计时“起立-行走”测验评估脑卒中患者功能性步行能力的信度和同时效度

目的：评估脑卒中患者的移动能力是康复医学重要内容。研究脑卒中患者计时“起立-行走”测试的信度和同时效度，为临床评定提供客观依据。方法：解放军总医院康复医学科收治47例脑卒中偏瘫患者，均符合第四届全国脑血管病会议通过的诊断标准，意识清晰，可接受动作行指令，可独立或在监视下步行20m以上，排除下肢全关节置换术后、严重关节炎而影响步行者以及存在其他限制下肢活动的合并症者。有5位医师参与，其中2位医师评估47例脑卒中偏瘫患者的计时“起立-行走”的测试作为评测者间信度研究，患者在同一时间段内被同一医师再评估1次，以作为评测者内信度研究。由另3位医师共同利用Berg平衡量表(BBS)，FIM和最大步行速度测量评估患者的平衡功能、日常生活能力和步行速度作为效标尺度，进行同时效度的研究。结果：在信度方面，在同一评定者的两次评定结果之间高度相关ICC=0.982(95％CI:0.901—0．992)；不同评定者的同一次评定结果之间也高度相关ICC=0．984(95％ CI：0．889～0．995)，同时在效度方面．计时“起立-行走”测试与BBS，FIM和最大步行速度之间有较好的相关性(r=-0．914～-0.646，P&;lt;0．001)。结论：计时“起立-行走”测试方法用于评定脑卒中患者的功能性步行能力方面具有良好的信度和效度，可供国内同行在进行功能性步行定量评定时选用。     

不同类型量表对住院老年患者跌倒风险评估的区分效度及关系

目的总结不同类型量表对住院老年患者跌倒风险评估的区分效度及关系。方法选取2012年10月~2014年10月我院接受诊治的76例住院老年患者,由两名专业测试人员以Morse跌倒评估量表、计时起立-步行测验表以及Berg平衡量表对其跌倒风险进行准确评估,以1年是否存在着跌倒史将其分为实验组21例和对照组55例。分析各种量表的区分效度及其相关性。结果实验组Morse跌倒评估量表评分显著高于对照组,Berg平衡量表评分以及计量起立-步行测验表评分明显低于对照组,有显著性差异(P0.05)。Morse跌倒评估量表和Berg平衡量表之间呈负相关。而Morse跌倒评估量表和计时起立-步行测验表间呈正相关,具有较强一致性。结论 Morse跌倒评估量表、计时起立-步行测验表以及Berg平衡量表对住院老年患者跌倒风险评估体现出显著敏感性,且具有较佳的区分效度与相关性。     

计时"起立-行走"测验评估脑卒中患者功能性步行能力的信度和同时效度

目的评估脑卒中患者的移动能力是康复医学重要内容,研究脑卒中患者计时"起立-行走"测试的信度和同时效度,为临床评定提供客观依据.方法解放军总医院康复医学科收治47例脑卒中偏瘫患者,均符合第四届全国脑血管病会议通过的诊断标准,意识清晰,可接受动作行指令,可独立或在监视下步行20 m以上,排除下肢全关节置换术后、严重关节炎而影响步行者以及存在其他限制下肢活动的合并症者.有5位医师参与,其中2位医师评估47例脑卒中偏瘫患者的计时"起立-行走"的测试作为评测者间信度研究,患者在同一时间段内被同一医师再评估1次,以作为评测者内信度研究.由另3位医师共同利用Berg平衡量表(BBS),FIM和最大步行速度测量评估患者的平衡功能、日常生活能力和步行速度作为效标尺度,进行同时效度的研究.结果在信度方面,在同一评定者的两次评定结果之间高度相关ICC=0.982(95%CI0.901～0.992);不同评定者的同一次评定结果之间也高度相关ICC=0.984(95%CI0.889～0.995),同时在效度方面,计时"起立-行走"测试与BBS,FIM和最大步行速度之间有较好的相关性(r=-0.914～-0.646,P＜0.001).结论计时"起立-行走"测试方法用于评定脑卒中患者的功能性步行能力方面具有良好的信度和效度,可供国内同行在进行功能性步行定量评定时选用.     

