膝骨关节炎患者动静态跌倒风险测试的临床应用价值

目的探讨膝骨关节炎(KOA)患者的平衡功能状况和动静态跌倒风险测试在KOA患者中的临床应用价值。方法对无膝痛的KOA患者(对照组,n=30)给予静态姿势稳定性(PS)、姿势稳定极限性(LOS)、动态跌倒风险指数(DFI)和静态跌倒风险指数(SFI)测试。对有膝痛的KOA患者(治疗组,n=30)给予10次双氯芬酸二乙胺乳胶剂经脉冲超声波导入和6次推拿手法联合治疗,并于治疗前后给予西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分及上述4种平衡功能测试。结果对照组与治疗组治疗前在PS总分、前后摆动系数、侧向摆动系数存在显著性差异(P<0.05);LOS完成时间、LOS总分和DFI存在非常显著性差异(P<0.01),而SFI无显著性差异(P>0.05)。治疗组治疗前后的WOMAC得分、PS总分、前后摆动系数、LOS完成时间、LOS总分和DFI存在显著性差异(P<0.05);侧向摆动系数、SFI无显著性差异(P>0.05)。结论有膝痛的KOA患者与年龄相匹配的无膝痛KOA受试者相比,平衡功能更差,跌倒风险更大。经有效治疗后,KOA患者的平衡功能明显改善,跌倒风险降低。与SFI测试相比,DFI测试对KOA患者平衡功能改善更加敏感。     

前庭感觉、本体感觉及视觉功能对老年人跌倒风险影响的因素分析

目的评价前庭感觉、本体感觉及视觉功能对老年人跌倒风险的影响。方法56例60岁以上老年患者采用Tetrax平衡测试系统分别检测受试者在自然站立（NO）、闭眼自然站立（NC）、脚垫站立（PO）、脚垫闭眼站立（PC）4种不同测试状态下的一般稳定性指数（ST）、体重分布指数（WDI）和跌倒指数（FI）。结果平均FI（48.21±26.47）;ST：PC组＞PO组＞NC组＞NO组（P=0.000）,但NC组与PO组无显著性差异（P=0.705）;WDI各组间无显著性差异（P=0.057）。FI与不同姿势ST相关（P<0.05）;与不同姿势WDI的无相关性（P>0.05）。结论视觉、本体感觉和前庭感觉在姿势控制和跌倒预测方面均有重要作用;稳定性指数不仅能精确反映静态平衡功能状态和姿势控制能力,而且能初步反映感觉因素对平衡调控和跌倒风险的影响;体重分布指数评估跌倒风险不敏感。     

青少年特发性脊柱侧凸患者的静态平衡功能研究

目的:研究青少年特发性脊柱侧凸(AIS)患者的静态平衡功能。方法:随机选取46例青少年特发性脊柱侧凸患者为AIS组,选取14例健康正常青少年为对照组,用Tetrax静态平衡仪测定所有研究对象在8种姿势下的静态平衡功能。结果:不同姿势下AIS组的体重分配系数、傅立叶协调系数与对照组相比差异无显著性意义。AIS组不同姿势下的稳定性指数均高于对照组,差异有显著性意义(P=0.000)。AIS组的跌倒指数平均为50.3±31.9,对照组的跌倒指数平均为13.3±8.3,AIS组潜在跌倒风险明显高于对照组,差异有显著性意义(P=0.000)。结论:青少年特发性脊柱侧凸患者稳定性降低,具有中等跌倒风险。     

前交叉韧带重建术后患者平衡功能的研究

目的:研究前交叉韧带重建术后患者的平衡功能情况。方法:观察组为前交叉韧带重建术后6个月患者55例,以健康成年人作为对照组。用Tetrax平衡功能检测系统测量其平衡功能,经SPSS10.0软件进行统计学分析。结果:在稳定测试平台睁眼和闭眼双腿站立模式下,两组间一般稳定性、体重分布指数、前后同步性、左右同步性差异无显著性(P0.05);在不稳定测试平台睁眼和闭眼双腿站立模式下,观察组的前后同步性高于对照组,差异具有显著性(P0.05),而一般稳定性、体重分布指数、左右同步性两组差异无显著性(P0.05)。结论:前交叉韧带损伤自体腘绳肌腱重建术后半年的患者,在不稳定的支持面上立位平衡功能尚未完全恢复到健康人水平。     

