步行训练和使用平行杠步行训练

康复医学主要目的是帮助身心受损的残疾人恢复机能，使之能够重返社会。其中最为基本的环节无疑是恢复步行能力，实现生活自理，目前有很多治疗方法，国内专业人员也较为熟悉。本着重介绍一下步行训练评价项目、步行训练中应遵循的原则、立位训练和使用闰行杠步行训练。     

水中运动训练与减重步行训练对脑卒中偏瘫患者步行能力的影响

目的 观察水中运动训练与减重步行训练对脑卒中偏瘫患者步行能力的影响.方法 脑卒中患者76例,分为水中运动训练组40例和减重步行训练组36例.水中运动训练组进行水中偏瘫体操训练、扶杠步行训练和水中跑步机训练等治疗;减重步行训练组进行平衡训练和减重步行训练.2组治疗前、后分别应用Fugl-Meyer运动功能评分量表(FMA)评定综合运动功能,采用功能性步行量表评定步行能力.结果 2组治疗后FMA评分、步行能力均较治疗前明显改善(P＜0.05),水中运动组训练疗效优于减重步行训练组(P＜0.05).结论 水中运动训练及减重步行训练均能改善脑卒中偏瘫患者的运动功能和步行能力,水中运动训练疗效更佳.     

减重平板步行训练对不完全性脊髓损伤患者步行能力的影响

目的 研究减重平板步行训练对不完全性脊髓损伤(ISCI)患者步行能力的影响.方法 36例ISCI患者(分类为ASIAC或D),随机分为对照组与减重组(各18例).所有患者采用综合康复治疗方法,减重组还在身体条件许可的情况下接受减重平板步行训练3个月.在训练前后对患者进行ASIA下肢运动评分、功能独立性评定(FIM)步行能力评定、10 m步行速度、日常生活活动能力(ADL)评定.结果 减重组患者ASIA下肢运动功能、步行能力、10 m步行速度的恢复好于对照组(P<0.05).康复治疗前后减重组与对照组ADL评分无显著性差异(P>0.05).结论 减重平板步行训练能够提高不完全性脊髓损伤患者的步行能力.     

减重步行训练在儿童脑瘫康复中的应用

减重步行器是专门为恢复步行能力而设计的一种训练装置,近年来广泛应用于神经康复领域。文章综述近年来国内外一些学者在儿童脑瘫康复中进行减重步行训练的研究,介绍减重步行器的组成、工作原理、训练方法、训练参数、效果测定方法和功效。     

减重步行训练的临床应用

文章介绍减重步行训练(BWSTT)对于脑卒中脊髓损伤(SCI)等运动功能障碍病人,康复作用的实验室依据,临床对照研究及康复治疗效果.提示BWSTT能使病人更早重建生理步态,较快恢复步行能力.     

结构性速度依赖性平板训练对脑卒中偏瘫患者步行功能的影响

目的比较结构性速度依赖性平板训练、减重平板步行训练和常规步行训练对脑卒中偏瘫患者步行功能的影响.方法将恢复步行能力的脑卒中偏瘫患者45例随机分为结构性速度依赖性组(15例)、减重组(15例)和常规组(15例).在治疗开始和治疗结束时对3组患者进行步行功能性分级和最大步行速度评定.结果经过4周治疗后,3组患者步行功能较治疗前均明显改善(P＜0.001),但结构性速度依赖性训练组较减重步行训练组和常规步行训练组的步行功能的改善更为明显(P＜0.001).结论对于恢复脑卒中偏瘫患者的步行能力,结构性速度依赖性训练较减重步行训练和常规步行训练更为有效.     

减重步行训练结合脑功能治疗对脑卒中患者步行功能的影响

目的 探讨减重步行训练结合脑功能治疗对脑卒中患者步行功能的影响.方法 112例脑卒中患者随机分为治疗组57例和对照组55例.对照组进行常规的康复训练,治疗组在常规康复训练的基础上配合减重步行训练及脑功能治疗.治疗前后分别对2组患者采用Fugl-Meyer评定法下肢运动功能和平衡功能评定、功能性步行量表(FAC)、改良Barthel指数(MBI)进行评定.结果 治疗后治疗组的下肢运动功能、半衡功能、FAC、MBI评分与对照组相比均有改善(P<0.05).结论 结合减重步行训练和脑功能治疗可以促进脑卒中患者下肢运动功能、平衡功能、步行能力和日常生活活动能力更好地恢复.     

