触觉振动反馈系统对单侧小腿假肢穿戴者平衡及行走功能的影响

doi:10.3969/j.issn.1006-9771.2021.04.013

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (4): 472-477.doi: 10.3969/j.issn.1006-9771.2021.04.013

触觉振动反馈系统对单侧小腿假肢穿戴者平衡及行走功能的影响

王世琦^1,²,高雅倩^1,²,胥泽华^1,²,林恒^1,²,胥方元^1,²(),袁丽^1,²()

^1.西南医科大学附属医院康复医学科，四川泸州市 646000
^2.西南医科大学康复医学系，四川泸州市 646000

收稿日期:2020-12-01 修回日期:2021-01-17 出版日期:2021-04-25 发布日期:2021-04-20
通讯作者: 胥方元,袁丽 E-mail:x5144@163.com;yuanli_swmu@163.com
作者简介:王世琦(1995-)，男，汉族，四川德阳市人，硕士研究生，医师，主要研究方向：骨科康复、康复工程。
基金资助:
四川省科技计划项目(2019YFS0139)

Effects of Tactile Vibration Feedback System on Balance Function and Walking Ability of Unilateral Transtibial Amputees with Prostheses

Shi-qi WANG^1,²,Ya-qian GAO^1,²,Ze-hua XU^1,²,Heng LIN^1,²,Fang-yuan XU^1,²(),Li YUAN^1,²()

^1.Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China
^2.Department of Rehabilitation Medicine, The Southwest Medical University, Luzhou, Sichuan 646000, China

Received:2020-12-01 Revised:2021-01-17 Published:2021-04-25 Online:2021-04-20
Contact: Fang-yuan XU,Li YUAN E-mail:x5144@163.com;yuanli_swmu@163.com
Supported by:
Sichuan Science and Technology Program(2019YFS0139)

摘要/Abstract

摘要： 目的

观察触觉振动反馈系统对单侧小腿假肢穿戴者的平衡和行走功能的影响。

方法

2019年10月至2020年11月，选取本院门诊和住院治疗的小腿截肢后穿戴假肢者11例，受试者佩戴本科自行研制的触觉振动反馈系统装置，进行日常活动3 h。分别于佩戴前和日常活动后采用Tinetti平衡与步态量表(POMA)、步态分析和室外1000 m复杂路面行走测试对受试者进行评定。

结果

与穿戴前相比，受试者POMA的平衡评分升高(Z = -2.264, P < 0.05)，步态评分和总分显著升高(|t| > 6.249, P < 0.001)；步态分析中，受试者患侧肢体步长改善，双侧肢体步长时间和双支撑相时间缩短，行走速度提高(|t| > 2.250, |Z| > 2.756, P < 0.05)；室外1000 m复杂路面行走测试显示，受试者步数、耗能和用时均降低(|t| > 2.412, |Z| > 2.045, P < 0.05)。所有受试者均完成试验，未出现不适。

结论

本触觉振动反馈系统可安全、有效地改善小腿假肢穿戴者平衡和行走功能。

关键词: 振动反馈, 假肢, 小腿截肢, 平衡, 步行

Abstract: Objective

To observe the effect of the tactile vibration feedback system on the balance and walking function of the unilateral transitional amputees with prostheses.

Methods

From October, 2019 to November 2020, eleven unilateral transtibial amputees with prostheses were selected from our hospital. They performed daily activities for three hours wearing tactile vibration feedback system designed by our department. The patients were evaluated by Performance Oriented Mobility Assessment (POMA), gait analysis and outdoor 1000 meters complex road walking test before and after treatment.

Results

The balance score of the POMA improved (Z = -2.264, P < 0.05), the gait score and total score of the POMA increased significantly (|t| > 6.249, P < 0.001) after treatment. Gait analysis showed that the step length of the affected side improved, the bilateral step time and double support phase shortened, and the walking speed increased (|t| > 2.250, |Z| > 2.756, P < 0.05) after installation. The outdoor 1000 meters complex road walking test showed that the total steps, energy consumption and time decreased (|t| > 2.412, |Z| > 2.045, P < 0.05). All the patients finished the trail, and no discomfort appeared.

