星状伸展平衡测试评定脑卒中患者动态平衡的信度和效度

探讨星状伸展平衡测试(SEBT)对脑卒中患者动态平衡功能评定的价值。     

Lower limb kinematics and hip extensors strengths are associated with performance of runners at high risk of injury during the modified Star Excursion Balance Test

BackgroundReduced trunk and lower limb movement and hip and trunk muscles weakness may compromise the athletes’ performance on the modified Star Excursion Balance Test (mSEBT).ObjectiveTo investigate the relationship of trunk and lower limb kinematics and strength with the performance on the mSEBT of runners at high risk of injury.MethodsThirty-nine runners performed the mSEBT with the dominant limb as the support limb. An Inertial System was used to capture the trunk, hip, knee and ankle movement during the mSEBT. A handheld dynamometer was used to measure the strength of trunk extensors and lateral flexors muscles, and hip extensors, lateral rotators and abductors of the support limb. Multiple regressions were used to investigate if trunk and lower limbs kinematics and trunk and hip muscles strength are associated with performance during the mSEBT.ResultsReduced hip flexion and greater knee flexion range of motion (ROM) were associated with anterior reach in the mSEBT (r² = 0.45; p < .001), greater hip flexion ROM was associated with posteromedial reach (r² = 0.15; p = .012) and greater knee flexion ROM was associated with posterolateral reach (r² = 0.23; p < .001). Hip extensor strength was associated with posteromedial (r² = 0.14; p = .017), posterolateral (r² = 0.10; p = .038) and composite reaches (r² = 0.16; p = .009).ConclusionHip and knee kinematics in the sagittal plane explained 15–45% of the runners’ performance on the mSEBT and hip extensor strength explained 10–16% of the mSEBT performance. These findings provide useful information on the contribution of joints kinematics and strength when evaluating dynamic postural control in runners at high risk of injury.     

Reliability of the Modified Star Excursion Balance Test in individuals with Down Syndrome

Neuromotor problems such as hypotonia, incoordination, impaired sensory-motor integration lead to significant delays in motor skills and balance development in individuals with Down Syndrome (DS). Balance control is essential for performing many motor skills independently and safely. Standardised testing of balance control can contribute significantly to the rehabilitation of individuals with DS. The purpose of this study was to determine intrarater and interrater reliability of the Modified Star Excursion Balance Test (SEBT) for individuals with DS. Thirteen individuals with DS were recruited in this study. Intraclass correlation coefficients (ICC [3,1]) with 95% confidence intervals, standard error of measurement (SEM), the smallest detectable difference (SDD) and the Spearman rank correlation coefficient were calculated. In all directions of the Modified SEBT, no statistically significant difference was found between two raters’ first and second measurements (p > 0.05). Interrater reliability for all reach directions of the Modified SEBT was high, with ICC ranging from 0.990 to 0.998.95% confidence intervals, SEM and SDD ranged from 0.924 to 0.999, 0.180–2.434 and 3.270–6.747, respectively. The Modified SEBT are reliable for evaluating dynamic balance in individuals with DS aged between 6 and 24 years.     

Effects of posture on plasma and serum viscosity

Summary This study demonstrates the importance of defining normal reference population ranges for P- and S-viscosity with respect to posture. The normal ranges determined for P-viscosity are not acceptable as a reference range for a hospitalized population that is predominantly in a supine position. Mean percentage changes of P-and S-viscosity in the recumbent posture as compared to the same population in the upright posture were 7.51 and 5.88, respectively.     

The Reliability of an Instrumented Device for Measuring Components of the Star Excursion Balance Test

Background

The Star Excursion Balance Test (SEBT) is a dynamic test that requires strength, flexibility, and proprioception and has been used to assess physical performance, identify chronic ankle instability, and identify athletes at greater risk for lower extremity injury. In order to improve the repeatability in measuring components of the SEBT, the Y Balance Test™ has been developed.