功能性步态评价在帕金森病患者中的效度

目的检验功能性步态评价(FGA)在帕金森病患者中的结构效度和同时效度。方法 2011年3月至12月,住院帕金森病患者121例(平均年龄61.9岁)行FGA评定,同时采用Berg平衡量表、功能性步态分级、计时起立-走测验、特异性活动平衡自信量表、运动障碍学会统一帕金森病评定量表第3部分、改良Barthel指数、最大步行速度和改良Hoehn and Yahr量表进行评定。采用主成分法正交旋转法分析其结构效度,计算FGA与其他评价方法之间的相关性分析同时效度。结果 FGA提取到1个公因子,解释总变异64.0%;FGA与其他评价之间的相关系数0.57～0.85。结论 FGA在帕金森病患者中效度较好。     

Barthel指数量表应用于急性脑卒中患者生活能力测量的信度研究

目的:探讨Barthel指数量表在急性脑卒中患者中的评价者间信度和内在一致性。方法:32例急性脑卒中患者参与本研究。在入院和出院时由两位护士各自独立地应用Barthel指数量表评价。检验Barthel指数量表的评价者间信度和内在一致性。结果:评价者间信度统计分析结果显示,在入院和出院时的Barthel指数量表总分的ICC值分别为0.987和0.945。内在一致性统计分析结果显示,在入院和出院时的Barthel指数量表的Cronbach’sα系数分别为0.908和0.890,Barthel指数量表的10项目Cronbach’sα系数范围为0.871～0.915。结论:Barthel指数量表具有良好的评价者间信度和内在一致性,本研究为护士在急性脑卒中患者中应用Barthel指数量表提供了参考依据。     

步行和平衡功能康复训练对脑卒中后遗症期患者的疗效分析

目的:观察脑卒中后遗症期患者步行和平衡功能康复训练前后Berg平衡量表评分、平地50 m最大步行速度、起立-行走计时测试和上下楼梯时间变化。方法:选取脑卒中后遗症期患者120例,随机分为对照组及治疗组各60例。2组均给予传统康复训练,治疗组还进行步行及平衡功能康复训练;分别于训练前、训练后1月、3月对2组进行Berg平衡量表评分、平地50 m最大步行速度测定、起立-行走计时测试、测定上下20阶楼梯时间变化情况,并进行统计学分析。结果:训练后1月、3月,2组的Berg平衡量表评分均高于训练前(均P0.05),且治疗组均高于对照组(均P0.05)。训练后1月、3月,2组的平地50 m最大步行速度、起立-行走计时测试、上下20阶楼梯时间均低于训练前(均P0.05),且治疗组上述指标均低于对照组(均P0.05)。结论:步行和平衡功能康复训练能够明显改善脑卒中后遗症期患者的步行能力及平衡功能。     

水中平板步行训练对脑卒中患者步行功能的影响

目的探讨水中平板步行训练对脑卒中患者步行功能的影响。方法 2015年7月至2017年10月,33例脑梗死患者随机分为对照组(n=16)和治疗组(n=17)。对照组采用常规水中运动训练,治疗组加水中平板步行训练,共6周。治疗前后采用Berg平衡量表、计时起立走测试、2分钟步行测试和步态分析进行评定。结果治疗后,两组各项指标均较治疗前改善(t 2.536, P 0.05),治疗组Berg平衡量表评分、计时起立-走测试、2分钟步行测试、患侧步长、步速和步宽均优于对照组(t 2.057, P 0.05),Berg平衡量表改善率显著优于对照组(χ~2=33, P 0.001)。结论水中平板步行训练可改善脑卒中患者的步行功能。     

脑卒中患者步行功能恢复的客观依据：自由和最大步行速度测量的信度和同时效度研究

目的：步行速度是反映脑卒中患者功能恢复的重要指标。研究采用自由和最大步行速度测量法进行脑卒中患者步行能力评定时的信度和同时效度，为临床评定提供客观依据。方法：解放军总医院康复医学科收治脑卒中偏瘫患者55例，符合第四届全国脑血管病会议通过的诊断标准，意识清晰，可接受动作行指令，患者可独立或在监视下步行20m以上，排除下肢全关节置换术后、严重关节炎而影响步行者，以及存在其他限制下肢活动的并发症者。有5位医师参与，其中2位医师评估55例脑卒中偏瘫患者的10m自由和最大步行速度，作为评测者间信度研究，患者在同一时间段内被同一医师再评估1次，以作为评测者内信度研究。由另3位医师共同利用下肢Fugl-Meyer评价、Berg平衡量表和功能独立性测量作效标尺度进行同时效度的研究。结果：在信度方面，10m自由和最大步行速度的测量在同一评定者的两次评定结果之间高度相关(ICC=0．912—0．937)，不同评定者的同一次评定结果之间也高度相关(ICC=0．961～0．972)，在同时效度方面，自由和最大步行速度与Fugl-Meyer评价，Berg平衡量表和功能独立性测量有较好的相关性(r=0．595～0．693，P&;lt;0．001)。结论：自由和最大步行速度测量法评定具有良好的信度与同时效度．推荐在临床结局评价中使用。     