Conclusion

The tactile vibration feedback system could safely and effectively improve the balance and walking function of the unilateral transtibial amputees with prostheses.

Key words: vibration feedback, prostheses, transtibial amputation, balance, walking

中图分类号:

R496

王世琦,高雅倩,胥泽华,林恒,胥方元,袁丽. 触觉振动反馈系统对单侧小腿假肢穿戴者平衡及行走功能的影响[J]. 《中国康复理论与实践》, 2021, 27(4): 472-477.

Shi-qi WANG,Ya-qian GAO,Ze-hua XU,Heng LIN,Fang-yuan XU,Li YUAN. Effects of Tactile Vibration Feedback System on Balance Function and Walking Ability of Unilateral Transtibial Amputees with Prostheses[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(4): 472-477.

图/表 5

表1

图1

表2

表3

表4

参考文献 29

1	Ülger Ö, Yıldırım Şahan T, Çelik S E. A systematic literature review of physiotherapy and rehabilitation approaches to lower-limb amputation [J]. Physiother Theory Pract, 2018, 34(11): 821-834.
2	王世琦,袁丽,胥方元. 小腿截肢者穿戴假肢步行和平衡功能康复研究进展[J]. 四川医学, 2020, 41(6): 649-652.
	Wang S Q, Yuan L, Xu F Y. Research progress on walking and balance function rehabilitation of transtibial amputees with prostheses [J]. Sichuan Med, 2020, 41(6): 649-652.
3	Highsmith M J, Andrews C R, Millman C, et al. Gait training interventions for lower extremity amputees: a systematic literature review [J]. Technol Innov, 2016, 18(2-3): 99-113.
4	魏艳琴,曹学军,杨平,等. 单侧小腿截肢者穿戴假肢后行走功能的评价[J]. 中国康复理论与实践, 2017, 23(3): 358-362.
	Wei Y Q, Cao X J, Yang P, et al. Walking ability of unilateral transtibial amputees with prostheses [J]. Chin J Rehabil Theory Pract, 2017, 23(3): 358-362.
5	Montgomery J R, Grabowski A M. Use of a powered ankle-foot prosthesis reduces the metabolic cost of uphill walking and improves leg work symmetry in people with transtibial amputations [J]. J R Soc Interface, 2018, 15(145): 20180442.
6	Esquenazi A. Gait analysis in lower-limb amputation and prosthetic rehabilitation [J]. Phys Med Rehabil Clin N Am, 2014, 25(1): 153-167.
7	Van Gelder L M A, Barnes A, Wheat J S, et al. The use of biofeedback for gait retraining: a mapping review [J]. Clin Biomech (Bristol, Avon), 2018, 59: 159-166.
8	李瑨,喻洪流,曹武警,等. 智能假腿膝关节的控制方法研究及发展趋势[J]. 中国康复医学杂志, 2017, 32(8): 963-965.
	Li J, Yu H L, Cao W J, et al. Research and development trend of control methods of intelligent prosthesis knee joint [J]. Chin J Rehabil Med, 2017, 32(8): 963-965.
9	寇洋洋. 髋外展肌群增强训练对小腿截肢术后平衡和步态的影响研究[D]. 成都:成都中医药大学, 2014.
	Kou Y Y. The study of hip abduction muscle strengthen training on trans-tibia amputated patients Effecting on balance and gait [D]. Chengdu: Chengdu Univ Trad Chin Med, 2014.
10	袁丽,胥方元,胥泽华. 感觉反馈对小腿截肢者行走和平衡功能影响的研究进展[J]. 中国康复医学杂志, 2016, 31(4): 489-493.
	Yuan L, Xu F Y, Xu Z H. Research progress on the effect of sensory feedback on walking and balance function in transtibial amputees [J]. Chin J Rehabil Med, 2016, 31(4): 489-493.
11	吴志彬,蒋宛凌,舒彬,等. 功能性反馈疗法在下肢假肢装配中的应用 [J]. 中国康复医学杂志, 2014, 29(7): 628-632.
	Wu Z B, Jiang W L, Shu B, et al. A study on functional feedback therapy in lower limb prosthesis assembly [J]. Chin J Rehabil Med, 2014, 29(7): 628-632.
12	杨琛,王秀华,刘莉. Tinetti平衡与步态量表在移动及平衡能力评估中的应用进展[J]. 中国康复医学杂志, 2019, 34(5): 601-606.
	Yang C, Wang X H, Liu L. Progress in the application of performance oriented mobility assessment (POMA) in the evaluation of movement and balance ability [J]. Chin J Rehabil Med, 2019, 34(5): 601-606.
