姿势对脑卒中偏瘫患者站-坐转移下肢负重及稳定性的影响

目的:探讨不同的四肢体位对脑卒中偏瘫患者站-坐转移下肢负重及稳定性的影响。方法:选取30例脑卒中偏瘫患者为实验组,30例正常人为对照组,两组受试者均在4种肢位下完成站-坐转移,对受试者完成站-坐转移的时间、双下肢负重、人体重心点在冠状面上的最大摆动幅度(COGX)进行比较。结果:不同上肢体位下脑卒中偏瘫患者站-坐转移的所需时间、下肢负重及COGX的差异不显著(0.05P0.1)。不同足位下脑卒中偏瘫患者站-坐转移的时间、下肢负重及COGX有差异,差异具有显著性意义(P0.05);患足置后,脑卒中偏瘫患者完成站-坐转移时双下肢负重的不对称性要明显小于健足置后(P0.05);而当健足置后时,脑卒中偏瘫患者完成站-坐转移的稳定性要明显优于患足置后(P0.05)。正常人在不同四肢体位下其站-坐转移的时间、下肢负重及COGX均无显著性意义(P0.05)。结论:不同上肢体位对脑卒中偏瘫患者站-坐转移的稳定性及下肢负重无明显影响;不同足位能显著影响脑卒中偏瘫患者站-坐转移时稳定性及下肢负重,患足置后可视为一种潜在提高患侧下肢功能的训练方法。     

不同足位对脑卒中偏瘫患者坐-站转移稳定性及下肢负重的影响

目的探讨不同足位对脑卒中偏瘫患者坐-站转移稳定性及下肢负重的影响。 方法选取脑卒中偏瘫患者36例（实验组）和健康人36例（对照组）,2组受试者均需在双足（BF）踝背屈10°、BF踝背屈10°时患足置后（PFP）或非优势足置后（UFDP）、BF踝背屈10°时健足置后（NPFP）或优势足置后（DFP）3种足位下完成坐-站转移测试,采用AL-080型步态与平衡功能训练评估系统对受试者完成坐-站转移的时间、双下肢负重差异（ALD）、人体重心点（COG）在冠状面上的摆动幅度（COGX）进行测量,探讨其不同差异。 结果BF踝背屈10°时,除坐-站转移所需的时间外,健足平均负重［（59.12±2.71）%］、患足平均负重［（40.88±2.71）%］、ALD［（18.24±5.41）%］及COGX［（3.58±0.76）cm］与PFP比较,差异均有统计学意义（P<0.05）。NPFP时,上述所有指标与PFP比较,差异均有统计学意义（P<0.05）,与BF踝背屈10°时各指标比较,除坐-站转移所需时间外,剩余指标与其差异均有统计学意义（P<0.05）。与对照组UDEP比较,BF踝背屈10°时所有指标均有不同程度增高或降低（P<0.05）,DFP时,除坐-站转移所需时间外,剩余指标与UDFP时比较,差异均有统计学意义（P<0.05）。对照组3种足位下所有指标与实验组比较,差异均有统计学意义（P<0.05）。实验组PFP时（r=0.753、P=0.00）、BF踝背屈10°时（r=0.798、P=0.00）、NPFP时（r=0.814、P=0.00）ALD与COGX之间呈高度正相关性,对照组UDFP时（r=0.764、P=0.00）、BF踝背屈10°时（r=0.824、P=0.00）、DFP时（r=0.838、P=0.00）ALD与COGX之间亦呈高度正相关性。 结论不同足位对脑卒中偏瘫患者坐-站转移稳定性及下肢负重的影响较大,患者双下肢负重的对称性越高,其姿势稳定性越好。     