跑台扰动训练对脑卒中偏瘫患者平衡功能及跌倒风险的影响

摘要 目的：探讨跑台扰动训练对脑卒中偏瘫患者平衡功能及跌倒风险的影响。 方法：将97例脑卒中偏瘫伴有平衡障碍的患者随机均分为观察组和对照组,两组均进行常规PT训练,对照组在此基础上进行传统静动态平衡训练,20min/d;观察组中应用跑台扰动训练进行危机模拟步行功能训练,20min/d。两组训练时间均为5d/周,共6周。在治疗前和治疗6周后分别采用STABLE三维平衡姿势控制训练与评估系统进行静动态平衡功能测试,应用Tetrax平衡仪进行跌倒风险评估。 结果：治疗前,两组受试对象各项指标无显著性差异（P>0.05）;治疗6周后,对照组的睁眼站立、闭眼站立、脚前后站立、动态稳定时间明显改善（P<0.001）。单腿站立时重心摆动速度和跌倒风险评则进步不显著（P=0.482,P=0.066）。治疗组的上述指标均较治疗前显著进步（P<0.001）,进步程度大于对照组,除了睁眼站立和动态稳定时间外均P<0.05。 结论：跑台扰动训练可以更好地帮助脑卒中后偏瘫患者改善动态平衡功能,降低跌倒风险。     

Tetrax平衡测试系统用于老年人平衡功能测试的重测信度

目的检验Tetrax测试系统在老年人平衡功能测试中的重测信度。方法对22名符合入选条件的老年人(66～84岁),应用Tetrax测试系统测定受试者睁眼自然站立状态下的稳定性指数、姿势摆动频谱和体重分布状态。1周后同一时间由同一测试者重复测试1次。采用组内相关系数(ICC)分析两次测试的重测信度。结果平衡功能测试的各个指标ICCs=0.797～0.882(P<0.01)。结论 Tetrax平衡测试系统用于老年人平衡功能评估时具有较高的重测信度。     

老年衰弱患者基于埃德蒙顿衰弱量表评估分层抗阻运动的效果观察

目的 探讨基于埃德蒙顿衰弱量表评估分层抗阻运动在老年衰弱患者中的应用效果。方法 2021年1—12月安徽省某三级甲等医院老年病房340例老年衰弱患者,按随机数字表法随机分为对照组和观察组,对照组给予8周常规健康教育和运动指导,观察组在对照组基础上实施基于埃德蒙顿衰弱量表评估的强度分层抗阻运动,比较2组老年人平衡能力、握力指数、跌倒效能、跌倒风险、睡眠质量。结果 共308例患者完成研究,对照组156例,观察组152例,干预前2组老年衰弱患者平衡能力、握力指数、跌倒效能、跌倒风险、睡眠质量评分比较差异无统计学意义（P>0.05）;干预8周末2组老年衰弱患者平衡能力、握力指数、跌倒效能、跌倒风险、睡眠质量评分比较,差异均具有统计学意义（P<0.05）。结论 基于埃德蒙顿衰弱量表评估分层抗阻运动可改善老年患者平衡能力、握力指数、跌倒效能、睡眠质量,降低跌倒风险。     

