-行走"测试(TUGT)评估病人的步行能力及动态平衡能力,用重心摇摆面积评估静态平衡能力。[结果]训练后步速加快,步长增长,TUGT时间缩短,重心摇摆面积缩小,差异均有统计学意义(P<0.05)。[结论]简易步态训练能改善老年帕金森病病人的平衡能力,可有效地预防跌倒。     

老年人跌倒与平衡及步态异常

老年人跌倒是一种常见的社会流行病,一般是由自身生理、病理、心理因素与存在危险因素的环境相互作用的后果,其中老年人的腿部肌力减退和平衡及步态异常为最重要原因。预防和治疗应该在全面评估的基础上采取以运动治疗为主要内容的综合性措施,其中太极拳运动从多个方面消除老年人跌倒的危险因素,值得临床借鉴。     

太极拳在帕金森病步态及平衡功能康复中的应用现况

<正>帕金森病(Parkinson's disease,PD)是一种发病率仅次于阿尔茨海默病的中枢神经系统退行性疾病[1],主要表现为静止性震颤、肌张力增高、姿势平衡障碍和运动迟缓,具有较高的发病率、死亡率和致残率[2]。我国现有PD患者超过200万,且PD的发病率伴随年龄增长而迅速上升,65岁以上人群的发病率约为1.7%。伴随世界人口的老龄化发展趋势,预期未来PD的发病率将会急剧升高[3]。世界卫生组织全球     

平衡和步态分析测试在老年人跌倒风险评估中的应用

摘要 目的: 探讨老年人跌倒发生几率,分析相关因素,为制定预防措施提供依据。 方法: 72位老年人根据在过去一年内有无跌倒现象,分为跌倒组（14例）和对照组（58例）,分别进行平衡功能、步态的测试,比较有跌倒经历者和无跌倒经历者的各项参数。 结果: 两组自我平衡感觉及平衡功能跌倒指数比较差异有显著性意义（P＜0.05）;两组步幅变异系数差异有显著性意义（P＜0.05）,但在6min内的总路程、平均步速、左步长、右步长差异无显著性意义（P＞0.05）。 结论: 平衡功能、步态的测试是跌倒风险评估的重要评估方法。     

步态联合平衡训练对原发性帕金森病患者运动及平衡功能的影响

目的观察步态联合平衡训练对原发性帕金森病（PD）患者运动及平衡功能的影响。 方法采用随机数字表法将72例PD患者分为对照组及训练组。对照组患者给予常规抗PD药物治疗,训练组患者在此基础上给予步态训练及平衡功能训练。于训练前、训练8周后应用统一帕金森病评定量表第三部分运动功能检查（UPDRS-Ⅲ）、10 m行走速度及6 min行走距离评定患者运动功能改善情况;采用Berg平衡量表（BBS）评定患者平衡能力变化,并记录跌倒次数。 结果经治疗8周后发现训练组10 m行走速度［（1.43±0.32 ）m/s］、6 min行走距离［（380.65±96.55）m］、BBS评分［（49.61±5.14）分］均较对照组［分别为（0.89±0.41）m/s,（291.67±115.74）m、（41.53±3.62）分）］显著增加,UPDRS-Ⅲ评分［（23.89±6.83）分］及跌到次数［（2.78±7.55）次］均较对照组［分别为（27.52±7.56）分和（5.78±9.45）次］显著降低（P<0.05）。 结论在传统药物干预基础上辅以步态及平衡功能训练,能进一步改善PD患者运动功能及平衡能力,减少患者跌倒次数,抑制相关并发症发生。     

帕金森病患者跌倒评估的研究进展

本文从运动功能障碍和认知功能障碍两个方面对帕金森病患者跌倒评估的研究进行了综述,并对各种评估方法的临床操作性、信度、效度和对跌倒预测的有效性进行了分析,从而筛选并推荐出操作性强、可靠、有效的评估方法,以期为帕金森病患者跌倒评估的临床应用及研究提供参考。     