对称负重式坐站-站坐训练对脑卒中偏瘫患者平衡功能以及ADL的影响

目的：探讨对称负重式坐站-站坐训练对脑卒中偏瘫患者平衡功能以及ADL的影响。方法：48例脑卒中偏瘫患者随机分为2组各24例,生命体征平稳后均接受常规康复治疗,对照组给予常规的双足平行位进行坐站-站坐训练;观察组患者采用患足置后下坐站-站坐训练;2组患者均接受4周,每周5次,每次30min的坐站-站坐训练。训练前后分别采用Berg平衡量表(BBS)评分、改良Barthel指数评定量表 (MBI)评定平衡能力、日常生活活动能力,使用平衡评估系统测试2组患者训练前后坐位静态下压力中心点的轨迹长及轨迹面积（COP-SL、COP-SA）、训练后独立完成坐站及站坐的时间、双下肢负重对称性（WBasym）。结果：训练后,2组患者CoP-SL较训练前明显降低（P<0.01）,2组患者CoP-SA、BBS及MBI较训练前明显提高（P<0.01）;观察组的BBS及MBI评分更高于对照组（P<0.01）,2组的坐位平衡比较差异无统计学意义。训练4周后,观察组完成坐-站转移所需的时间、健侧下肢负重、WBasym均明显低于对照组（P<0.01）,患足负重明显高于对照组（P<0.01）。观察组完成站-坐转移所需的时间、健/患侧下肢负重、WBasym与对照组相比较,差异无统计学意义。结论：对称负重式坐站-站坐训练能更好地促进脑卒中偏瘫患者平衡功能以及ADL提高。     

改良坐-站转移训练对脑卒中偏瘫患者下肢运动功能及平衡能力的影响

目的观察改良坐-站训练对脑卒中偏瘫患者下肢运动功能及平衡能力的影响。 方法采用随机数字表法将50例脑卒中后偏瘫患者分为实验组及对照组,每组25例。2组患者于生命体征稳定后均给予常规康复治疗,对照组患者在此基础上辅以常规坐-站转移训练,实验组患者则辅以改良坐-站转移训练（即在患足置后情况下进行坐-站转移训练）。于治疗前、治疗4周后分别采用Berg平衡量表(BBS)、Fugl-Meyer评定法下肢部分（FMA-L）对2组患者进行评定,同时使用AL-080型平衡功能评估系统对2组患者坐-站转移所需时间、下肢负重差异（ALD）及人体重心在冠状面上摆动幅度（COGX）进行评测,并观察其差异性。 结果与治疗前比较,2组患者治疗后其BBS评分、FMA-L评分、坐-站转移所需时间、ALD及COGX均显著改善（P<0.05）;进一步分析发现,实验组患者治疗后其BBS评分［(47.5±5.3)分］、FMA-L评分［(22.4±7.3)分］、坐-站转移所需时间［(3.01±0.61)s］、ALD［(17.24±5.35)］及COGX［(2.87±0.52)cm］均显著优于对照组水平（P<0.05）。 结论改良坐-站转移训练能进一步促进脑卒中偏瘫患者下肢运动功能及平衡能力提高,该疗法值得临床推广、应用。     

脑卒中偏瘫患者坐-站转移生物力学分析研究进展

脑卒中偏瘫常导致患者坐-站转移功能障碍。本文从生物力学角度综述脑卒中偏瘫患者在坐-站转移过程中的运动学、动力学及表面肌电的研究进展,介绍脑卒中偏瘫患者坐-站转移功能障碍的康复方案。发现在自然、对称和健足置后等三种不同足位条件下站起,患者的稳定性、坐-站转移时间、下肢负重对称性、肌肉激活程度和时序都有所不同;偏瘫患者进行早期坐-站转移康复训练或配合其他康复可改善患侧下肢功能,预防跌倒和患侧肢体失用。     