老年单、双膝痛骨关节炎患者的平衡功能及其跌倒风险对比分析

目的比较单膝痛和双膝痛骨关节炎老年患者的平衡功能特点及其跌倒风险。方法对30例老年无膝痛骨关节炎患者、30例老年单膝痛骨关节炎患者和32例老年双膝痛骨关节炎患者进行计时起立-行走测试(TUG)、静态姿势稳定性测试(PS)、动态姿势稳定极限性测试(LOS)以及动态跌倒风险测试(DFI)。结果单膝痛组TUG时间长于无膝痛组(P<0.05),双膝痛组明显长于无膝痛组(P<0.01),单、双膝痛组之间无显著性差异(P>0.05)。双膝痛组PS得分高于无膝痛组与单膝痛组(P<0.05),无膝痛组与单膝痛组之间无显著性差异(P>0.05)。双膝痛组的LOS完成时间明显长于无膝痛组和单膝痛组(P<0.01),无膝痛组与单膝痛组之间无显著性差异(P>0.05)。单、双膝痛组的DFI得分高于无膝痛组(P<0.05),双膝痛组高于单膝痛组(P<0.05)。结论老年单膝痛骨关节炎患者动态平衡功能的下降,存在高跌倒风险;老年双膝痛骨关节炎患者静态和动态平衡功能均下降,跌倒风险更高。     

PDCA模式及平衡姿势认知训练在预防脑卒中患者跌倒中的应用

目的:探讨PDCA模式及平衡姿势认知训练在预防脑卒中患者跌倒中的应用效果。方法:将我院2015年1月~2016年1月收治的141例脑卒中患者随机分为观察组71例和对照组70例,对照组予以常规护理以防跌倒,观察组予以PDCA模式及平衡姿势认知训练以防跌倒。比较两组护理前后Berg平衡量表评分与跌倒总发生率。结果:观察组患者护理后Berg评分高于对照组(P0.05),跌倒发生率低于对照组(P0.05)。结论:临床予以脑卒中患者PDCA模式及平衡姿势认知训练,有利于优化患者姿势控制能力与提升平衡功能,从而有效实现预防跌倒的目的,值得临床推广应用。     

外周前庭训练对脑卒中恢复期患者平衡功能的影响

目的：探讨前庭训练对脑卒中恢复期患者平衡功能的影响。方法：选取34例脑卒中恢复期患者为研究对象,并随机分为对照组与观察组各17例,对照组进行常规康复训练,观察组在进行常规康复训练的同时进行前庭训练。比较2组治疗前后的Berg平衡功能量表评分(BBS)、Fugl-Meyer下肢功能评估量表（FMA-LE）以及Tetrax平衡功能诊断及训练系统测定的中枢前庭与周围前庭跌倒风险指数的数值差异。结果：训练一周后,2组的平衡功能量表BBS与训练前比较均显著提高（P<0.05）,且观察组明显高于对照组（P<0.05）。2组下肢功能量表FMA-LE与训练前比较均显著提高（P<0.05）,但2组间评分无显著差异。2组的周围前庭跌倒风险指数F2-F4均有降低（P<0.05）,且观察组较对照组显著降低（P<0.05）,中枢前庭跌倒风险指数F7-F8得分2组差异无统计学意义。结论：前庭训练能有效改善脑卒中恢复期患者的外周前庭功能,存在提高偏瘫患者平衡功能的可能性。     

Correlation between balance and gait according to pelvic displacement in stroke patients

[Purpose] The purpose of this study was to investigate the correlations of balance and gait according to pelvic displacement in stroke patients. [Subjects] The subjects of this study were 58 stroke patients who had been admitted to a hospital. [Methods] A Global Postural System was used to measure pelvic displacement. To measure the balance ability, a Tetrax balance system was used to measure the weight distribution index and stability index. Gait ability was measured during the 10-Meter Walking Test and Figure-of-8 Walk Test. [Results] The results of this study showed that was significant positive correlation between the anterior superior iliac spine height difference in pelvic displacement and the weight distribution index and significant positive correlation between the posterior superior iliac spine height difference and the stability index in the normal position with the eyes closed. Statistically significant positive correlation also was found between the anterior superior iliac spine height difference and the straight and curved gait ability. [Conclusion] The increased pelvic displacement in stroke patients results in a decrease in balance ability and gait speed. This suggests that control of pelvic displacement is necessary before functional training for patients with stroke.Key words: Balance, Pelvic displacement, Stroke     

