功能性步态评价的临床应用

临床医学中,神经科、眼科、耳鼻喉科的许多疾病均可导致患者出现平衡及步态障碍。为客观评价平衡及步态障碍,临床上产生了许多有关的评价量表,如Berg平衡量表(Berg balance scale,BBS)、计时起立—步行测验(timed up and go test,TUGT)、功能性运动量表(functional ambulation category,FAC)、动态步态指数(dynamic gait index,DGI)等。功     

脑卒中患者平衡功能评定方法的应用进展

脑卒中患者平衡功能评定方法包括仪器评定和量表评定。仪器包括静态平衡测试系统和动态平衡测试系统。静态平衡测试系统包括平衡测试仪和Tetrax平衡测试系统;动态平衡测试系统包括Active Balancer EAB-100和Pro-Kin 254。常用量表有Berg平衡量表、脑卒中患者姿势控制量表、起立-步行计时测试、Fugl-Meyer运动功能评分平衡量表、Tinetti平衡与步态量表和五次站立实验等。本文综述以上方法的特点和适应证。     

运动体操训练对老年人平衡及运动能力的影响研究

[目的]探讨运动体操训练对老年人平衡及运动能力的影响。[方法]选择2014年6月—2014年12月老干部病房长期住院病人72例,坚持运动体操训练12周,比较训练前后Tinetti平衡步态量表得分、单腿平衡时间、特定动作平衡信心、计时"起立-行走"时间、日常生活活动能力(ADL)得分情况。[结果]训练12周后,Tinetti平衡步态量表中平衡及总分明显提高;单腿平衡时间明显延长;平衡信心有所增加;"起立-行走"测试完成时间明显缩短,ADL评分增加,与训练前比较差异有统计学意义(均P0.05)。[结论]运动体操训练可以改善老年人平衡能力及运动能力、增强平衡信心,是预防跌倒的有效措施之一。     

触觉振动反馈系统对单侧小腿假肢穿戴者平衡及行走功能的影响

目的 观察触觉振动反馈系统对单侧小腿假肢穿戴者的平衡和行走功能的影响.方法 2019年10月至2020年11月,选取本院门诊和住院治疗的小腿截肢后穿戴假肢者11例,受试者佩戴本科自行研制的触觉振动反馈系统装置,进行日常活动3 h.分别于佩戴前和日常活动后采用Tinetti平衡与步态量表(POMA)、步态分析和室外100...     

老年人脑白质病变相关性跌倒患者的脑弥散张量成像研究

目的定量分析老年人脑白质病变(white matter lesions,WMLs)相关性跌倒患者的脑弥散张量成像(diffusion tensor imaging,DTI)及临床改变,初步探索老年人跌倒风险的影像学预测指标。材料与方法选择2015年6月至2016年1月期间首都医科大学附属北京天坛医院60岁以上的WMLs患者,根据Tinetti平衡和步态量表划分为跌倒风险组15人(Tinetti25分)及对照组29人(Tinetti≥25分)。运用基于纤维束追踪空间统计分析(tract based spatial statistics,TBSS)识别跌倒风险组患者异常的脑白质纤维束,并与简易精神状态检查量表(mini mental state exam,MMSE)、蒙特利尔认知评估(montreal cognitive assessment,Mo CA)量表、Tinetti平衡和步态量表(tinetti balance and gait analysis)、计时起立-步行测验(timed up and go test,TUGT)分别进行相关性分析。结果跌倒风险组的MMSE(t=2.806,P=0.008)及Mo CA(t=2.890,P=0.006)量表评分低于对照组。跌倒风险组的全脑平均各向异性分数(fractional anisotropy,FA)值低于对照组(t=2.862,P=0.007);跌倒风险组全脑平均FA值与MMSE(r=0.533,P=0.041)及Mo CA(r=0.642,P=0.010)量表呈正相关。跌倒风险组FA值减低的脑白质纤维束为右侧钩束、胼胝体膝部、体部及压部、双侧放射冠前部、右侧放射冠上部、右侧上纵束、左侧扣带回;其中跌倒风险组的胼胝体膝部、右侧放射冠前部、胼胝体体部、胼胝体压部、右侧上纵束、左侧扣带回的平均FA值均与Mo CA呈正相关(P值均0.05);右侧钩束的平均FA值(r=0.562,P=0.029)与Tinetti平衡量表呈正相关;右侧钩束(r=0.572,P=0.026)、胼胝体体部(r=0.538,P=0.038)、胼胝体压部(r=0.580,P=0.023)、左侧扣带回(r=0.520,P=0.047)的平均FA值与Tinetti步态量表呈正相关;胼胝体体部(r=-0.582,P=0.023)及左侧扣带回(r=-0.538,P=0.039)的平均FA值与TUGT呈负相关。结论跌倒风险组的全脑平均FA值及9条脑白质纤维束平均FA值低于对照组,并与认知、步态、平衡功能存在一定的相关性。DTI定量分析可用于识别老年人WMLs相关性跌倒患者的颅脑结构特点,为具有跌倒风险的WMLs患者的识别、判断病情及预后评价提供了重要的影像学依据。     