早期坐-站转移训练对亚急性脑卒中偏瘫患者平衡功能的影响

目的：探讨早期坐-站训练对亚急性脑卒中偏瘫患者平衡功能的影响。方法：44例亚急性不能独立完成坐-站转移的脑卒中偏瘫患者随机分为2组各22例,均接受常规康复治疗,对照组给予常规辅助下坐-站转移训练;观察组患者采用患足置后下辅助坐-站转移训练。训练前后采用Berg平衡量表(BBS)评估2组患者的平衡功能、AL-080平衡功能评估系统测试2组患者训练前后坐位静态下压力中心点的轨迹长（SLsi）、坐位稳定极限下压力中心点的最大面积（SAsi）、训练后独立完成坐-站转移时间（T）、双下肢负重差异（ALD）、足底压力峰值（Fmax）以及站立静态下压力中心点的轨迹长（SLst）、站立稳定极限下压力中心点的最大面积（SAst）。结果：训练2周后,2组SLsi评分均较训练前明显下降(P<0.01),且观察组更低于对照组(P<0.05);2组SAsi及BBS评分均较训练前明显提高(P<0.01),且观察组更高于对照组(P<0.05)。训练后, 观察组完成坐-站转移所需的时间、健侧下肢负重及ALD评分均明显低于对照组(P<0.05),观察组患侧下肢负重、Fmax及动态SAst评分均明显高于对照组(P<0.05);2组SLst评分比较差异无统计学意义。结论：早期坐-站转移训练能更好地促进脑卒中偏瘫患者平衡功能提高,且采用患足置后下坐-站转移训练效果更佳。     

对称负重式坐站—站坐训练对脑卒中偏瘫病人平衡功能、坐站转移能力及双下肢负重对称性的影响

目的:探讨对称负重式坐站—站坐训练对脑卒中偏瘫病人平衡功能、坐站转移能力及双下肢负重对称性的影响。方法:选取本院150例脑卒中偏瘫病人为研究对象,依据训练干预方式不同分为常规组和观察组各75例。两组均行常规康复治疗,常规组予常规双足平行位行坐站—站坐训练,观察组予对称负重式坐站—站坐训练,对比两组平衡功能,坐站转移能力,步态对称性。结果:两组干预2个月末Berg平衡量表(BBS)评分、压力中心轨迹包围的最大面积(CoP-SA)较干预前升高,观察组高于常规组;坐位静态下压力中心点的轨迹长(CoP-SL)较干预前降低,观察组低于常规组(P<0.05)。两组干预2个月末5次坐立测试(FTSST)、起立-行走计时测试(TUGT)水平较干预前降低,观察组低于常规组;观察组干预2个月末独立完成坐站、独立完成站坐时间低于常规组(P<0.05)。两组干预2个月末健患侧支撑比值、患健摆动比值、步长偏差水平较干预前降低,观察组低于常规组;观察组由坐到站、由站到坐下肢负重的不对称性(WBasym)水平高于常规组(P<0.05)。结论:对称负重式坐站-站坐训练可调节脑卒中偏瘫病人步态对称性,...     

强化蹲-起训练联合核心稳定性训练对脑卒中偏瘫患者坐-站转移能力及步态对称性的影响

目的：探讨强化蹲-起训练及核心稳定性训练对恢复期脑卒中偏瘫患者坐-站转移能力及步态对称性 的影响。方法：恢复期脑卒中偏瘫患者50例随机分为常规组和强化组,各25例。2组均给予常规康复治疗 并强化核心稳定性训练,强化组在此基础上增加强化蹲-起训练。训练前、训练6周后分别采用5次坐立测 试（FTSST）评估坐站转移能力,起立-行走计时测试（TUGT）评估坐-站-步行能力,Gait Watch三维步态分析 系统评估步态对称性参数（包括步长偏差、健患侧支撑比值及患健侧摆动比值）。结果：训练6周后,2组患 者FTSST、TUGT测试结果,步长偏差、健患侧支撑比值及患健侧摆动比值均显著低于同组训练前（均P＜ 0.05）,且强化组低于常规组（均P＜0.05）。结论：强化蹲-起训练联合核心稳定性训练可有效改善恢复期脑 卒中偏瘫患者坐站转移能力及步态对称性。     

偏瘫患者上肢位置对坐站转移姿势稳定性的影响

目的:探讨偏瘫患者不同的上肢位置对坐站转移稳定性的影响。方法:观察组(脑卒中偏瘫患者)和对照组(正常人)各30例,2组均在两种上肢位置下完成坐站转移,对受试者完成坐站转移的时间、下肢负重、人体重心点的摆动幅度进行比较。结果:观察组受试者上肢的体位对坐站转移的稳定性影响显著(P0.05),双手叉握下完成坐站转移的稳定性要明显优于双手自然放于身体两侧(P0.05)。结论:脑卒中偏瘫患者上肢位置影响坐站转移的稳定性,当双手叉握时,完成坐站转移的稳定性较好。     