Objective

The purpose of this paper is to report the development and reliability of the Y Balance Test™.

Methods

Single limb stance excursion distances were measured using the Y Balance Test™ on a sample of 15 male collegiate soccer players. Intraclass Correlation Coefficients (ICC) were used to determine the reliability of the test.

Results

The ICC for intrarater reliability ranged from 0.85 to 0.91 and for interrater reliability ranged from 0.99 to 1.00. Composite reach score reliability was 0.91 for intrarater and 0.99 for interrater reliability.

Discussion

This study demonstrated that the Y Balance Test™ has good to excellent intrarater and interrater reliability. The device and protocol attempted to address the common sources of error and method variation in the SEBT including whether touch down is allowed with the reach foot, where the stance foot is aligned, movement allowed of the stance foot, instantaneous measurement of furthest reach distance, standard reach height from the ground, standard testing order, and well defined pass/fail criteria.

Conclusion

The Y Balance Test™ is a reliable test for measuring single limb stance excursion distances while performing dynamic balance testing in collegiate soccer players.     

Reliability of the Star Excursion Balance Test and Two New Similar Protocols to Measure Trunk Postural Control

Background

Although the Star Excursion Balance test (SEBT) has shown a good intrasession reliability, the intersession reliability of this test has not been deeply studied. Furthermore, there is an evident high influence of the lower limbs in the performance of the SEBT, so even if it has been used to measure core stability, it is possibly not the most suitable measurement.

髋关节外展肌训练对全膝关节置换术后下肢肌力和步行功能的影响

摘要 目的：探究全膝关节置换（TKA）术后早期康复训练中强化髋关节外展肌训练对患者下肢肌力及步行功能的影响。 方法：选取2020年1月至2021年10月在山东大学齐鲁医院（青岛）因膝关节骨性关节炎初次行全膝关节置换的患者60例,采用随机数字法分为试验组（n=30）和对照组（n=30）,对照组采用常规康复训练方法,试验组在常规康复基础上增加髋关节外展肌训练,两组进行4周每周5次的训练。干预前后分别对两组进行等速肌力测试、膝关节功能（KSS）评分、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分、“起立-行走”计时测试（TUGT）、三维步态分析。 结果：经4周康复干预后：试验组髋关节外展相对峰力矩、膝关节屈伸相对峰力矩、KSS评分均显著高于干预前（均P＜0.01）;WOMAC疼痛、僵硬、功能、总分及TUGT完成时间显著低于干预前（均P＜0.05）;步速、步幅、患侧支撑百分比及髋、膝关节矢状面活动范围显著高于干预前（均P＜0.05）;双支撑百分比低于干预前（P＜0.05）。干预后试验组髋关节外展相对峰力矩、KSS评分显著高于对照组（均P＜0.01）;WOMAC疼痛、功能、总分及TUGT完成时间低于对照组（均P＜0.05）;步幅、患侧支撑百分比患侧髋、膝关节矢状面活动范围均高于对照组（均P＜0.05）。 结论：全膝关节置换术后早期康复训练中强化髋关节外展肌训练能更好改善患者的下肢肌力及步行功能。     

体位干预对剖宫产术后下肢深静脉血栓形成的影响

目的:探讨体位干预对剖宫产术后下肢深静脉血栓形成(LEDVT)的影响.方法:将1170例剖宫产产妇随机分为观察组590例和对照组580例,观察组于剖宫产术后采用体位干预,而对照组则采用常规体位.分别观察、记录两组产妇产后下肢肿胀、疼痛及发生LEDVT的情况,并进行对照比较.结果:观察组术后下肢肿胀、疼痛发生率为2.37%.LEDVT发生率为0.85%;对照组下肢肿胀、疼痛发生率为5.69%,LEDVT发生率为3.10%.两组比较均有极显著性差异(P<0.01).结论:体位干预能有效地预防剖宫产术后LEDVT的发生,对减少产后并发症、促进产后恢复具有重要的临床意义.     