卒中单元病房综合治疗对脑卒中患者生存质量的影响

目的：研究卒中单元病房中综合治疗对脑卒中患者生活质量的影响。方法：随机抽取卒中单元病房的脑卒中患者176例为康复组、神经内科脑卒中患者84例为对照组，均采用常规药物治疗和护理，康复组同时配合运动疗法，语言训练、心理康复及健康教育。治疗前和治疗8周后采用Spitzer生活质量指数量表（QLI）和Barthel指数（BI）量表评定患者生活质量，并采用Zung氏抑郁自评量表评定患者抑郁状态。结果：治疗后QLI总分及各分项得分、BI指数得分康复组均明显高于对照组（P〈0．01），抑郁状态的发生率明显低于对照组（P〈0．01）。结论：采用卒中单元病房综合治疗脑卒中能明显改善患者的ADL，减少抑郁状态的发生，提高生活质量。     

Postural control of patients with hemiparesis: force plates measurements based on the clinical sensory organization test

Standing balance of hemiparetic patients is characterized by increased sway and an asymmetrical weight bearing distribution. The objectives of the study were to determine the feasibility of using a modified clinical sensory organization test with patients following a stroke and to evaluate the contribution of visual and somatosensory input to the standing balance of hemiparetic patients during the first two months following a stroke. Thirty patients with hemiparesis underwent functional and posturographic testing one and two months following their stroke. Testing was conducted in six stance conditions differing in somatosensory and visual input. Fifteen age-matched non-impaired subjects served as the control group. Sway Index (SI) representing the displacement of the subjects’ center of pressure during stance, was generally affected by time (p = 0.003), visual input (p = 0.0001), and somatosensory input (p = 0.0061), with the effect of vision significantly greater in the patient group as compared with the control group (p = 0.0006). Despite significant functional gains in the Barthel Index and functional ambulation (p = 0.01), percentage of body weight on the involved extremity (%BW) by stance condition did not change over time. Posturographic testing is useful for determining the sensory organization abilities of stroke patients with moderate impairment and indicates that these patients are dependent on visual input for postural control. The decrease in %BW borne on the affected extremity does not change over time or with the varying of sensory input.     

Postural control of patients with hemiparesis: force plates measurements based on the clinical sensory organization test

Standing balance of hemiparetic patients is characterized by increased sway and an asymmetrical weight bearing distribution. The objectives of the study were to determine the feasibility of using a modified clinical sensory organization test with patients following a stroke and to evaluate the contribution of visual and somatosensory input to the standing balance of hemiparetic patients during the first two months following a stroke. Thirty patients with hemiparesis underwent functional and posturographic testing one and two months following their stroke. Testing was conducted in six stance conditions differing in somatosensory and visual input. Fifteen age-matched non-impaired subjects served as the control group. Sway Index (SI) representing the displacement of the subjects' center of pressure during stance, was generally affected by time (p = 0.003), visual input (p = 0.0001), and somatosensory input (p = 0.0061), with the effect of vision significantly greater in the patient group as compared with the control group (p = 0.0006). Despite significant functional gains in the Barthel Index and functional ambulation (p = 0.01), percentage of body weight on the involved extremity (%BW) by stance condition did not change over time. Posturographic testing is useful for determining the sensory organization abilities of stroke patients with moderate impairment and indicates that these patients are dependent on visual input for postural control. The decrease in %BW borne on the affected extremity does not change over time or with the varying of sensory input.     

The effect of two different arm positions on body weight distribution when rising from sitting to standing in stroke patients

Acommon goal in the rehabilitation of persons with stroke is to improve their abilityto bear weighton the affected lower extremity.With respect to arm positions, rising from a sitting to standing position can be trained in different ways. For example, the hands can be clasped with the arms stretched forward or the arms can be free to move. The purpose of this studywas to examine howthese twodifferent arm positions effect body weight distribution and estimation of perceived exertion when rising from sitting to standing in stroke patients. Ten stroke patients (23-63 years) and ten age and sex-matched controls participated in the study. Two force measuring platforms were used to estimate ground reaction forces and body weight distribution. Perceived exertion was rated on a scale developed by Borg. No differences in body weight distribution or perceived exertion were found between the two ways of rising from sitting to standing in either the patient group or the control group. The results of this studysuggest that to improve stroke patients' symmetryof bodyweight distribution, it is not helpful to train the use of specific arm positions.     