不同站立姿势对偏瘫患者足底压力及平衡功能的影响

摘要 目的：探讨偏瘫患者不同站立姿势下足底压力的变化及对平衡功能的影响。 方法：选择24例偏瘫患者,要求每位患者在Novel Zebris压力测试平板上,分别以四种姿势站立,即双足并拢、双足左右分开、健足在前患足在后,以及患足在前健足在后站立,测试患者在四种不同站立姿势下的压力峰值、平均压力、压力中心偏移的椭圆轨迹长度,以及椭圆轨迹包络面积。 结果：①压力峰值：双足分开较双足并拢站立时,健侧前半足和后半足压力峰值均有明显下降（P＜0.05）;患足在前较患足在后站立时,患足压力峰值明显下降（P＜0.05）。②平均压力值：双足分开较双足并拢站立时,健侧前半足平均压力明显下降,后半足平均压力明显提高（P＜0.05）,但患侧前半足和后半足平均压力变化不大（P＞0.05）;健侧和患侧整足平均压力无明显变化（P＞0.05）;患足在前较患足在后站立时,健足平均压力明显提高,患足平均压力明显下降（P＜0.05）。③压力中心偏移的椭圆轨迹长度和椭圆面积：双足分开较双足并拢站立时椭圆面积明显下降（P＜0.05）,椭圆轨迹长度明显增加（P＜0.05）,椭圆轨迹长度与椭圆面积比值明显下降（P＜0.05）;患足在前较患足在后站立时,椭圆面积明显下降（P＜0.05）,椭圆轨迹长度与椭圆面积比值明显下降（P＜0.05）。 结论：①四种常见的站立姿势中,患足在前站立时健患足平均压力较其它三种站立姿势有明显差异,双足并拢、双足分开、健足在前站立时健患足平均压力几乎一致。②四种站立姿势中,双足分开站立时患者的平衡稳定性最好。     

Effects of a knee–ankle–foot orthosis on gait biomechanical characteristics of paretic and non-paretic limbs in hemiplegic patients with genu recurvatum

Background

A knee–ankle–foot orthosis may be prescribed for the prevention of genu recurvatum during the stance phase of gait. It allows also to limit abnormal plantarflexion during swing phase. The aim is to improve gait in hemiplegic patients and to prevent articular degeneration of the knee. However, the effects of knee–ankle–foot orthosis on both the paretic and non-paretic limbs during gait have not been evaluated. The aim of this study was to quantify biomechanical adaptations induced by wearing a knee–ankle–foot orthosis, on the paretic and non-paretic limbs of hemiplegic patients during gait.

Methods

Eleven hemiplegic patients with genu recurvatum performed two gait analyses (without and with the knee–ankle–foot orthosis). Spatio-temporal, kinematic and kinetic gait parameters of both lower limbs were quantified using an instrumented gait analysis system during the stance and swing phases of the gait cycle.

Findings

The knee–ankle–foot orthosis improved spatio-temporal gait parameters. During stance phase on the paretic side, knee hyperextension was reduced and ankle plantarflexion and hip flexion were increased. During swing phase, ankle dorsiflexion increased in the paretic limb and knee extension increased in the non-paretic limb. The paretic limb knee flexion moment also decreased.

Interpretation

Wearing a knee–ankle–foot orthosis improved gait parameters in hemiplegic patients with genu recurvatum. It increased gait velocity, by improving cadence, stride length and non-paretic step length. These spatiotemporal adaptations seem mainly due to the decrease in knee hyperextension during stance phase and to the increase in paretic limb ankle dorsiflexion during both phases of the gait cycle.     