Effects of posture on upper and lower limb peripheral resistance following submaximal cycling

The purpose of this study was to determine postural effects on upper and lower limb peripheral resistance (PR) after submaximal exercise. Twelve subjects (six men and six women) completed submaximal cycle ergometer tests (60% age-predicted maximum heart rate) in the supine and upright seated positions. Each test included 20 minutes of rest, 20 minutes of cycling, and 15 minutes of recovery. Stroke volume and heart rate were determined by impedance cardiography, and blood pressure was measured by auscultation during rest, immediately after exercise, and at minutes 1-5, 7.5, 10, 12.5, and 15 of recovery. Peripheral resistance was calculated from values of mean arterial pressure and cardiac output. No significant (p less than 0.05) postural differences in PR were noted during rest for either limb. Immediately after exercise, PR decreased (55% to 61%) from resting levels in both limbs, independent of posture. Recovery ankle PR values were significantly different between postures. Upright ankle PR returned to 92% of the resting level within four minutes of recovery, compared to 76% of the resting level after 15 minutes in the supine posture. Peripheral resistance values in the supine and upright arm were not affected by posture and demonstrated a gradual pattern of recovery similar to the supine ankle recovery response (85% to 88% of rest within 15 minutes). The accelerated recovery rate of PR after upright exercise may result from local vasoconstriction mediated by a central regulatory response to stimulation from gravitational pressure on lower body circulation.     

不同下肢体位振动对脑卒中患者下肢肌力及运动功能的影响

目的:探讨不同下肢体位振动治疗对脑卒中患者下肢功能和肌力的影响。方法:选择2018年7月至2019年8月于西南医科大学附属医院康复科收治的72例脑卒中患者,随机分为对照组、迈步振动组、后伸振动组、屈膝运动振动组,每组18例。三种振动治疗组在对照组基础上增加不同体位下的振动治疗,20min/次,1次/天,5天/周,持续6周。在基线、振动训练6周、随访12周时评估Fugl-Meyer量表下肢部分、起立-行走计时试验(TUG)、膝屈伸肌等速肌力峰力矩。结果:共66例患者完成该研究。各组6周及12周时Fugl-Meyer、TUG、双侧伸膝及屈膝肌峰力矩均较治疗前有显著性差异(P<0.05)。三种振动治疗组6周及12周时Fugl-Meyer、TUG、患侧伸膝肌峰力矩较对照组有显著性差异(P<0.05)。屈膝运动振动组6周时患侧伸膝肌峰力矩显著高于迈步组及后伸组(P<0.05)。四组健侧伸膝肌、双侧屈膝肌峰力矩在6周与12周差异不具备显著性意义(P>0.05)。结论:全身振动疗法能提高脑卒中患者患侧膝关节伸肌肌力与下肢整体运动功能,且屈膝运动振动治疗在提高患侧伸肌力量方面更具优势。     

Correlation between lower limb and trunk muscle endurance with drop vertical jump in the special military forces

ObjectivePolice officers, particularly the ones who are trained to be on “special forces”, perform a wide range of hazardous and physically demanding activities when aiming to protect and serve. The purpose of this study was to investigate the association between lower limb and trunk muscle endurance with drop vertical jump (DVJ) height in a special military police force.MethodsOne hundred and three male military men (age: 36 ± 5.0 years; height: 1.76 ± 0.05 m; weight: 81.8 ± 9.7 kg) volunteered to take part in this study.Six tests were performedDVJ, McGill core battery (trunk flexion, trunk extension, and side bridge test—right and left), and single-leg squat repetitions. Correlations were analyzed using the Pearson correlation coefficient (r). The level of significance for all analyses was set at p ≤ 0.05.ResultsSingle-leg squat repetitions were positively associated with DVJ height, contact time and flight time (p = 0.000937, p = 0.000857, and p = 0.000987 respectively). No correlation was observed between trunk muscle endurance and DVJ.ConclusionTherefore, it was concluded that greater endurance of the lower limb muscles, as demonstrated by the single leg squat, was associated with better performance in a DVJ. Individuals should consider incorporating single leg squats into their fitness program to develop muscular endurance and possibly perform better in the DVJ.     