八段锦训练对帕金森病患者步态和平衡功能改善的影响CSCD

目的:研究八段锦训练对帕金森病(PD)患者步态和平衡功能的影响,探讨将八段锦训练作为PD患者进行运动干预的有效手段。方法:将符合纳入标准的63例轻中度PD患者按照随机数字表法分为对照组32例和治疗组31例。对照组给予维持既往常规药物治疗方案,治疗组在常规药物治疗基础上接受3周八段锦训练。采用步态指标、平衡指标对2组患者分别于治疗前、治疗3周后进行评估和分析比较。结果:(1)IDEEA步态指标:治疗前2组患者步态指标比较,差异均无统计学意义(P>0.05);治疗3周后与治疗前比较,治疗组周期时间、步幅持续时间2项步态指标改善,差异均有统计学意义(P<0.05),而对照组步态指标治疗前后比较,差异均无统计学意义(P>0.05);治疗组治疗后周期时间、步幅持续时间分别为(1.30±0.32)s、(645.90±156.65)ms,均优于对照组的(1.56±0.38)s、(765.05±158.93)ms,差异均有统计学意义(P<0.05)。(2)平衡指标:治疗前2组患者平衡指标比较,差异均无统计学意义(P>0.05);治疗3周后与治疗前比较,治疗组平衡得分和等级均改善,差异均有统计学意义(P<0.05),而对照组平衡指标治疗前后比较,差异均无统计学意义(P>0.05);治疗组治疗后平衡测试等级为1.00(1.00,2.20)级,优于对照组的2.15(1.00,3.83)级,差异具有统计学意义(P<0.05)。结论:八段锦训练对轻、中度PD患者步态及平衡能力均具有显著的改善作用。     

帕金森病患者跌倒原因分析

背景：帕金森病是老年人常见的运动障碍性疾病，跌倒、跌伤是帕金森病患者日常生活中较易发生的不良事件。 目的：调查帕金森病患者跌倒原因，分析跌倒与患者认知功能、运动功能、生活环境因素的关系。 设计：病例调查。 单位：解放军总医院南三科。 对象：调查2002-04／09解放军总医院南三科就诊近1个月内有过2次以上跌倒史的帕金森病患者37例。纳入标准：所有患者均符合帕金森病的诊断标准；近1个月内有过2次跌倒史的帕金森病患者。排除标准：①伴有痴呆或其他精神疾病。②合并脑出血、脑梗死、风湿性关节炎等其他影响运动功能疾病者。男31例，女6例，年龄62-76岁，平均（72&;#177;4）岁；病程3～8年，平均（6．43&;#177;1．54）年。 方法：对所有患者进行认知功能、运动功能、帕金森病严重程度以及一般状况的调查，其中37例患者均为已婚且与配偶／子女同住，大部分患者称对自身疾病有粗浅了解，简易智力状态检查量表得分22～30分，Hoehn-Yahr分级为1．5-3级，统一帕金森疾病量表-Ⅱ得分9-33分，统一帕金森疾病量表-Ⅲ得分19-69分。 主要观察指标：帕金森病跌倒患者认知功能下降患病率，严重运动障碍表现的发生率以及不良生活环境状况的出现率。 结果：①认知功能检查发现有过跌倒史的帕金森病患者有记忆力或注意力、计算力的下降17例（45．9％），有视夺间功能障碍18例（48．6％），表现出视空间功能的损伤21例（56．8％）。认知功能尤其是视空间功能损伤是引起帕金森病患者跌倒的重要因素之一。②运动功能检查患者有“开-关”现象18例（48．6％），冻结现象15例（40．5％），而起立行走姿势不当27例（73．0％），不能独自活动23例（62．2％）。说明行走功能的异常与帕金森病患者跌倒有关。⑧生活环境因素调查在病程中存在生活环境不当（地面、物品放置、光线不宜等）19例（51.4％），衣着鞋子不适宜12例（32．4％），不能按规定服药15例（40．5％）。提示环境因素也是引起帕金森病患者跌倒的潜在危险因素。 结论：帕金森病患者跌倒与认知功能障碍、运动功能障碍、生活环境等因素有关。帕金森病患者跌倒的常见因素依次为：起立行走姿势不当，尤其是转弯时发生意外者居多；不能独立活动，身边缺少他人照料或擅自活动者；视空间结构失用，环境不当，出现“开-关”现象，注意力、记忆力、计算力下降，冻结发作，药量不足，服药时间有误，以及衣着鞋子不适宜等，由于疾病发展，出现不同程度运动障碍，在活动中身体失平衡，极易跌倒。虽然大部分患者通过科普书籍或医学书籍尽可能了解自身所患疹病，但基本都局限于关注当前的治疗状况如药物治疗、手术治疗，对自身防护方面的知识了解微乎其微，未得到应有的重视。     

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.     