脑卒中患者坐位及站立位胫骨前肌和腓肠肌表面肌电图信号特征研究

目的分析脑卒中患者坐位及站立位胫骨前肌和腓肠肌表面肌电图(sEMG)信号特征。方法选取15例脑卒中患者和15例正常人作为实验组和对照组,令受试者连续做5次由坐到站,采用表面电极引导和记录两侧胫骨前肌和腓肠肌肌电信号并进行线性时、频分析。结果脑卒中患者坐位患侧与健侧、健侧与正常人对应健侧胫骨前肌的平均功率频率(MPF)和中位频率(MF)差异有显著性意义(P<0.05);脑卒中患者健侧与正常人对应健侧腓肠肌均方根差异有显著性意义(P<0.05);脑卒中患者站立位患侧与健侧、健侧与正常人对应健侧胫骨前肌均方根和积分肌电(iEMG)差异有非常显著性意义(P<0.01);脑卒中患者健侧与患侧、患侧与正常人对应患侧腓肠肌均方根和iEMG差异有显著性意义(P<0.05或P<0.01)。结论sEMG是一种简单、实用、可行的康复评定方法。     

Weight-bearing on the lower limbs in a sitting position during bilateral movement of the upper limbs in post-stroke hemiparetic subjects.

OBJECTIVE: Verify weight-bearing on the feet in a sitting position during pointing in different directions with 1 or both upper limbs. DESIGN: Comparative study. SUBJECTS: Fifteen subjects with post-stroke hemiparesis with good to very good motor recovery and 13 healthy subjects participated in the study. METHODS: The subjects were seated on a chair with each foot resting on a force plate. They had to touch with 1 or, simultaneously with both hands, 2 target(s) located in front of them or at a 45 degrees angle on either side at a standardized distance beyond their upper limb's length. The percentage of weight loading variation under each foot was measured. RESULTS: Weight-bearing on the paretic foot is reduced during unilateral and bilateral pointing in the anterior direction and 45 degrees ipsilateral to the paretic side. However, both unilateral and bilateral pointing 45 degrees contralateral to the paretic side produced symmetrical weight-bearing on both feet, paretic and non-paretic. CONCLUSION: Since the paretic muscles of the trunk are probably used to control the leaning of the trunk towards the non-paretic side, the subjects with hemiparesis may put weight on the paretic foot to compensate for trunk weakness and maintain balance.     

Determinants of the sit-to-stand movement: a review

BACKGROUND AND PURPOSE: The sit-to-stand (STS) movement is a skill that helps determine the functional level of a person. Assessment of the STS movement has been done using quantitative and semiquantitative techniques. The purposes of this study were to identify the determinants of the STS movement and to describe their influence on the performance of the STS movement. METHODS: A search was made using MEDLINE (1980-2001) and the Science Citation Index Expanded of the Institute for Scientific Information (1988-2001) using the key words "chair," "mobility," "rising," "sit-to-stand," and "standing." Relevant references such as textbooks, presentations, and reports also were included. Of the 160 identified studies, only those in which the determinants of STS movement performance were examined using an experimental setup (n=39) were included in this review. RESULTS: The literature indicates that chair seat height, use of armrests, and foot position have a major influence on the ability to do an STS movement. Using a higher chair seat resulted in lower moments at knee level (up to 60%) and hip level (up to 50%); lowering the chair seat increased the need for momentum generation or repositioning of the feet to lower the needed moments. Using the armrests lowered the moments needed at the hip by 50%, probably without influencing the range of motion of the joints. Repositioning of feet influenced the strategy of the STS movement, enabling lower maximum mean extension moments at the hip (148.8 N m versus 32.7 N m when the foot position changed from anterior to posterior). DISCUSSION AND CONCLUSION: The ability to do an STS movement, according to the research reviewed, is strongly influenced by the height of the chair seat, use of armrests, and foot position. More study of the interaction among the different determinants is needed. Failing to account for these variables may lead to erroneous measurements of changes in STS performance.     