Orem支持教育系统对脑卒中偏瘫患者自我管理能力及希望水平的影响

目的:探讨奥瑞姆(Orem)支持教育系统对脑卒中偏瘫患者自我管理能力及希望水平的影响。方法:将2018年7月1日～2020年7月1日收治的80例脑卒中偏瘫患者,按照随机数字表法分为观察组43例和对照组37例,对照组接受常规护理干预,观察组在常规基础上接受基于Orem支持教育系统的护理干预;比较两组干预前后步态及平衡功能[采用Tinetti步态评估量表、Berg平衡量表(BBS)]、生活质量[采用脑卒中专用生活质量量表(SS-QOL)]、自我管理能力和希望水平。结果:干预后,两组Tinetti、BBS、SS-QOL、自我管理能力、希望水平评分均高于干预前(P<0.05),且观察组高于对照组(P<0.01,P<0.05)。结论:Orem支持教育系统可改善脑卒中偏瘫患者的步态及平衡功能,提开患者自我管理能力和希望水平,改善生活质量。     

弹力带抗阻运动对老年脑小血管病伴步态障碍患者姿势稳定性及下肢力量的影响

目的制定符合老年脑小血管病（cerebral small-vessel disease,CSVD）伴步态障碍患者弹力带抗阻运动方案,评价其对患者姿势稳定性及下肢力量的影响。方法 便利选取南宁市某三级甲等综合医院老年神经内科2021年2月至2022年2月收治80例的老年CSVD伴步态障碍患者,采用随机数字表法分为对照组和试验组,每组各40例。对照组患者给予常规治疗护理及步态康复锻炼,试验组在对照组基础上给予12w弹力带抗阻运动训练,比较两组患者的姿势稳定性（采用Tinetti平衡与步态总分、平衡得分、步态得分和起立-行走-计时测试时间评价）和下肢力量。结果 干预后试验组患者的Tinetti平衡与步态总分、平衡得分、步态得分均高于对照组,起立-行走-计时测试时间少于对照组,两组比较,差异具有统计学意义（均P<0.05）。干预后试验组患者的下肢力量优于对照组,两组比较,差异有统计学意义（P<0.05）。结论 弹力带抗阻运动不仅能提高老年CSVD伴步态障碍患者姿势稳定性,有效改善患者下肢力量,提高患者运动与平衡功能。     

Tinetti平衡与步态量表在移动及平衡能力评估中的应用进展

正移动及平衡能力是维持个体自主、自立及确保生存质量的基本条件。移动及平衡能力的下降往往会导致个体生活自理能力受损,跌倒风险增高。准确评估移动及平衡能力,对于早期识别高跌倒风险个体、采取针对性的干预措施以及指导疾病治疗与康复有重要意义~([1])。目前国内外有多种评估工具用于评价移动及平衡能力,其中Tinetti平衡与步态量表(performance oriented mobility assessment, POMA)自报道     