偏瘫患者应用步行训练

为了降低脑卒中偏瘫患者的致残率,提高偏瘫病人的平衡能力、步行能力及日常生活活动能力(ADL),我们通过分析步行障碍的原因,探讨开始步行的条件,尽早采取应用步行训练项目,实施步行前训练项目、独立步行训练项目及应用步行训练项目.采取急性期患肢功能位及被动运动,步行前站立位平衡训练,适时进行坐椅动作训练,单腿站立动作训练,斜面步行训练,上下台阶动作训练,交叉迈步训练,上下阶梯动作训练,开关门动作,入厕,上下交通工具动作等行之有效的训练方法,使更多的脑卒中偏瘫患者的日常生活能力接近正常人的水平.     

下肢步行机器人用于C-D级脊髓损伤患者步行训练的疗效研究

正脊髓损伤后主要功能缺陷是步行功能障碍~([1]),因此,步行功能恢复是脊髓损伤患者康复的重要方面,特别是C-D级脊髓损伤患者,由于这类患者大部分双下肢均残存有部分肌肉力量,但常因肌力不足、肌痉挛等因素的影响,导致无法步行或步态的异常。在目前的康复治疗中,主要是通过给予肌力训练、牵伸训练、站立训练、平衡训练等一系列治疗后,患者功能条件允许,才进行步行、步态训练。为了寻找更好的训练方法,部分有条件的医院,会运用运动平板训练。但是,由     

减重步行训练对脑卒中早期偏瘫患者步行能力恢复的影响

目的探讨减重步行训练对脑卒中早期患者步行能力恢复的影响。方法将60例脑卒中偏瘫患者随机分成2组，减重组30例，行减重步行训练加常规康复治疗；对照组30例，仅行常规康复训练。用Fugl—Meyer下肢运动功能评分、Fugl-Meyer平衡功能评分、改良Ashworth法肌张力评级和Holder步行功能分级进行训练前、后评定。结果经过4周治疗后。2组患者Fugl—Meyer下肢运动功能评分、Fugl-Meyer平衡功能评分、肌张力评级和步行功能分级较治疗前明显改善（P〈0．01），但减重组Fugl—Meyer下肢运动功能评分、肌张力评级、步行功能分级改善均明显优于对照组（P〈0．05）。结论减重步行训练加常规康复治疗对脑卒中早期患者步行功能恢复具有明显促进作用。     

步行训练中助行器的选择和使用问题

本文介绍了手杖用途、步行辅助工具的种类、使用步行器所需条件、与杖类处方有关问题以及注意事项.步行训练中合理地选择和正确地使用助行器问题以及注意事项是个很重要的问题.     

矫形器在步行训练中的应用

矫形器疗法是最大限度地改善功能,矫正畸形方法之一.矫形器分为治疗用矫形器和改善用矫形器,本文主要介绍早期康复疗法步行训练中使用的治疗矫形器,简述一下在不同障碍、不同病变时期的应用及训练使用时应注意的事项.     

想象行走训练对脑血管意外偏瘫患者下肢功能恢复的影响

目的:探讨常规功能锻炼结合想象行走训练对脑血管意外偏瘫患者下肢功能恢复的影响.方法:选择40例病情稳定且病程>6个月的脑血管意外偏瘫患者随机分为A、B两组进行两阶段交叉实验研究.在实验过程中两组患者均进行常规功能锻炼,其中A组于常规功能锻炼前进行想象行走训练.分别在每一阶段实验前后评测10 m最快步行速度(MWS)、跨步长(SL)以及FMA(下肢部分).结果:在常规功能锻炼结合想象行走训练阶段与常规功能锻炼相比,10m MWS 差异有显著性意义(P<0.05);SL差异具有显著性意义(P<0.05);FMA差异无显著性意义(P>0.05).结论:常规功能锻炼结合应用想象行走训练可以改善脑血管意外慢性期偏瘫患者下肢功能.     

The six-minute walk test

The American Thoracic Society has issued guidelines for the 6-minute walk test (6MWT). The 6MWT is safer, easier to administer, better tolerated, and better reflects activities of daily living than other walk tests (such as the shuttle walk test). The primary measurement is 6-min walk distance (6MWD), but during the 6MWT data can also be collected about the patient's blood oxygen saturation and perception of dyspnea during exertion. When conducting the 6MWT do not walk with the patient and do not assist the patient in carrying or pulling his or her supplemental oxygen. The patient should walk alone, not with other patients. Do not use a treadmill on which the patient adjusts the speed and/or the slope. Do not use an oval or circular track. Use standardized phrases while speaking to the patient, because your encouragement and enthusiasm can make a difference of up to 30% in the 6MWD. Count the laps with a lap counter. If the 6MWD is low, thoroughly search for the cause(s) of the impairment. Better 6MWD reference equations will be published in the future, so be sure you are using the best available reference equations.     