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     

子午流注择时穴位敷贴对膝关节骨性关节炎患者平衡能力的影响

目的探讨子午流注择时穴位敷贴疗法对膝关节骨性关节炎患者平衡能力的影响。方法将60例膝关节骨性关节炎患者随机分为对照组和实验组各30例。对照组实施患处穴位敷贴,实验组实施子午流注择时穴位敷贴。采用闭目单足站立、计时起立一步行测验、Berg平衡量表评价2组患者平衡能力的改善效果。结果干预后实验组闭目单足站立测试时间和Berg平衡量表得分均显著高于对照组,差异有统计学意义;干预后实验组计时起立一步行测验时间显著少于对照组,差异有统计学意义。结论子午流注穴位敷贴能有效提高膝关节骨性关节炎患者的平衡能力,从而预防跌倒的发生。     

Psychometric evaluation of the original and Canadian French version of the activities-specific balance confidence scale among people with stroke

OBJECTIVE: To evaluate the internal and absolute reliability and construct validity of the Activities-Specific Balance Confidence (ABC) scale and a new Canadian French version (ABC-CF) of it among people with stroke. DESIGN: Cross-sectional data from a randomized controlled trial. SETTING: Community. PARTICIPANTS: Ninety-one people with a residual walking deficit between 57 and 386 days poststroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The ABC and ABC-CF scales, Berg Balance Scale (BBS), comfortable and maximum gait speeds, Timed Up & Go (TUG) test, 6-minute walk test (6MWT), Barthel Index, physical function scale of the Medical Outcomes Study 36-Item Short-Form Health Survey, Geriatric Depression Scale (GDS), and the EQ-5D visual analog scale (EQ VAS). RESULTS: Internal consistency (Cronbach alpha) was .94 and .93 and the standard error of measurement was 5.05 and 5.13 for the ABC (n=51) and the ABC-CF (n=35) scales, respectively. Spearman rho values ranged from .30 to .60 for the ABC scale and from .45 to .68 on the ABC-CF scale for associations with scores on the BBS, comfortable and maximum gait speeds, TUG, 6MWT, Barthel Index, physical function scale, GDS, and EQ VAS. CONCLUSIONS: Evidence of internal and absolute reliability and of construct validity of the ABC and the ABC-CF scales supports their use for cross-sectional measurements of balance self-efficacy among community-dwelling people in the first year poststroke.     

Effect of coordination movement using the PNF pattern underwater on the balance and gait of stroke patients

[Purpose] To investigate the effect of coordination movement using the Proprioceptive Neuromuscular Facilitation pattern underwater on the balance and gait of stroke patients. [Subjects and Methods] Twenty stroke patients were randomly assigned to an experimental group that performed coordination movement using the Proprioceptive Neuromuscular Facilitation pattern underwater and a control group (n =10 each). Both the groups underwent neurodevelopmental treatment, and the experimental group performed coordination movement using the Proprioceptive neuromuscular facilitation pattern underwater. Balance was measured using the Berg Balance Scale and Functional Reach Test, and gait was measured using the 10-Meter Walk Test and Timed Up and Go Test. To compare in-group data before and after the intervention, paired t-test was used. Independent t-test was used to compare differences in the results of the Berg Balance Scale, Functional Reach Test, 10-Meter Walk Test, and Timed Up and Go Test before and after the intervention between the groups. [Results] Comparison within the groups showed significant differences in the results of the Berg Balance Scale, Functional Reach Test, 10-Meter Walk Test, and Timed Up and Go Test before and after the experimental intervention. On comparison between the groups, there were greater improvements in the scores of the Berg Balance Scale, Functional Reach Test, 10-Meter Walk Test, and Timed Up and Go Test in the experimental group. [Conclusion] The findings demonstrate that coordination movement using the Proprioceptive Neuromuscular Facilitation pattern under water has a significant effect on the balance and gait of stroke patients.Key words: Coordination movement using the PNF pattern, Balance, Gait     