以护士为主导的多学科团队干预对预防老年患者跌倒的效果研究

目的探讨以护士为主导的多学科团队干预模式对预防老年患者跌倒的效果。方法根据SPSS 19.0软件生成的随机化编码,将370例老年患者分为对照组和观察组各185例,对照组采用挂警示标识、健康教育等预防跌倒的常规护理方法,观察组采用护士为主导的多学科团队综合干预模式。干预6个月后比较两组患者跌倒发生率、跌倒可以预防知晓率、Tinetti平衡和步态量表评分、Morse跌倒评估量表评分、中文版跌倒效能量表评分。结果观察组患者跌倒发生率低于对照组,跌倒可以预防知晓率高于对照组,Tinetti平衡和步态量表及中文版跌倒效能量表评分均高于对照组,Morse跌倒评估量表评分低于对照组,比较差异均有统计学意义(P0.05)。结论以护士为主导的多学科团队综合干预模式可改善老年患者对跌倒的认知,改善老年患者躯体功能状态,从而降低跌倒发生率。     

反重力跑台系统在老年脑卒中患者平衡及步行训练中的疗效

目的:观察反重力跑台训练系统在老年脑卒中患者平衡及步行训练中的应用效果.方法:选取我院60例老年卒中住院患者,随机分为研究组和对照组各30例.2组均予常规康复训练及步行训练,研究组加用反重力跑台步行训练,连续治疗12周,并在治疗前后采用Berg平衡量表、Tinetti步态评估量表、10m最大步行速度测试评估患者平衡及步...     

视觉反馈平衡训练对髋部骨折术后患者平衡和行走功能的影响

目的:观察视觉反馈平衡功能训练对髋部骨折术后患者平衡和行走功能的影响。方法:髋部骨折术后患者120例,随机分为观察组和对照组各60例,均配合常规康复训练,观察组于术后2～12周时利用MTD平衡仪进行视觉反馈法静、动态平衡功能训练。训练1周和12周时2组分别采用MTD平衡测定训练仪进行站立平衡功能评定,采用Tinetti步态及平衡试验和"起立-走"计时试验评定步态和静动态平衡、行走能力。结果:治疗1周时2组各项评定指标比较差异无统计学意义。治疗12周时2组MTD平衡测定,其平均压力峰值差和百分比差均较1周时明显缩小;Tinetti步态及平衡试验评分明显提高;"起立-走"计时试验所需时间明显减少(均P0.05),且观察组较对照组表现更显著(P0.05)。结论:在常规康复训练的基础上加MTD平衡仪进行视觉反馈平衡功能训练对改善髋部骨折术后患者的平衡和行走功能有明显促进作用。     

Examination of the use of a dual-channel functional electrical stimulation system on gait,balance and balance confidence of an adult with spastic diplegic cerebral palsy

Abstract

The purpose of this case report is to determine the effects of a dual-channel functional electrical stimulation (FES) system on gait and balance of a 57-year-old male diagnosed with spastic diplegic cerebral palsy (CP). Outcome measures included the: Activities-specific Balance Confidence Scale (ABC); Dynamic Gait Index (DGI); Observational Gait Scale (OGS) and Tinetti Performance Oriented Mobility Assessment (POMA). Assessments were completed with and without use of FES during the initial examination and after two, four and six weeks of intervention with FES. ABC Scale scores improved from 32.8 to 48.1% during the 6-week intervention. Scores on the DGI improved from 6/24 to 9/24 without FES and from 9/24 to 14/24 with FES. OGS scores improved on both legs with and without FES. Tinetti POMA scores improved from 12/28 to 15/28 without FES and decreased from 16/28 to 15/28 with FES. The patient demonstrated improvement in both objective and subjective measures. The use of FES facilitated improved gait and balance; however, the patient was still at increased risk for falls after the 6-week intervention despite improved scores on the ABC Scale, DGI, OGS and Tinetti POMA.     

FES辅助踏车与MOTOmed智能训练系统对早期脑卒中患者下肢功能的对比研究

目的:探讨功能性电刺激(FES)辅助踏车对脑卒中偏瘫患者早期下肢运动功能以及日常生活活动能力的影响。方法:将早期脑卒中偏瘫患者40例随机分为观察组和对照组各20例。2组均采用常规个体化康复治疗,观察组加用FES踏车进行治疗,对照组给予MOTOmed下肢踏车治疗。治疗前后分别采用功能性步行分级量表(FAC)、Tinetti量表、Berg平衡量表、Fugl-Meyer评分法(FMA)及改良Barthel指数(MBI)进行评估。结果:治疗6周后,2组FAC等级较治疗前均有显著提高(P0.01),2组间比较差异无统计学意义。治疗后,2组Tinetti量表、FMA下肢评分、MBI及BBS评分均较治疗前明显提高(P0.01),且观察组高于对照组(P0.05,0.01)。结论:FES辅助踏车系统和MOTOmed智能训练系统均有助于脑卒中早期下肢功能的恢复,而FES辅助踏车系统对下肢功能的改善效果优于MOTOmed智能训练系统。     

Investigating the Effects of an Otago-Based Program among Individuals Living with Dementia

Abstract

Aim: To examine the impact of an Otago-based exercise program (OEP) on physical function in patients living with mild cognitive impairment (MCI) or dementia receiving home heath physical therapy.