Test of Intrarater and Interrater Reliability for the Star Excursion Balance Test

[Purpose] The aim of this study was to examine the intrarater and interrater reliability of the Star Excursion Balance Test (SEBT), thereby increasing understanding of its efficient utilization. [Subjects and Methods] There were 67 subjects (49 female; 18 male). For the SEBT, eight lines were made using tape at 45-degree angles from the center of a circle. The experiment was conducted in the following order: the anterior, anterior-medial, medial, posterior-medial, posterior, posterior-lateral, lateral, and anterior-lateral directions. Intraclass correlation coefficients (ICC) (3,1) were used to evaluate the intrarater and interrater reliability (2,1) for each reach distance, while the standard error of measurement (SEM) and smallest detectable distance (SDD) were employed to assess absolute reliability. [Results] For intraratar reliability, the ICC values for all directions ranged from 0.88 to 0.96, SEM values ranged from 2.41 to 3.30, and SDD values ranged from 6.68 to 9.15. For interrater reliability, the ICC values for all directions ranged from 0.83 to 0.93, SEM values ranged from 3.19 to 4.26, and SDD values ranged from 8.85 to 11.82 [Conclusion] The SEBT is a highly reliable tool for measuring dynamic balance. Measurements for intrarater reliability are more reliable than measurements for interrater reliability. When measurement for eight directions was difficult, the SEBT was used. While the anterior, posteromedial, and posterolateral directions employed in the Y Balance Test Kit^TM can be utilized, this study recommends using the reverse Y Balance Test Kit^TM method with the posterior direction, not the anterior direction.Key words: Star excursion balance test (SEBT), Dynamic balance, Reliability     

Effects of involuntary eccentric contraction training by neuromuscular electrical stimulation on the enhancement of muscle strength

Background

Neuromuscular electrical stimulation is well-known as a modality to improve the performance of neuromuscular system, but its clinical value on muscle strengthening remains equivocal. In this study, we designed a system for an involuntary eccentric contraction of biceps brachii muscles using continuous passive movement and commercial neuromuscular electrical stimulation devices.

Methods

To investigate the effects of involuntary eccentric contraction training by neuromuscular electrical stimulation on the enhancement of muscle strength, seven healthy men between the ages of 24 and 29 years participated in this study. Participants were trained two times per week for 12 weeks. Each exercise session was performed for 30 min with no rest intervals. Isometric elbow flexion torque and biceps brachii muscle thickness were chosen as evaluation indices, and were measured at pre-/post-training.

Findings

After the 12-week training, the isometric elbow flexion torque of the trained side significantly increased by approximately 23% compared to the initial performance (P < 0.01). Meanwhile, the torque of the untrained side showed no significant change (P = 0.862). During the 12-week training period, the biceps brachii muscle thickness of the trained side significantly increased by around 8% at rest and 16% at maximum voluntary contraction (P < 0.01).

Interpretation

The developed system and the technique show promising results, suggesting that it has the potential to be used to increase the muscle strength in patients with neuromuscular disease and to be implemented in design rehabilitative protocols.     