正常人动态平衡能力测试的信度及效度分析

目的　对正常人平衡功能进行动态姿势图重复检测 ,分析各参数间的内在一致性、重测信度及不同测试者间的信度 ;并与Berg平衡量表、功能性前伸测量、起立行走计时测定结果比较 ,检验其效标效度。方法　 2名测试者应用BiodexBalanceSystem (BBS)分别对 40名正常受试者 ( 18～ 67岁 )进行 2次 8级平台稳定性动态姿势图测试及稳定性测试 ;同时还应用Berg平衡量表、功能性前伸距离及起立行走计时等方法进行检测。结果　研究结果发现年龄因素对所有检测参数均有影响 ,体重指数对稳定指数及平均方向控制能力有影响。各参数间内部存在一致性 (r =0 .2 2～ 0 .93 ,均P <0 .0 1) ,其重测信度 (r =0 .70～ 0 .99)及不同测试者间信度 (r =0 .71～ 0 .98)较佳 (ICC =0 .88～ 0 .99)。在测试过程中 ,发现不同跌下次数的受试者其年龄差异和测试结果间差异显著相关 (P <0 .0 0 1)。BBS测试数据与Berg平衡量表、功能性前伸测量、起立行走计时测评结果有较高的相关性 (r =0 .72～ 0 .86)。结论　BBS能反映受试者平衡能力的年龄变化趋势 ,具有较高的内在一致性、重测信度及不同测试者间的信度 ,与Berg平衡量表、起立行走计时及功能性前伸测量结果具有一致性 ,可用于平衡功能的定量评定。     

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     

平衡仪反馈训练法和Bobath平衡训练法对偏瘫患者平衡和功能性行走能力的影响

目的：探讨平衡仪反馈训练法和Bobath平衡训练法对偏瘫患者平衡和功能性行走能力的影响。方法：将符合试验条件的住院卒中患者分层随机分为试验组（20例）和对照组（20例）,两组对象在试验开始前Berg平衡得分（BBS）、“起立-走”计时试验（Up＆Go）比较差异无显著性意义。试验组的平衡训练使用平衡仪视觉反馈法,对照组平衡训练使用Bobath平衡训练法,测试指标采用BBS和Up＆Go,在试验开始前和训练6周后各评定1次。结果：训练6周后试验组的BBS、Up＆Go均优于对照组比较差异具有显著性意义。结论：使用平衡仪训练对改善脑卒中患者的平衡和行走功能比单纯的Bobath平衡训练法更有效。     

Concurrent and construct validity of scores on the Timed Movement Battery

BACKGROUND AND PURPOSE: The Timed Movement Battery (TMB) is a new assessment tool designed to measure mobility in elderly individuals. "Mobility" was defined as a person's ability to maneuver his or her body independently in order to accomplish everyday tasks. The purpose of this study was to assess the concurrent and construct validity of scores obtained with the TMB as a measure of mobility in a group of elderly individuals who reported moderate or no difficulty in performing either basic or instrumental activities of daily living (BADL or IADL). SUBJECTS: Thirty community-dwelling elderly people, with a mean age of 77.5 years (SD=7.0, range=65-92), participated in this study. METHODS: Subjects responded to 2 questionnaires regarding their activities of daily living (ADL) (ie, Barthel Index and an 18-item ADL/IADL scale) and completed 3 assessments of mobility (ie, Berg Balance Scale, Timed "Up & Go" Test, and the TMB). Subjects were asked to perform the items on the TMB at a "self-selected" speed (their normal speed) and at a "maximum-movement" speed (as quickly as they could safely perform the items). Subjects' scores on the TMB were cross-correlated with data for 4 criterion tests (ie, Berg Balance Scale, Timed "Up & Go" Test, Barthel Index, and the 18-item ADL/IADL scale) using Spearman rank correlations and Pearson product moment correlations. RESULTS: Composite scores of the TMB performed at self-selected speeds correlated highly with data for the criterion tests and differentiated between those subjects reporting difficulty with ADL and those reporting no difficulty. CONCLUSION AND DISCUSSION: These results support the validity of scores obtained with the TMB as a measure of mobility in this sample of elderly individuals with moderate or no reported difficulty with ADL.     

Clinical utility of the modified trunk impairment scale for stroke survivors

Objective: The present study aimed to determine the discriminant power of the modified Trunk Impairment Scale (mTIS) in stroke survivors versus healthy adults.

Design: Cross-sectional.

Setting: Inpatient rehabilitation center.

Participants: Fifty-five subjects with stroke and 29 healthy adults.