Methods: 34 patients (mean age 88.3?years; 62% female; mean Mini-Cog 1.76) completed the following assessments: Four-Stage Balance test, Timed Up & Go, 30-Second Chair Stand test, and Tinetti Gait and Balance. Assessments were completed at baseline and an average of 4.79 (2.29) visits later, with a mean of 1.74 (0.79) months between assessments. The OEP-based exercises were individually tailored and progressed based on performance as recommended by the program protocol.

Results: A paired samples t-test revealed significant differences in scores for the Four-Stage Balance Test (p?<?0.001), the Timed Up & Go (p?=?0.002), and the Tinetti Gait and Balance (p?=?0.002).

Conclusion: The OEP can potentially be used for individuals living with cognitive impairments to improve performance outcomes such as balance and functional mobility.     

老年人下肢肌力和功能性活动测试与步速的相关性

目的了解老年人下肢特殊肌群肌力和几种功能性活动测试与步速的相关性。方法341 名居家老年人(65~94 岁),按步速<0.8 m/s 为肌少症的筛查标准,分为可疑肌少症组(n=137)和正常组(n=204)。比较两组人群的基本特征,下肢肌群(包括髂腰肌、股四头肌、腘绳肌、胫前肌)肌力,单腿站立测试、Berg 平衡量表、功能性步态测试、功能性伸展测试、计时起立-走测试评分,及其与步速的相关性。结果两组间体重、身高无显著性差异(P>0.05),可疑肌少症组年龄较大(P<0.05)。双侧下肢肌群肌力两组间无显著性差异(P>0.05);髂腰肌、股四头肌、腘绳肌肌力与步速呈弱相关(r=0.121~0.227, P<0.05),胫前肌肌力与步速无显著相关性(P>0.05)。步速与单腿站立试验呈弱相关(r=0.121~0.236, P<0.05),与Berg 平衡量表、功能性步态测试、功能性伸展试验评分呈中度相关(r=0.479~0.584, P<0.001),与计时起立-走测试评分呈中度负相关(r=-0.502, P<0.001);除功能性伸展测试(P=0.28)外,其他测试两组间均有非常高度显著性差异(P<0.001)。结论诊断肌少症不能仅依靠肌力,还应结合功能性活动。     

Does hippotherapy effect use of sensory information for balance in people with multiple sclerosis?

Abstract

Objective: This case-series study aimed to determine if there were observable changes in sensory processing for postural control in individuals with multiple sclerosis (MS) following physical therapy using hippotherapy (HPOT), or changes in balance and functional gait. Design: This pre-test non-randomized design study, with follow-up assessment at 6 weeks, included two females and one male (age range 37–60 years) with diagnoses of relapse-remitting or progressive MS. The intervention consisted of twelve 40-min physical therapy sessions which included HPOT twice a week for 6 weeks. Sensory organization and balance were assessed by the Sensory Organization Test (SOT) and Berg Balance Scale (BBS). Gait was assessed using the Functional Gait Assessment (FGA). Results: Following the intervention period, all three participants showed improvements in SOT (range 1–8 points), BBS (range 2–6 points), and FGA (average 4 points) scores. These improvements were maintained or continued to improve at follow-up assessment. Two of the three participants no longer over-relied on vision and/or somatosensory information as the primary sensory input for postural control, suggesting improved use of sensory information for balance. Conclusion: The results indicate that HPOT may be a beneficial physical therapy treatment strategy to improve balance, functional gait, and enhance how some individuals with MS process sensory cues for postural control. Randomized clinical trials will be necessary to validate results of this study.     