应用功能性步态评价预测帕金森病患者跌倒情况的研究

目的:本研究拟应用功能性步态评价(FGA)对帕金森病(PD)患者进行跌倒预测。方法:选择北京天坛医院神经内科入院PD患者121例。由1名治疗师进行FGA测评,6个月后,另外一名神经病学医师对患者进行电话随访。收集其6个月内的跌倒情况,绘制FGA的接受者操作特征曲线,并确定FGA预测跌倒的分界值、敏感性、特异性、似然比等。结果:FGA对未来6个月内的跌倒预测,其最佳分界值为18,敏感度为80.6%,特异度为80.0%,似然比为4.03。结论:FGA可用于预测未来6个月内PD患者的跌倒,是较好的评价工具。     

原发性震颤患者的平衡功能及相关因素分析

目的:探讨原发性震颤(ET)患者步态和平衡功能特点,有助于更加全面地认识ET.方法:选取ET患者(研究组)和健康志愿者(对照组)各80例纳入研究,采用六项平衡信心活动量表(ABC-6)评估患者的平衡信心,采用Berg平衡量表(BBS)评估患者步态和平衡功能,收集患者过去一年中跌倒次数及几近跌倒的次数.结果:根据ABC-...     

Effect of robotic locomotor training in an individual with Parkinson's disease: a case report

Purpose.?The purpose was to test the effect of robot-assisted gait therapy with the Lokomat system in one representative individual with Parkinson's disease (PD).

Methods.?The patient was a 67-year-old female with more than an 8-year history of PD. The manifestations of the disease included depressive mood with lack of motivation, moderate bradykinesia, rigidity and resting tremor, both involving more the right side of the body, slow and shuffling gait with episodes of freezing and risk of falling. The patient underwent six sessions of robot-assisted gait training. The practice included treadmill walking at variable speed for 25–40?min with a partial body weight support and assistance from the Lokomat orthosis.

Results.?After the therapy, the patient increased the gait speed, stride length and foot clearance during over ground walking. She reduced the time required to complete a 180° turn and the latency of gait initiation. Improvements were observed in some items of the Unified Parkinson's Disease Rating Scale including motivation, bradykinesia, rigidity, freezing, leg agility, gait and posture.

Conclusions.?Although the results supported the feasibility of using robot-assisted gait therapy in the rehabilitation an individual with PD, further studies are needed to assess a potential advantage of the Lokomat system over conventional locomotor training for this population.     

帕金森患者跌倒发生情况及其相关因素分析

目的探讨帕金森患者跌倒发生情况及其相关因素。方法由专人对100例帕金森患者进行回顾性分析,了解其跌倒发生情况及其相关因素。结果帕金森患者住院期间跌倒事件发生率为46．0％;单因素分析结果：男性患者、药物因素致头晕、有跌倒史及住院期间无陪护组患者发生跌倒明显高于未跌倒组,组间比较,均P〈0．05,差异具有统计学意义;Logistic回归分析显示,男性患者、药物因素致头晕、有跌倒史是帕金森患者住院期间跌倒事件发生的危险因素（均P〈0．05）。结论帕金森患者住院期间跌倒事件发生率较高,男性患者、药物因素致头晕及入院前有跌倒史为帕金森患者住院期间发生跌倒的高危因素。在患者入院前应进行跌倒风险性评估,根据患者跌倒发生的原因,采取跌倒风险管理和跌倒危险分级管理,减少患者跌倒事件的发生。     

Evaluation of the effectiveness of a novel gait trainer in increasing the functionality of individuals with motor impairment: A case series

Regaining the ability to independently ambulate following a physical disability can increase functional ability and participation of patients in daily life. Gait trainers are assistive devices that enable body support and provide safety during gait. However, most conventional gait trainers are pre-configured to a constant position, therefore not suitable for practicing sit-to-stand function, and require assistance from a caregiver in order to mount the device from a sitting position. We therefore evaluated the effectiveness of a dynamically-adjusting gait trainer, designed to provide independence and safety during gait and various activities, in both lab setting and at home in four subjects (one female, three males, ages 32–79 years) with limited ambulation. Spatiotemporal parameters and gait symmetry were recorded, as well as activity levels, actual use of device, and satisfaction. Although gait parameters and physical activity levels were not notably improved, and in one case were worsened, three subjects reported positive experience with the gait trainer. The new gait trainer may have advantages in supporting users with limited mobility during walking and various functions and decrease the risk for falls. A longer practice time and individual fitting process are recommended for better accommodation to the new possibilities.     