Influence of stroke-related impairments on performance in 6-minute walk test

The 6-minute walk test is a clinical measure of endurance, but it is not known if it is useful for individuals with mobility impairments secondary to stroke. Purposes of this study were to assess which stroke-related physical impairments influence performance in the 6-minute walk test and to evaluate if this test provides a measure of functional walking endurance after stroke. Seventy-two adults poststroke completed the 6-minute walk as part of baseline testing for a randomized intervention clinical trial. Pulse and blood pressure were taken before and after the walk. Subjects walked an average of 216 m in 6 minutes. The Fugl-Meyer lower-limb motor score and the Berg Balance score explained 45 percent of the variance in distance walked. Pulse and systolic blood pressure increased significantly with the 6-minute walk. Neuromuscular impairments poststroke contribute to diminished performance in the 6-minute walk test. Pulse and blood pressure pre- and posttesting can indicate cardiovascular stress.     

Reliability of the two-minute walk test in individuals with transtibial amputation

OBJECTIVE: To determine inter- and intrarater reliability of the two-minute walk test (2MWT) in individuals with transtibial amputation. DESIGN: Prospective; test-retest method by a pair of trained physical therapists. SETTING: Two regional amputee rehabilitation centers in Canada. PARTICIPANTS: Thirty-three subjects (23 men, 10 women; mean age +/- standard error, 63.6+/-2.0y) with transtibial amputation; 6 in outpatient rehabilitation, 27 in inpatient rehabilitation. The most common primary diagnoses were peripheral vascular disease (n=15) and diabetes (n=11). INTERVENTIONS: Each subject performed a total of four 2MWTs, 1 test for each rater, on 2 consecutive days at approximately the same time of day. Subjects were given at least a 20-minute rest between tests. The order of raters was randomized on the first day and reversed for the next day. The walk tests were performed in the same enclosed corridors with the same starting point for all tests. The subjects were familiar with the test or were given 1 or more practice tests at least 1 day before testing. Subjects were allowed to walk with a mobility aid of their choice. Raters used a digital stopwatch to time the tests and a calibrated wheel with a counter to measure the distance walked in meters. The raters were blinded to each other's scores. MAIN OUTCOME MEASURE: Distance walked in 2 minutes (in meters). RESULTS: Within-rater reliability was high (intraclass correlation coefficient [ICC],.90-.96). Between rater reliability was also high (ICC.98-.99). Analysis of variance (ANOVA) showed a significant effect for day of test (P<.001) in the inpatient group but no effect for therapist (P=.098) or for interaction of day and therapist (P=.710). Similarly, in the outpatient group, ANOVA showed a significant effect for day (P=.013) but no effect for therapist (P=.259) or interaction of day and therapist (P=.923). CONCLUSION: Although the 2MWT showed evidence of inter- and intrarater reliability in individuals with unilateral below-knee amputation, the distance walked in 2 minutes continued to improve over time. This improvement was not solely the result of a training and learning effect.     

引导式教育在小儿脑性瘫痪步行训练中的应用

Theconductiveeducationapproachwasapplytocerebralpalsy(CP)walktraininginDecember1999inourcentre,andachievedsomeresults.Thefollowingistheresult.1Subjectsandmethods1.1SubjectsDuringDecember1999toFeburary2002,theCPchildreninouroutpatientserviceandhospitalwereallaccordingtothediagnosticstandardmadeintheFirstNationalChildrenCPConferencein1988犤1犦.Altogether86,and49boys,37girls.Theyweredividedintotwogroupsatrandom.43inobservationgroup,withconductiveeducationapproach,attheageof(46±20)months;C…     

Use of walk tests in pulmonology

Functional assessment is an obligatory part of examination of patients with chronic respiratory diseases. Ergospirometry is a "gold standard" of functional examination of the cardiorespiratory system. Walk tests are alternative to ergospirometry and can be performed outside laboratories of functional diagnosis. A 6-min walk test provides information on functional condition, treatment efficacy and prognosis in many diseases of the heart and lungs. The result of this test under 350 m suggests a high risk of death. However this test has a serious defect--an insignificant result in weak motivation of the patient. The defects of a 6-min walk test can be corrected by the shuttle-test with growing or permanent load. The test with growing load measures physical performance, while that with permanent load estimates the ability to endure long-term loading.