早期按摩足底反射区及关节训练对脑卒中病人预后的影响

[目的]探讨按摩足底反射区及关节训练对脑卒中病人康复的影响。[方法]将80例偏瘫病人随机分为两组,每组40例,两组病人均实施神经内科常规护理和体住护理,另外实验组入院后生命体征稳定后开始按摩足底反射区及关节训练;采用Barthel指数（B1）、神经功能缺损量表（NIHSS）、Fugl—Meyer量表评价病人关节活动度、日常生活能力和神经缺损功能。[结果]病人BI、NIHSS、Fugl—Meye评分实验组各个时点之间比较差异均有统计学意义（P均〈0．001）。两组干预后各个时点BI、NIHSS、Fugl—Meye评分比较差异均有统计学意义（P均〈0．001）。[结论]早期按摩足底反射区及关节训练能够提高日常生活能力、改善急性脑卒中偏瘫病人神经缺损功能和肢体运动功能。     

A study of structural foot deformity in stroke patients

[Purpose] The aim of this study was to evaluate the structural deformity of the foot joint on the affected side in hemiplegic patients to examine factors that affect this kind of structural deformity. [Subjects and Methods] Thirty-one hemiplegic patients and 32 normal adults participated. The foot posture index (FPI) was used to examine the shape of the foot, the modified Ashworth scale test was used to examine the degree of ankle joint rigidity, the navicular drop test was used to investigate the degree of navicular change, and the resting calcaneal stance position test was used to identify location change of the heel bone. [Results] The FPIs of the paretic side of the hemiplegic patients, the non-paretic side of the hemiplegic patients, and normal participants were −0.25 ± 2.1, 1.74 ± 2.3, and 2.12 ± 3.4 respectively. [Conclusion] Our findings indicated that in stroke-related hemiplegic patients, the more severe the spasticity, the more supinated the foot. Further, the smaller the degree of change in the navicular height of hemiplegic patients is, the more supinated the paretic side foot is. Additionally, a greater change in the location of the calcaneus was associated with greater supination of the overall foot.Key words: Foot posture index, Hemiplegic foot, Foot deformity     

Differences in Rheobase and Chronaxie between the Paretic and Non-Paretic Sides of Hemiplegic Stroke Patients: a Pilot Study

[Purpose] Rheobase and chronaxie are used to confirm muscle degeneration. For stroke patients, however, the uses of rheobase and chronaxie in determining paretic side muscle degeneration is not yet fully understood. Thus, in this study, we examined the electrical properties of the quadriceps muscles of stroke patients’ paretic side and compared them with their respective values on the non-paretic side. [Method] The subjects were six stroke patients (three females, three males). The pad of an electrical stimulator was applied to the vastus lateralis and vastus medialis regions to measure rheobase and chronaxie until the contractive muscle response to electrical stimulation became visible. [Result] Rheobase was significantly increased on the paretic side compared to that of the non-paretic side of hemiplegic stroke patients. Furthermore, chronaxie was significantly increased on the paretic side compared to the non-paretic side of hemiplegic stroke patients. [Conclusion] These results suggest that stroke affects the sensitivity of skeletal muscle contraction. Therefore, this data may contribute to our understanding of the muscle status of stroke patients.Key words: Rheobase, Chronaxie, Hemiplegic stroke patients     

Compensatory stepping responses in individuals with stroke: a pilot study

Impaired postural control and a high incidence of falls are commonly observed following stroke. Compensatory stepping responses are critical to reactive balance control. We hypothesize that, following a stroke, individuals with unilateral limb dyscontrol will be faced with the unique challenge of controlling such rapid stepping reactions that may eventually be linked to the high rate of falling. The objectives of this exploratory pilot study were to investigate compensatory stepping in individuals poststroke with regard to: (1) choice of initial stepping limb (paretic or non-paretic); (2) step characteristics; and (3) differences in step characteristics when the initial step is taken with the paretic vs. the non-paretic limb. Four subjects following stroke (38-165 days post) and 11 healthy young adults were recruited. Anterior and posterior perturbations were delivered by using a weight drop system. Force plates recorded centre-of-pressure excursion prior to the onset of stepping and step timing. Of the four subjects, three only attempted to step with their non-paretic limb and one stepped with either limb. Time to foot-off was generally slow, whereas step onset time and swing time were comparable to healthy controls. Two of the four subjects executed multistep responses in every trial, and attempts to force stepping with the paretic limb were unsuccessful in three of the four subjects. Despite high clinical balance scores, these individuals with stroke demonstrated impaired compensatory stepping responses, suggesting that current clinical evaluations might not accurately reflect reactive balance control in this population.