脑卒中偏瘫患者步行时间-距离因子临床决定因素的分析

目的判别决定脑卒中偏瘫患者步行时间-距离因子最重要的临床变量,为优化此类患者步行训练提供理论依据。方法30例恢复步行能力的脑卒中偏瘫患者,测定在自由状态的10m步行速度,求得患者的步行速度、步长和步频等时间-距离因子。用Fugl-Meyer评价法评测下肢运动功能,用Motricity指数评测下肢肌力,用Berg平衡量表评定平衡功能,用改良Ashworth评定法评定足跖屈肌张力。对步行时间-距离因子和临床变量间进行Pearson相关分析,然后进行逐步回归分析。结果30例患者的步行速度为35.45(4.10～67.40)m/min,平均步长为34.41cm,平均步频为91.59steps/min。患者的步行时间-距离因子与下肢运动功能、平衡功能和下肢肌力之间呈高度正相关(Pearson'sr=0.669～0.880;P<0.001);步行速度和步长与足跖屈肌张力痉挛程度呈负相关(Pearson'sr=-0.280～-0.481;P<0.001)。逐步回归分析发现决定步行速度、步长和步频的最重要的临床变量分别为下肢运动功能(R2=0.766,P<0.001)、平衡功能(R2=0.701,P<0.001)和下肢肌力(R2=0.757,P<0.001);决定步行速度、步长和步频的最重要的下肢肌力分别为髋屈曲肌力(R2=0.573,P<0.001)、膝伸展肌力(R2=0.583,P<0.001)和髋屈曲肌力(R2=0.191,P<0.05)。结论下肢运动功能、平衡功能和下肢肌力(尤其髋屈

Analysis of the clinical factors determining temporal-distance parameters of walking in hemiparetic stroke patients

Aim To identify the most important clini cal variables determining temporal-distance parameters of wa lking in hemiparetic stroke patient s so as to optimize the walking training.Methods Thirty hemiparetic stroke pa-tients who had recovered their abili ty to walk independently were asked t o walk comfortably without a brace or o rthopedic instrument for ten meters three times so as to detect the temporal-distance parameters:walking sp eed(WS ),stride length(SL),walking rate(WR)and the ratio of stride length /walking rate(SL /WR).The motor function,strengths of th e paretic lower limb,balance and the muscle tone of t he plantarflexor were evaluated wit h the Fugl-Meyer Assessment,Motrici ty Index,Berg balance scale and Mod-ified Ashworth Scale.Pearson' s correlation analysis,Speramen' s correlation analysis,regression analysis,and multiple linear regression analysis using the stepwise method were conducted t o examine the relationships between WS and SL and between WS and WR.Results The WS of the 30patients was35.45(4.10-67.40)m /min,the mean SL was 34.41cm,the mean WR was 91.59steps /min.Pearson' s correlation analysis showed that t he pa-tients' temporal-distance parameters was h ighly positively correlated with their motor function,strengths of t he paretic lower limb and balance(r=0.669-0.880,P<0.001),that WS and SL were significantly negatively correlated to the muscle tone of the p lantarflexor(r=-0.280--0.481,P<0.001).Regression analysis showed that th e most important clinical vari-ables of temporal-distance paramet ers were the motor function(R 2 =0.766,P<0.001),strengths of the paretic lower limb (R 2 =0.757,P<0.001)and balance(R 2 =0.701,P<0.001).Step regression analysis selected the strength of hip flexor(R 2 =0.573,P<0.001),knee extensor(R 2 =0.583,P<0.001)and hip flexor(R 2 =0.191,P<0.05)as a signifi-cant variable for temporal-distance parameters.Conclusion The motor function and strength of the lower li mb (particularly the hip flexor)were important clinical factor determin ing the temporal-distance paramete rs of the walking in hemiparetic stroke patie nts.