脑卒中偏瘫患者下肢痉挛与步行速度的关系

目的探讨脑卒中偏瘫患者下肢痉挛与步行速度之间的关系。方法对 3 5例脑卒中偏瘫痉挛患者用改良Ashworth法评定下肢膝伸肌和足跖屈肌的痉挛程度 ;测定步行速度、步距和步频 ;分析膝伸肌和足跖屈肌痉挛与步行速度、步长和步频之间的相关性 ,以及决定步行速度、步长和步频的下肢痉挛因素。结果患者在自由步行时的步行速度与膝伸肌和足跖屈肌痉挛呈中度负相关 (r =-0 .43 2 ,P <0 .0 5 ;r =-0 .44 8,P <0 .0 5 ) ,其中膝伸肌痉挛仅与步频呈中度负相关 (r =-0 .415 ,P <0 .0 5 ) ,而足跖屈肌痉挛与步距和步频呈中度负相关 (r =-0 .41,P <0 .0 5 ;r =-0 .3 3 5 ,P <0 .0 5 )。最大步行速度时的步长和步频与膝伸肌和足跖屈肌痉挛之间无相关性 (r =-0 .118— 0 .3 0 7,P >0 .0 5 )。决定自由步行速度、步长的下肢痉挛因素是足跖屈肌痉挛 (分别为R2 =0 .2 0 ,P <0 .0 1;R2 =0 .168,P <0 .0 5 ) ;决定步频的是膝伸肌痉挛 (R2 =0 .172 ,P <0 .0 5 )。结论脑卒中偏瘫患者下肢痉挛对步行速度的影响力较小 ,在以改善患者步行能力为目的的治疗中 ,应重点关注痉挛以外的其他更重要的临床因素。

Relationship of spasticity of the affected lower extremity and gait speed in hemiplegic stroke patients

ObjectiveTo explore the relationship of spasticity of the affected lower extremity and gait speed in hemiplegic stroke patients.MethodsThe knee extensor and ankle plantar flexor of the affected lower extremity of 35 hemiplegic stroke patients were evaluated with modified Ashworth Scale to determine the degree of spasticity. Gait speed, step length and walking frequency of patients were tested to find out if they were correlated with spasticity of lower extremity and affected by which spastic factor.ResultsThere was a moderate negative correlation between gait speed and spasticities of the knee extensor and ankle plantar flexor ( r=- 0.432, P<0.05; r=-0.448, P< 0.05), but the spasticity of the knee extensor was only negatively correlated to the walking rate( r=-0.415, P<0.05) and plantar flexor was negatively correlated to the step length and walking rate( r=-0.41, P<0.05; r=-0.335, P<0.05). Spasticities of the knee extensor and ankle plantar flexor were not related to the maximal gait speed ( r=-0.118-0.307, P>0.05). Regression analyses revealed that the spasticity of plantar flexor was independent determinants of the comfortable gait speed ( R2=0.20, P<0.01) and step length ( R2=0.168, P<0.05), the spasticity of knee extensor was the independent determinant of the walking rate ( R2=0.172, P<0.05).ConclusionSpasticity of the affected lower extremity in hemiplegic stroke patients only has a small effectiveness to gait speed, more important clinical factors other than spasticity should be considered when the treatment is aimed to improve aspects of gait capacity of stroke patients.