基于ICF核心分类组合运动疗法结合足底响声诱导法对脑卒中后下肢运动功能康复效果的研究

doi:10.3969/j.issn.1006-9771.2021.03.001

摘要/Abstract

摘要： 目的

采用《国际功能、残疾和健康分类》(ICF)脑卒中核心分类组合，评价运动干预结合足底响声诱导法对脑卒中患者下肢运动、移动和日常生活功能的康复效果。

方法

选择2018年4月至2020年5月本院收治的脑卒中患者113例，按脑卒中类型分为缺血组(n = 67)和出血组(n = 46)。两组均行下肢运动疗法训练结合足底响声诱导法治疗8周。治疗前后，采用ICF脑卒中核心分类组合中步态部分、Fugl-Meyer评定量表下肢部分(FMA-LE)、计时起立-行走测试(TUGT)和改良Barthel指数(MBI)进行评定。

结果

ICF脑卒中核心分类组合步态部分限定值、FMA-LE评分、TUGT时间和MBI评分时间主效应显著(F > 100.59, P < 0.001)，两两比较，各时间点间均有非常高度显著性差异(P < 0.001)；组间主效应不显著(F < 2.29, P > 0.05)，各时间点两两比较均无显著性差异(P > 0.05)；TUGT交互效应显著(F = 6.45, P < 0.01)，出血组缩短更明显；其余指标交互效应均不显著(F < 2.56, P > 0.05)。

结论

运动疗法结合足底响声诱导法可明显改善脑卒中后偏瘫步态患者的下肢运动、移动和日常生活活动能力。

关键词: 脑卒中, 运动疗法, 下肢, 康复, 国际功能、残疾和健康分类, 核心分类组合

Abstract: Objective

To study the effect of physical therapy and heel sound feedback on lower limbs motor function, mobility and activities of daily living (ADL) for stroke patients based on International Classification of Functioning, Disability and Health (ICF) core set.

Methods

From April, 2018 to May, 2020, 113 stroke patients with motor dysfunction were divided into ischemia group (n = 67) and hemorrhagia group (n = 46) according to the cause of stroke. They received physical therapy for lower limbs and heel sound feedback for eight weeks, and assessed with ICF core set for stroke-gait, Fugl-Meyer Assessment-Lower Extremities (FMA-LE), Timed 'Up and Go' Test (TUGT), and modified Barthel index (MBI) before and after intervention.

Results

The main effect of time was significant for qualifiers of ICF core set for stroke-gait, the scores of FMA-LE and MBI, and TUGT time (F > 100.59, P < 0.001), and it improved time by time as Post Hoc test. The main effect of groups was not significant (F < 2.29, P > 0.05), nor as Post Hoc test. The interactive effect between time and groups was significant for TUGT time (F = 6.45, P < 0.01), perhaps improved more in the hemorrhagia group, however, the interactive effect was not significant for the others.

Conclusion

Physical therapy and heel sound feedback can improve motor function of lower limb, mobility and ADL for stroke patients.

Key words: stroke, physical therapy, lower limbs, rehabilitation, International Classification of Functioning, Disability and Health, core set

中图分类号:

R743.3

崔文华,王敏莉,杨清珊,马堆贤,梁红卫,陈向梅,渠旭升. 基于ICF核心分类组合运动疗法结合足底响声诱导法对脑卒中后下肢运动功能康复效果的研究[J]. 《中国康复理论与实践》, 2021, 27(3): 249-255.

Wen-hua CUI,Min-li WANG,Qing-shan YANG,Dui-xian MA,Hong-wei LIANG,Xiang-mei CHEN,Xu-sheng QU. Effect of Physical Therapy and Heel Sound Feedback on Motor Function of Lower Limbs for Patients with Stroke Based on ICF Core Set[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(3): 249-255.

图/表 5

表1

表2

下肢运动功能评估指标与ICF类目的匹配分析"