13	Riis J, Byrgesen S M, Kragholm K H, et al. Validity of the GAITRite walkway compared to Functional Balance Tests for fall risk assessment in geriatric outpatients [J]. Geriatrics (Basel), 2020, 5(4): 77.
14	包忠颖. 下肢截肢患者装配假肢后康复训练的疗效观察[J]. 临床医药文献电子杂志, 2015, 2(13): 2565, 2568.
	Bao Z Y. To observe the curative effect of rehabilitation training on the patients after lower limb amputation prosthesis [J]. J Clin Med, 2015, 2(13): 2565, 2568.
15	Claret C R, Herget G W, Kouba L, et al. Neuromuscular adaptations and sensorimotor integration following a unilateral transfemoral amputation [J]. J Neuroeng Rehabil, 2019, 16(1): 115.
16	Charkhkar H, Christie B P, Triolo R J. Sensory neuroprosthesis improves postural stability during Sensory Organization Test in lower-limb amputees [J]. Sci Rep, 2020, 10(1): 6984.
17	Ku P X, Abu Osman N A, Wan Abas W A. Balance control in lower extremity amputees during quiet standing: a systematic review [J]. Gait Posture, 2014, 39(2): 672-682.
18	Miller W C, Deathe A B. A prospective study examining balance confidence among individuals with lower limb amputation [J]. Disabil Rehabil, 2004, 26(14-15): 875-881.
19	Bourque M O, Schneider K L, Calamari J E, et al. Combining physical therapy and cognitive behavioral therapy techniques to improve balance confidence and community participation in people with unilateral transtibial amputation who use lower limb prostheses: a study protocol for a randomized sham-control clinical trial [J]. Trials, 2019, 20(1): 812.
20	Husman M A, Maqbool H F, Awad M I, et al. A wearable skin stretch haptic feedback device: Towards improving balance control in lower limb amputees [J]. Conf Proc IEEE Eng Med Biol Soc, 2016, 2016: 2120-2123.
21	Wall C I, Weinberg M S. Balance prostheses for postural control [J]. IEEE Engineer Med Biol Mag, 2003, 22(2): 84-90.
22	Sienko K H, Balkwill M D, Oddsson L I, et al. Effects of multi-directional vibrotactile feedback on vestibular-deficient postural performance during continuous multi-directional support surface perturbations [J]. J Vestib Res, 2008, 18(5-6): 273-285.
23	金振华,陈玲,叶祥明. 全身振动训练对脑卒中患者下肢功能的效果[J]. 中国康复理论与实践, 2019, 25(3): 347-351.
	Jin Z H, Chen L, Ye X M. Effect of whole body vibration on abilities of lower extremities for stroke patients [J]. Chin J Rehabil Theory Pract, 2019, 25(3): 347-351.
24	Duclos C, Roll R, Kavounoudias A, et al. Vibration-induced post-effects: a means to improve postural asymmetry in lower leg amputees? [J]. Gait Posture, 2007, 26(4): 595-602.
25	Wang S Q, Gao Y Q, Xu Z H, et al. Effects of tactile vibration feedback system on balance function and walking ability of a unilateral transtibial amputee with a prosthesis: a case report [J]. Med (Baltimore), 2020, 99(39): e22450.
26	Kwon Y, Kwon J W, Cho I H. The difference of gait characteristic according to the variety of dual tasks in young healthy adults [J]. Work, 2019, 63(1): 33-38.
27	Yoo S. Complications following an amputation [J]. Phys Med Rehabil Clin N Am, 2014, 25(1): 169-178.
28	Fan R E, Culjat M O, King C H, et al. A haptic feedback system for lower-limb prostheses [J]. IEEE Trans Neural Syst Rehabil Eng, 2008, 16(3): 270-277.
29	Fan R E, Wottawa C, Mulgaonkar A, et al. Pilot testing of a haptic feedback rehabilitation system on a lower-limb amputee [C]. 2009 ICME International Conference on Complex Medical Engineering, Tempe, AZ, 2009: 1-4