Methods: Subjects were examined using the mTIS, Berg Balance Scale, and Timed Up and Go test for balance; 5-m Walk Test and Functional Ambulation Category for gait; Fugl-Meyer Assessment for motor function; Postural Assessment Scale for Stroke-Trunk Control and Trunk Control Test for trunk control; and Modified Barthel Index for activities of daily living performance.

Results: The mTIS results differed significantly between stroke survivors and healthy adults (p?r?=?0.82), Timed Up and Go test (r?=?–0.70), 5-m Walk Test (r?=?0.73), Functional Ambulation Category (r?=?0.54), Fugl-Meyer Assessment (r?=?0.37–0.80), Postural Assessment Scale for Stroke-Trunk Control and Trunk Control Test (r?=?0.55–0.63), and Modified Barthel Index score (r?=?0.56) results (p?10.5 points, while the area under the curve had a moderate accuracy of 73%.

Conclusion: The mTIS can be used to examine the degree of trunk control or the level of trunk impairment, which is seen as a prerequisite for balance, gait, motor function, and activities of daily living performance in stroke survivors.

• Implications for Rehabilitation

• The modified Trunk Impairment Scale can be used as an assessment tool to classify the degree of trunk control or its level of impairment in stroke survivors.

• The modified Trunk Impairment Scale may have a favorable correlation with assessing physical functions such as balance, gait, motor function, and ADL in stroke survivors.

     

平衡评价量表在临床中的应用

临床评定平衡障碍的方法很多,其中最常用的是量表评定法.本文介绍Berg平衡量表((BBS)、Tinetti平衡与步态量表(Tinetti POMA)、计时起立一步行测验(TUGT)、特异性活动平衡自信量表(ABC),Brunei平衡量表(BRA)、动态步态指数(DGI)、功能性步态评价(FGA)、平衡评价系统测试(BEST)等国内外常用的平衡评价量表及其信度、效度分析结果.并为临床推荐较好的平衡及步态障碍评价工具.     

Therapeutic effects of reaching with forward bending of trunk on postural stability,dynamic balance,and gait in individuals with chronic hemiparetic stroke

[Purpose] The objective of this study was to perform forward bending of the trunk and reaching training in chronic stroke patients and to investigate subsequent changes in trunk control, dynamic balance, and gait. [Subject] Twenty-three chronic stroke patients were randomly divided into two groups, with 10 patients in the forward bending of the trunk and reaching group and 13 patients in the control group. [Methods] Both groups underwent 30 minutes of rehabilitation therapy, five days a week, for four weeks. The forward bending of the trunk and reaching group additionally performed forward bending of the trunk and reaching training five times a week for four weeks, which involved four sets of pressing buttons 35 times, for a total of 140 button presses per session. The subjects were tested before and after training using the Trunk Impairment Scale, Berg Balance Scale, Timed Up and Go Test, Six-Minute Walking Test, and 10-Meter Walking Test. Trunk control, dynamic balance, and walking ability were compared between the two groups. [Result] The results of the study showed that the results of the Trunk Impairment Scale, Berg Balance Scale, Timed Up and Go Test, Six-Minute Walking Test improved significantly in the FBR group, while there were no significant differences in the control group. [Conclusion] This study results suggest that forward bending of the trunk and reaching training can be an effective exercise method for chronic stroke patients.Key words: Postural control, Stroke, Trunk     

An efficacy study on improving balance and gait in subacute stroke patients by balance training with additional motor imagery: a pilot study

[Purpose] The few studies conducted on subacute stroke patients have focused only on gait function improvement. This study therefore aimed to confirm the effect of balance training with additional motor imagery on balance and gait improvement in subacute stroke patients. [Subjects and Methods] Participants were divided into an experimental or control group. The experimental group received balance training for 20 minutes/day with mental imagery for 10 minutes/day, three days/week, for four weeks. The control group received only balance training for 30 minutes. Before and after the 12 sessions, balance and gait ability were assessed by the researcher and a physical therapist. [Results] After completion of the 4-week intervention, Berg Balance Scale, Timed Up and Go test, Functional Reach Test, and Four Square Step test scores significantly increased in the experimental group. In the control group, Berg Balance Scale and Functional Reach Test scores significantly improved. Changes in the Timed Up and Go test, Functional Reach Test, and Four Square Step Test scores after intervention were significantly higher in the experimental than in the control group. [Conclusion] Specific balance training with additional motor imagery may result in better rehabilitation outcomes of gait and balance ability than balance training alone.Key words: Balance, Gait, Motor imagery