Dysfunctional turning in Parkinson's disease

Purpose. People with Parkinson's disease (PD) frequently freeze or fall turning: They turn slowly taking numerous steps. We aimed to describe more fully the differences observed on turning between people with and without PD, in particular the extent of left-right asymmetry and the correlations between turning and age, balance and PD severity, using a simple clinical test.

Method. Twenty-eight people with PD (median age 71; median years since diagnosis eight) and 12 controls (median age 70) performed the video-based Standing Start 180° Turn Test. We counted turning steps (n), evaluated turn time (sec), type and quality (0 – 5, based on independence, ground clearance, stability, continuity and posture) and calculated the 95% limits of left-right agreement.

Results. The groups differed (p < 0.004) on step count (medians 4.5 vs. 3), time (2.3 sec vs. 1.7 sec) and quality (4 vs. 5). In the PD group, 75% turned ‘on-the-spot’ and differences turning left and right were marked (e.g., 95% upper limit for step count 6.6). Among controls, 42% turned ‘on-the-spot’ and turning was symmetrical (e.g., 95% upper limit for step count 1.7). Step count was most closely correlated with self-assessed disability in PD (r = 0.67; p = 0.001) and with age among controls (r = 0.87; p = 0.001).

Conclusions. People having difficulty turning are likely to have trouble with many everyday activities and thus may benefit from rehabilitation. Directional asymmetry in turning is easily identifiable and future studies should explore its diagnostic value.     

Assessing the effects of subthalamic nucleus stimulation on gait and mobility in people with Parkinson disease

Purpose.?To determine the effects of unilateral and bilateral subthalamic nucleus (STN) stimulation on gait and mobility in persons with Parkinson disease (PD).

Method.?We examined eight individuals with advanced PD who underwent staged stimulator implantation surgeries. Gait and mobility were assessed in the medication-on state with a variety of clinical and laboratory measures (Unified Parkinson Disease Rating Scale items, Timed Up and Go Test, gait speed) at three time points: prior to surgery, after the first surgery (unilateral stimulation) and after the second surgery (bilateral stimulation).

Results.?Despite overall improvements in motor function and reduction of dyskinesia, there were no significant group effects of unilateral or bilateral stimulation on gait and mobility compared to pre-surgical function. However, there were clinically meaningful changes, both improvements and declines, at the individual level.

Conclusions.?Because of the consequences of gait deficits and mobility limitations for people with PD, future research should examine the effects of STN stimulation on gait in the medication-on state using sensitive and specific measures such as gait speed. Accurate assessment of gait changes is necessary to improve the evaluation of STN effects and the prediction of individuals in need of rehabilitation services to manage gait and mobility deficits.     

Nordic Walking在帕金森患者步态康复训练中的研究

目的:评估Nordic Walking(NW)康复训练对帕金森(PD)患者步态的改善效果.方法:40例PD患者纳入研究,随机分为对照组和NW组,各20例.对照组不给予康复训练,仅维持入组前的用药.NW组在维持入组前用药的基础上,增加NW训练,1 h/次,2次/周,共训练3个月.于治疗前及治疗3个月后,收集并比较2组的步...     

Gait changes with walking devices in persons with Parkinson’s disease

Purpose: To study immediate gait changes in persons with PD when walking with different assistive walking devices. Methods: Ten individuals with idiopathic PD participated in the study. Gait parameters were recorded while walking with a cane and a wheeled walker, and were compared to a free walk without a walking device. Results: Persons with PD walked with slower gait speed when using a cane and a wheeled walker compared to walking without any device (p?=?0.007, p?=?0.002, respectively). Stride length reduced significantly when walking with a wheeled walker (p?=?0.001). Walking with the assistive devices did not affect cadence, double support phase, heel to heel base of support, stride time, and stance period. Conclusion: Persons with PD immediately walked with slower gait speed when using either a cane or a wheeled walker, and with shorter stride length when walking with a wheeled walker. The results may lead to more cautious clinical practice in gait rehabilitation using ambulatory assisted devices.

Implications for Rehabilitation

• Persons with PD immediately walked with slower gait speed when using either a cane or a wheeled walker, and with shorter stride length when walking with a wheeled walker.

• Clinicians should be cognizant of these modifications during gait rehabilitation using ambulatory assisted devices.