编号	年龄(岁)	性别	BMI (kg/m²)	截肢原因	截肢部位	假肢穿戴时间(年)	残肢长度(cm)	大腿围(cm)
编号	年龄(岁)	性别	BMI (kg/m²)	截肢原因	截肢部位	假肢穿戴时间(年)	残肢长度(cm)	健侧	患侧
1	20	男	21.37	车祸	右	4	18.2	49.8	42.4
2	62	男	23.44	静脉血栓	左	3	18.5	39.3	37.2
3	27	男	29.49	车祸	左	2	15.5	40.0	43.2
4	65	男	23.05	碎石砸伤	右	3	18.2	43.4	40.9
5	46	女	21.68	车祸	右	2	15.2	38.4	37.3
6	48	男	24.24	机器绞伤	左	1	16.7	52.0	49.8
7	48	男	21.51	电击伤	左	2	17.1	41.1	35.0
8	20	男	18.69	机器绞伤	右	4	17.4	44.0	39.1
9	67	女	24.97	车祸	左	2	16.4	39.2	36.7
10	57	女	28.40	车祸	左	2	18.3	42.7	40.3
11	53	女	23.62	车祸	右	3	17.9	38.5	37.8

项目	穿戴前	穿戴后	t/Z值	P值
平衡评分	10.00(12.00, 9.00)	12.00(13.00, 10.00)	-2.264	0.024
步态评分	7.45±1.13	9.00±1.00	-6.249	< 0.001
总分	18.00±2.37	20.27±2.41	-6.829	< 0.001

项目		穿戴前	穿戴后	t/Z值	P值
步长(cm)	健侧	56.26(61.41, 32.84)	59.98(63.52, 56.47)	-1.689	0.091
步长(cm)	患侧	48.77±12.05	59.25±9.19	-2.966	0.014
步长时间(s)	健侧	0.68±0.15	0.57±0.05	2.447	0.034
步长时间(s)	患侧	0.71±0.21	0.57±0.06	2.250	0.048
单支撑相(s)	健侧	0.50±0.12	0.45±0.05	1.246	0.241
单支撑相(s)	患侧	0.40(0.50, 0.37)	0.41(0.44, 0.39)	-0.889	0.374
双支撑相(s)	健侧	0.47(0.52, 0.28)	0.32(0.42, 0.29)	-2.756	0.006
双支撑相(s)	患侧	0.48(0.61, 0.43)	0.31(0.41, 0.26)	-2.934	0.003
摆动相(s)	健侧	0.41±0.06	0.40±0.04	0.204	0.843
摆动相(s)	患侧	0.49±0.13	0.47±0.05	0.922	0.378
行走速度(cm/s)		79.59±35.25	101.41±15.50	-2.394	0.038

项目	穿戴前	穿戴后	t/Z值	P值
步数	1878(2116, 1821)	1820(2008, 1716)	-2.045	0.041
总耗能(kCal)	86.08±18.86	83.34±19.27	-2.412	0.037
单位耗能(kCal/kg)	1.38±0.24	1.37±0.23	-2.462	0.034
总时间(s)	1021.55(1337.56, 991.62)	998.73(1197.38, 960.42)	-2.223	0.026