The effect of peripheral neuropathy on lower limb muscle strength in diabetic individuals

BackgroundSkeletal muscle strength is poorly described and understood in diabetic participants with diabetic peripheral neuropathy. This study aimed to investigate the extensor and flexor torque of the knee and ankle during concentric, eccentric, and isometric contractions in men with diabetes mellitus type 2 with and without diabetic peripheral neuropathy.MethodsThree groups of adult men (n = 92), similar in age, body mass index, and testosterone levels, were analyzed: 33 non-diabetic controls, 31 with type 2 diabetes mellitus, and 28 with diabetic peripheral neuropathy. The peak torques in the concentric, eccentric, and isometric contractions were evaluated using an isokinetic dynamometer during knee and ankle flexion and extension.FindingsIndividuals with diabetes and diabetic peripheral neuropathy presented similar low concentric and isometric knee and ankle torques that were also lower than the controls. However, the eccentric torque was similar among the groups, the contractions, and the joints.InterpretationRegardless of the presence of peripheral neuropathy, differences in skeletal muscle function were found. The muscle involvement does not follow the same pattern of sensorial losses, since there are no distal-to-proximal impairments. Both knee and ankle were affected, but the effect sizes of the concentric and isometric torques were found to be greater in the participants' knees than in their ankles. The eccentric function did not reveal differences between the healthy control group and the two diabetic groups, raising questions about the involvement of the passive muscle components.     

Foot and ankle strength, range of motion, posture, and deformity are associated with balance and functional ability in older adults

Spink MJ, Fotoohabadi MR, Wee E, Hill KD, Lord SR, Menz HB. Foot and ankle strength, range of motion, posture, and deformity are associated with balance and functional ability in older adults.

Objective

To determine the extent to which measures of foot and ankle strength, range of motion, posture, and deformity are associated with performance in a battery of balance and functional ability tests in older adults.

Design

Cross-sectional study of people over 65 years.

Setting

Community.

Participants

Participants (N=305; age range, 65–93y) recruited for a randomized trial investigating the efficacy of a podiatry intervention to prevent falls.

Interventions

Not applicable.

Main Outcome Measures

Clinical measures of foot and ankle strength (using hand-held dynamometry), range of motion, posture, and deformity, and a battery of balance tests (postural sway, maximum balance range, lateral stability, coordinated stability) and functional ability tests (alternate step test, sit-to-stand, timed 6-m walk).

Results

Most (67/88) of the correlations between the foot and ankle tests and performance on the balance and functional tests were statistically significant. Hierarchic linear regression analysis identified hallux plantar flexion strength and ankle inversion-eversion range of motion to be the most consistent significant and independent predictors of balance and functional test performance, explaining up to 25% of the variance in the test scores.

Conclusions

Foot and ankle characteristics, particularly plantar flexor strength of the hallux and ankle inversion-eversion range of motion, are important determinants of balance and functional ability in older people. Further research is required to establish whether intervention programs that include strengthening and stretching exercises for the foot and ankle may achieve improvements in balance and functional ability and reduce the risk of falls in older people.     

Relationship between the duration of taekwondo training and lower limb muscle strength in adolescents

Previous studies have suggested that different durations of taekwondo (TKD) training may result in different lower limb muscle strengths. The objective of this study was to explore the relationship between the duration of TKD training (i.e., number of hours spent training per week) and lower limb muscle strength (at both fast and slow testing speeds) in adolescents. Isokinetic concentric knee and ankle muscle strengths were measured in 20 TKD practitioners (mean age: 15.8 years) at two different speeds (60°/second and 240°/second). Pearson’s correlation coefficient (two-tailed) showed that the number of TKD training hours per week was positively correlated with the peak torque of the knee extensors (r = 0.639, p = 0.002) and knee flexors (r = 0.472, p = 0.036) at 240°/second. This study did not show any significant correlation between TKD training duration and the peak torque of the knee flexors and extensors at slower speeds (60°/second) or the ankle plantar flexors at any speed. Our results support the notion that the more time one spends in TKD training the greater the muscle strength one could gain and that any subsequent improvements in knee muscle strength is velocity specific. Further study is needed to confirm the optimal amount of training and training parameters required to develop knee muscle strength in TKD athletes.     