测量工具	内容	编码	类目名称
FMA-LE	跟腱反射(仰卧位)	b7500	牵张反射
	膝腱反射(仰卧位)	b7500	牵张反射
	髋关节屈曲(仰卧位)	b7600 b7650	简单随意运动的控制肌肉不随意收缩
	膝关节屈曲(仰卧位)	b7600 b7650	简单随意运动的控制肌肉不随意收缩
	踝关节屈曲(仰卧位)	b7600 b7650	简单随意运动的控制肌肉不随意收缩
	髋关节内收(仰卧位)	b7600 b7650	简单随意运动的控制肌肉不随意收缩
	膝关节伸展(仰卧位)	b7600 b7650	简单随意运动的控制肌肉不随意收缩
	踝关节跖屈(仰卧位)	b7600 b7650	简单随意运动的控制肌肉不随意收缩
	膝关节屈曲(坐位)	b7600 b7650	简单随意运动的控制肌肉不随意收缩
	踝关节背屈(坐位)	b7600 b7650	简单随意运动的控制肌肉不随意收缩
	膝关节屈曲(站立位)	b7600 b7603 b7650	简单随意运动的控制手臂或腿的支撑功能肌肉不随意收缩
	踝关节背屈(站立位)	b7600 b7603 b7650	简单随意运动的控制手臂或腿的支撑功能肌肉不随意收缩
	膝部屈肌(坐位)	b7500	牵张反射
	膝腱反射(坐位)	b7500	牵张反射
	跟腱反射(坐位)	b7500	牵张反射
	跟膝胫试验(震颤)	b7600 b7602 b7651	简单随意运动的控制随意运动的协调震颤
	跟膝胫试验(辨距)	b7600 b7602	简单随意运动的控制随意运动的协调
	跟膝胫试验(速度)	b7600 b7602	简单随意运动的控制随意运动的协调
TUGT	嘱患者坐于有扶手的靠背椅上，双手搭于扶手，将一方凳置于距靠背椅3 m处的地方并作一标记。发出“开始”口令后，患者起身走向方凳，反身折回坐回靠背椅，记录所用时间(s)	b760 b770 d4103 d4104 d4153 d4154 d4500 d4503 d465	随意运动控制功能步态功能坐下站起保持坐姿保持站姿短距离步行绕障碍物步行利用设备到处移动
MBI	大便	b110 b525 d5301	意识功能排便功能大便控制
	小便	b110 b620 d5300	意识功能排尿功能小便控制
	修饰	d510 d520	盥洗自身护理身体各部
	如厕	b525 b620 b650 d530	排便功能排尿功能月经功能入厕
	进食	b1302 d550 d560	食欲吃喝
	转移	d410 d420 d455 d465	改变身体姿势移动自身到处移动利用设备到处移动
	活动	d420 d450 d455 d460 d465 d470	移动自身步行到处移动在不同地点到处移动利用设备到处移动利用交通工具
	穿衣	d540 d5700	穿着确保个人身体舒适
	上下楼梯	b7603 d420 d465	手臂或腿的支撑功能移动自身利用设备到处移动
	洗澡	d510 d5700	盥洗自身确保个人身体舒适

表2

表3

表4

表5

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组别	n	性别 (男/女, n)	年龄(岁)	偏瘫侧 (左/右, n)
缺血组	67	54/13	57.64±11.08	33/33^a
出血组	46	32/14	50.00±10.92	20/26
χ²/t值		1.31	3.61	0.68
P值		0.193	< 0.001	0.501

指标	组别	时间
指标	组别	治疗前	治疗4周	治疗8周
b770限定值	缺血组	3.58±0.84	3.06±0.76	2.66±0.75
b770限定值	出血组	3.76±0.79	3.22±0.79	2.72±0.69
FMA-LE	缺血组	21.99±4.30	23.87±3.91	25.15±3.93
FMA-LE	出血组	21.46±3.76	23.67±3.93	25.78±5.56
TUGT (s)	缺血组	28.16±11.59	23.30±10.50	19.72±10.38
TUGT (s)	出血组	32.78±20.54	24.91±15.87	19.91±13.11
MBI	缺血组	66.55±9.42	74.52±10.49	79.75±10.63
MBI	出血组	69.87±10.69	76.59±10.55	82.57±9.09

变量	时间		时间×组别		组别
变量	F值	P值	F值	P值	F值	P值
b770限定值	154.38	< 0.001	0.63	0.507	0.99	0.322
FMA-LE	100.59	< 0.001	2.56	0.096	< 0.01	0.969
TUGT	145.62	< 0.001	6.45	0.008	0.74	0.392
MBI	210.64	< 0.001	0.50	0.558	2.29	0.133

组别	时间		b770限定值		FMA-LE		TUGT		MBI
组别	时间		SE	P值	SE	P值	SE	P值	SE	P值
缺血组	治疗8周	治疗前	0.09	< 0.001	0.42	< 0.001	1.07	< 0.001	1.01	< 0.001
		治疗4周	0.06	< 0.001	0.31	< 0.001	0.56	< 0.001	0.65	< 0.001
出血组	治疗8周	治疗前	0.10	< 0.001	0.51	< 0.001	1.29	< 0.001	1.22	< 0.001
		治疗4周	0.08	< 0.001	0.38	< 0.001	0.67	< 0.001	0.78	< 0.001

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