Effects of sensorimotor foot training on the symmetry of weight distribution on the lower extremities of patients in the chronic phase after stroke

[Purpose] To assess the effects of sensorimotor foot stimulation on the symmetry of weight distribution on the feet of patients in the chronic post-stroke phase. [Subjects and Methods] This study was a prospective, single blind, randomized controlled trial. In the study we examined patients with chronic stroke (post-stroke duration > 1 year). They were randomly allocated to the study group (n=8) or to the control group (n=12). Both groups completed a standard six-week rehabilitation programme. In the study group, the standard rehabilitation programme was supplemented with sensorimotor foot stimulation training. Each patient underwent two assessments of symmetry of weight distribution on the lower extremities with and without visual control, on a treadmill, with stabilometry measurements, and under static conditions. [Results] Only the study group demonstrated a significant increase in the weight placed on the leg directly affected by stroke, and a reduction in asymmetry of weight-bearing on the lower extremities. [Conclusion] Sensorimotor stimulation of the feet enhanced of weight bearing on the foot on the side of the body directly affected by stroke, and a decreased asymmetry of weight distribution on the lower extremities of patients in the chronic post-stroke phase.Key words: Rehabilitation, Sensorimotor foot training, Stroke     

急性脑梗死改良TOAST分型与踝臂指数、颈动脉彩超及相关危险因素分析

目的观察急性脑梗死改良脑卒中试验（M—TOAST）病因分型的构成,分析常见危险因素及踝臂指数（ABI）异常、颈动脉彩超异常在脑梗死中分布的差异。方法采用回顾性研究方法,收集2010年10月-2011年5月入院的急性脑梗死150例,根据M—TOAST标准进行病因分型,分析脑梗死常见危险因素及ABI异常、颈动脉超声异常与TOAST亚型的相关性。结果本组M-TOAST病因各亚型分布为动脉粥样硬化性血栓形成（AT）101例（67．3％）,小血管病变（SAD）14例（9．3％）,心源性栓塞型（CE）23例（15．3％）,不明原因卒中（SOD）9例（6．0％）,其他原因卒中（SUD）3例（2．0％）。卒中危险因素各组吸烟史以及高血压的比例均较高,但组间分布差异无统计学意义（P〉0．05）;不同类型脑梗死患者糖尿病、脂代谢紊乱、ABI异常及颈动脉彩超异常总体差异有统计学意义（P〈0．05）,组间比较AT型合并血脂紊乱比例高于SAD型及CE型,差异有统计学意义（P=0．03,0．03）,后两者间比较差异无统计学意义（P=0．8）;颈动脉彩超异常率AT型明显高于SAD型及CE型,差异有统计学意义（P〈0．01）,SAD型与CE型比较差异无统计学意义（P=0．8）;CE型合并心脏病比例显著高于AT型及SAD型,差异有统计学意义（P〈0．01）;SAD型合并糖尿病比例显著高于AT型及CE型,差异有统计学意义（P=0．04,0．01）;CE型ABI指数异常显著高于AT型及SAD型,差异有统计学意义（P=0．03）。结论M—TOAST分型中AT型为最多见的病因,吸烟、高血压、脂代谢紊乱、颈动脉彩超异常与AT密切相关,糖尿病与SAD密切相关。     

Effects of Progressive Body Weight Support Treadmill Forward and Backward Walking Training on Stroke Patients’ Affected Side Lower Extremity’s Walking Ability