Influence of posture and muscle length on stretch reflex activity in poststroke patients with spasticity

OBJECTIVE: To investigate the influence of different positions on stretch reflex activity of knee flexors and extensors measured by electromyography in poststroke patients with spasticity and its expression in the Ashworth Scale. DESIGN: Crossover trial with randomized order of positioning. SETTING: Outpatient rehabilitation center in the Netherlands. PARTICIPANTS: Poststroke patients (N = 19) with lower-limb spasticity. INTERVENTION: Changing position: sitting versus supine. MAIN OUTCOME MEASURES: Root mean square (RMS) values of muscle activity and goniometric parameters, obtained during the pendulum test and passive knee flexion and extension, and Ashworth scores. RESULTS: RMS values of bursts of rectus femoris activity were significantly higher in the supine compared with the sitting position (P = .006). The first burst of vastus lateralis activity during the pendulum test (P = .049) and semitendinous activity during passive stretch (P = .017) were both significantly higher in the supine versus the sitting position. For both the pendulum test and passive movement test, the duration and amplitude of the cyclic movement of the lower leg changed significantly as well. In the supine position, we found significantly higher Ashworth scores for the extensors (P = .001) and lower scores for the flexors (P = .002). CONCLUSIONS: The outcome of clinical and neurophysiologic assessment of spasticity is influenced considerably by subject positioning.     

下肢生物反馈训练对脑卒中患者运动及平衡功能的影响

目的:观察下肢生物反馈训练对脑卒中患者运动及平衡功能的影响。方法:选取脑卒中患者40例,按随机数字表法随机分为对照组(20例)和治疗组(20例)。对照组接受常规物理治疗;治疗组在常规物理治疗基础上接受下肢反馈训练。两组患者均接受8周治疗。比较两组患者治疗前后的下肢运动功能评分(Fugl-Meyer评价量表,FMA-L)、平衡功能评分(Berg平衡量表,BBS)、日常生活活动能力(改良Barthel指数,BI)以及下肢肌力(徒手肌力评估,MMT)的变化。结果:两组患者治疗前各项指标差异均无显著性意义(P0.05),经过8周康复训练后,治疗组FMA-L、MMT、BBS、BI分别由治疗前(20.75 5.37)、(8.70 2.43)、(14.70 6.89)、(16.60 4.10)提高至(31.05 3.32)、(41.20 5.33)、(15.65 1.84)、(32.00 6.39);对照组上述指标分别由治疗前(20.80 4.92)、(15.05 6.75)、(9.60 2.74)、(15.603.46)提高至(28.10 4.28)、(35.30 9.52)、(14.05 2.42)、(28.05 5.33);两组治疗前后的各项功能指标变化差异均有显著性意义(P0.05)。组间比较,治疗组各项指标明显优于对照组(P0.05)。结论:通过下肢生物反馈训练提高患者下肢本体感觉有助于脑卒中偏瘫患者运动及平衡功能的恢复,从而明显提高患者日常生活活动能力,值得临床应用及推广。     

Tetrax平衡测试与训练对脑梗死偏瘫患者平衡功能的影响

目的研究Tetrax平衡测试与训练对脑梗死偏瘫患者平衡功能的影响。方法将50例脑梗死偏瘫伴有平衡功能障碍的患者分为治疗组25例和对照组25例。两组患者给予常规的康复训练及药物治疗,治疗组在此基础上采用Tetrax平衡测试评估,并根据分析结论给予相应的平衡训练及运动功能训练。在治疗前及治疗4周、8周、12周后分别采用Berg平衡量表、Fugl-Meyer运动功能评定（FMA）下肢运动功能评定及日常生活活动能力（ADL）评定表进行评定。结果治疗前治疗组和对照组平衡能力,下肢运动功能及ADL能力无显著性差异（P>0.05),经4周、8周、12周治疗后,两组患者的平衡能力及下肢运动功能均较治疗前明显提高（P<0.01）,且治疗组功能改善情况优于对照组(P<0.05)。结论Tetrax平衡功能测试评估可进一步了解患者平衡功能障碍点,从而制订更合适的康复训练方法,更好地指导患者康复训练。