Bilateral step length estimation using a single inertial measurement unit attached to the pelvis

Background

The use of automated electromechanical devices for gait training in neurological patients is increasing, yet the functional outcomes of well-defined training programs using these devices and the characteristics of patients that would most benefit are seldom reported in the literature. In an observational study of functional outcomes, we aimed to provide a benchmark for expected change in gait function in early stroke patients, from an intensive inpatient rehabilitation program including both robotic and manual gait training.

Methods

We followed 103 sub-acute stroke patients who met the clinical inclusion criteria for Body Weight Supported Robotic Gait Training (BWSRGT). Patients completed an intensive 8-week gait-training program comprising robotic gait training (weeks 0-4) followed by manual gait training (weeks 4-8). A change in clinical function was determined by the following assessments taken at 0, 4 and 8 weeks (baseline, mid-point and end-point respectively): Functional Ambulatory Categories (FAC), 10 m Walking Test (10 MWT), and Tinetti Gait and Balance Scales.

Results

Over half of the patients made a clinically meaningful improvement on the Tinetti Gait Scale (> 3 points) and Tinetti Balance Scale (> 5 points), while over 80% of the patients increased at least 1 point on the FAC scale (0-5) and improved walking speed by more than 0.2 m/s. Patients responded positively in gait function regardless of variables gender, age, aetiology (hemorrhagic/ischemic), and affected hemisphere. The most robust and significant change was observed for patients in the FAC categories two and three. The therapy was well tolerated and no patients withdrew for factors related to the type or intensity of training.

Conclusions

Eight-weeks of intensive rehabilitation including robotic and manual gait training was well tolerated by early stroke patients, and was associated with significant gains in function. Patients with mid-level gait dysfunction showed the most robust improvement following robotic training.     

The sensitivity of three commonly used outcome measures to detect change amongst patients receiving inpatient rehabilitation following stroke

OBJECTIVE: To investigate the sensitivity of three commonly used functional outcome measures to detect change over time in subjects receiving inpatient rehabilitation post stroke. DESIGN: Subjects were assessed within one week of admission and one week of discharge from an inpatient rehabilitation facility. Several parameters of sensitivity were calculated, including floor and ceiling effects, the percentage of subjects showing no change and the effect size of the change between admission and discharge. SETTING: The medical rehabilitation ward of an inpatient rehabilitation facility. SUBJECTS: Seventy-eight subjects receiving inpatient rehabilitation following a first or recurrent stroke. MEASURES: Five-metre walk, comfortable pace (gait speed), the Berg Balance Scale and the Motor Assessment Scale. RESULTS: Sixty-one subjects had complete admission and discharge data. Gait speed and the Berg Balance Scale were both sensitive to change and demonstrated large effect sizes. The Motor Assessment Scale item five also showed a large effect size and was able to detect change amongst lower functioning subjects. The other items of the Motor Assessment Scale were less useful, in particular, the effect sizes for upper extremity change scores were small (d=0.36-0.5) and the majority of subjects (44.3-63.9%) showed no change over time on these measures. CONCLUSION: Gait speed, the Berg Balance Scale and the Motor Assessment Scale item five were sensitive to change over time in this sample.     

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 Correlation between Dynamic Balance Measures and Stance Sub-phase COP Displacement Time in Older Adults during Obstacle Crossing

[Purpose] This study examined the relationship between the center of pressure (COP) displacement time during the stance subphases and dynamic balance ability when elderly cross obstacles 0, 10, and 40 cm in height. [Subjects] Fifteen older adults were enrolled in this study (≥65 years of age). [Methods] An F-Scan System was used to measure the COP displacement time when subjects crossed obstacles 0, 10, and 40 cm in height, and the Dynamic Gait Index, Berg Balance Scale, and Four Square Step Test were used to measure dynamic balance ability. [Results] The Dynamic Gait Index, Berg Balance Scale, and Four Square Step Test were correlated with each other. Dynamic balance tests were correlated with the COP displacement time during the stance phase. At obstacle heights of 10 and 40 cm during loading response and at all heights during pre-swing, there were correlations with dynamic balance ability. However, dynamic balance ability did not affect the COP displacement time during mid-stance and terminal stance. [Conclusion] People with a lower dynamic balance ability show a larger COP displacement time during loading response and pre-swing. Therefore, dynamic balance ability can be predicted by measuring the COP displacement time.Key words: Dynamic balance, Obstacle crossing, Center of pressure