[Purpose] The purpose of the present study was to examine the effects of progressive body weight supported treadmill forward and backward walking training (PBWSTFBWT), progressive body weight supported treadmill forward walking training (PBWSTFWT), progressive body weight supported treadmill backward walking training (PBWSTBWT), on stroke patients’ affected side lower extremity’s walking ability. [Subjects and Methods] A total of 36 chronic stroke patients were divided into three groups with 12 subjects in each group. Each of the groups performed one of the progressive body weight supported treadmill training methods for 30 minute, six times per week for three weeks, and then received general physical therapy without any other intervention until the follow-up tests. For the assessment of the affected side lower extremity’s walking ability, step length of the affected side, stance phase of the affected side, swing phase of the affected side, single support of the affected side, and step time of the affected side were measured using optogait and the symmetry index. [Results] In the within group comparisons, all the three groups showed significant differences between before and after the intervention and in the comparison of the three groups, the PBWSTFBWT group showed more significant differences in all of the assessed items than the other two groups. [Conclusion] In the present study progressive body weight supported treadmill training was performed in an environment in which the subjects were actually walked, and PBWSTFBWT was more effective at efficiently training stroke patients’ affected side lower extremity’s walking ability.Key words: Support treadmill training, Forward walking, Backward walking     

Weight distribution in standing and sitting positions,and weight transfer during reaching tasks,in seated stroke subjects and healthy subjects

Background and Purpose. The recovery of sitting balance after a stroke is assumed to be essential to obtain independence in other vital functions. The purpose of the present study was to investigate weight distribution while sitting and standing still, and weight transfer during seated reaching tasks performed by stroke subjects and healthy subjects. Method. The study was cross‐sectional. Twenty‐one stroke subjects and 21 healthy subjects, matched by age and gender, participated. Main measures were weight distribution while standing and sitting still, and displacements of centre of pressure (COP) during seated reaching tasks. Data were collected using a balance performance monitor (BPM), including software. Results. Stroke subjects had less symmetrical weight distribution in standing than that of healthy subjects (p < 0.001). No significant differences between the groups were found while sitting still, and no associations between asymmetries in standing still and sitting positions within individual stroke subjects were found. Neither did the degree of weight distribution in sitting correspond to COP displacements in seated reaching tasks. However, COP displacement patterns in reaching tasks in the seated position were different in stroke subjects from those of healthy subjects. Stroke subjects showed more lateral displacement when reaching forwards (p < 0.001), and less lateral displacement when reaching sideways to the unaffected side (p = 0.01). Conclusion. COP displacement patterns in stroke subjects deviate more than those of healthy subjects in seated reaching tasks. The deviating COP displacement patterns are discussed as a possible dysfunction in the ability to make postural adjustments and learn an efficient movement pattern. Copyright © 2007 John Wiley & Sons, Ltd.     

Symmetrical body-weight distribution training in stroke patients and its effect on fall prevention

OBJECTIVE: To determine the role of symmetrical body-weight distribution training in preventing falls among patients with hemiplegic stroke. DESIGN: A prospective study using a standing biofeedback trainer. SETTING: Hospital-based rehabilitation units. PATIENTS: Fifty-four patients with hemiplegic stroke (30 in the training group, 24 in the control group). INTERVENTIONS: Conventional stroke rehabilitation program, plus symmetrical standing training and repetitive sit-to-stand training, with a standing biofeedback trainer. Training effect was evaluated by assessing the sit-to-stand performance and comparing the occurrence of falls in the 2 groups at a 6-month follow-up. MAIN OUTCOME MEASURES: Occurrence of falls, sit-to-stand performance, including body-weight distribution, rate of rise in force, and sway in center of pressure (COP). RESULTS: Significant improvement in sit-to-stand performance was found in patients in the training group. Body weight was distributed more symmetrically in both legs, with less mediolateral sway in the COP when rising and sitting down. The mean difference in body-weight distribution between the left and right legs while subjects were rising from a chair significantly decreased, from 49.5% +/- 18.9% to 38.6% +/- 15.8% of body weight (BW) (p < .005). The rate of rise in force while rising from a chair significantly increased, from 28.3% +/- 13.5%BW/s to 53.6% +/- 20.5%BW/s (p < .001). At the 6-month follow-up, 10 of 24 patients (41.7%) in the control group had fallen, compared with only 5 of 30 patients (16.7%) in the training group (p < .05). CONCLUSIONS: Symmetrical body-weight distribution training may improve sit-to-stand performance and, consequently, decrease the number of falls by stroke patients.