[1]	王昊懿, 史亚伟, 鲁俊, 许光旭. 主观垂直感知障碍对脑卒中患者功能影响的回顾性研究[J]. 《中国康复理论与实践》, 2024, 30(1): 68-73.
[2]	魏梦力, 钟亚平, 周易文, 桂辉贤, 关烨明, 于婷婷. 单侧前交叉韧带重建患者步行双侧下肢肌肉协同模式差异[J]. 《中国康复理论与实践》, 2024, 30(1): 95-104.
[3]	胡晓诗, 张琦, 岳青, 梁艳华, 李晓松, 冯啊美, 张燕庆. 矫形弹力绷带对痉挛性偏瘫脑性瘫痪患儿步态对称性和步行能力的效果[J]. 《中国康复理论与实践》, 2023, 29(9): 1083-1089.
[4]	杨雅楠, 穆丽萍, 邢凤梅, 薛新宏, 王晓光, 陶徉聿, 孙竹梅, 张小丽. 基于计划行为理论的干预对肌少症老年人肌肉衰减状况及平衡能力的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 869-874.
[5]	孙藤方, 任梦婷, 杨琳, 王耀霆, 王红雨, 闫兴洲. 高压氧治疗联合重复外周磁刺激干预脑卒中患者踝运动功能和平衡能力的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 875-881.
[6]	马圣楠, 柯竟悦, 董洪铭, 李建萍, 张洪浩, 刘超, 沈双, 李古强. 核心稳定性训练干预前交叉韧带重建术后动态平衡及表面肌电的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 882-889.
[7]	王亚楠, 刘西花. 脑卒中偏瘫患者主观和客观平衡功能测量的相关性及预测效能[J]. 《中国康复理论与实践》, 2023, 29(8): 890-895.
[8]	张意彬, 吕杰, 喻洪流. 基于模糊逻辑算法的智能膝关节假肢步态相位识别[J]. 《中国康复理论与实践》, 2023, 29(8): 896-902.
[9]	谭晓欢, 姜桂萍, 黄芯怡, 王丹丹, 张磊, 卜庆国, 吴雪萍. 社区高龄老年人下肢肌力与步速的关系：柔韧和动态平衡的链式中介作用[J]. 《中国康复理论与实践》, 2023, 29(6): 646-653.
[10]	张倩, 孙新亭. 视频镜像训练对脑卒中恢复期患者下肢功能的效果[J]. 《中国康复理论与实践》, 2023, 29(6): 703-707.
[11]	赵雅娴, 唐芷晴, 孙新亭, 王荣荣, 刘天昊, 张皓. 不同强度穿戴式下肢康复机器人训练对脑卒中后下肢功能的效果[J]. 《中国康复理论与实践》, 2023, 29(5): 497-503.
[12]	金振华, 陈玲, 刘勇. 基于自我效能理论的数字化步行功能训练对脑卒中患者下肢功能的效果[J]. 《中国康复理论与实践》, 2023, 29(5): 504-509.
[13]	朱晓敏, 刘惠林, 刘元旻, 闫志宇, 杜雪晶, 王亚囡, 张通. 脑卒中患者步行中自发性转身方向与平衡和跌倒风险间的关系[J]. 《中国康复理论与实践》, 2023, 29(5): 510-515.
[14]	王雨生, 贾子善, 张攻孜, 左秀芹, 孙彤, 赵艺扬. 人体自主平衡恢复过程中姿势调控的个体影响因素[J]. 《中国康复理论与实践》, 2023, 29(5): 590-594.
[15]	张意彬, 李剑峰, 喻洪流. 一种智能膝关节假肢及其步态对称性评价[J]. 《中国康复理论与实践》, 2023, 29(4): 402-407.

触觉振动反馈系统对单侧小腿假肢穿戴者平衡及行走功能的影响

Effects of Tactile Vibration Feedback System on Balance Function and Walking Ability of Unilateral Transtibial Amputees with Prostheses

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 5

参考文献 29

相关文章 15

Metrics

本文评价

推荐阅读 0