《中国康复理论与实践》

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (5): 510-515.doi: 10.3969/j.issn.1006-9771.2023.05.003

• 专题 脑卒中肢体功能康复 • 上一篇    下一篇

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

朱晓敏1,2, 刘惠林1,2, 刘元旻1,2, 闫志宇1,2, 杜雪晶1,2, 王亚囡1,2, 张通1,2()   

  1. 1.中国康复研究中心北京博爱医院物理疗法3科，北京市 100068
    2.首都医科大学康复医学院，北京市 100068
  • 收稿日期:2022-10-25 修回日期:2023-02-24 出版日期:2023-05-25 发布日期:2023-06-19
  • 通讯作者: 张通(1961-)，男，汉族，博士，主任医师、教授，博士研究生导师，主要研究方向：神经病学、神经康复学。E-mail：Tom611@126.com
  • 作者简介:朱晓敏(1986-)，女，汉族，河北唐县人，硕士研究生，主管治疗师，主要研究方向：神经康复。

Relationship among spontaneous turning direction, balance and fall risk in stroke patients during walking

ZHU Xiaomin1,2, LIU Huilin1,2, LIU Yuanmin1,2, YAN Zhiyu1,2, DU Xuejing1,2, WANG Ya'nan1,2, ZHANG Tong1,2()   

  1. 1. The Third Department of Physiotherapy, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China
    2. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
  • Received:2022-10-25 Revised:2023-02-24 Published:2023-05-25 Online:2023-06-19
  • Contact: ZHANG Tong, E-mail: Tom611@126.com

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摘要：

目的 分析脑卒中患者步行中自发性转身方向与平衡能力和跌倒风险之间的关系。

方法 2021年12月至2022年11月，北京博爱医院脑卒中患者94例，分别进行单任务计时“起立-行走”测试(TUGT, TUGT1)、拿水杯TUGT (TUGT2)和计算任务下TUGT (TUGT3)，根据患者3项TUGT于标记点处自发转弯方向分为转向一致组和转向不一致组(n = 34)，转向一致组再分为患侧组(n = 33)和健侧组(n = 27)；每次TUGT后，要求患者再进行一次与自发方向相反转身的TUGT；并进行患侧下肢单腿支撑测试、功能性前伸测试(FRT)、患侧360°转向测试和Morse跌倒量表评定。

结果 患侧组左侧偏瘫比例最高(χ2 = 7.995, P < 0.05)。TUGT1、TUGT2、TUGT3向健侧和患侧转向后测试时间均为患侧组最长，健侧组最短(F > 4.009, P < 0.05)，患侧组长于健侧组(P < 0.05)。单腿支撑时间(H = 9.403, P = 0.009)、FRT距离(F = 4.300, P = 0.016)均为患侧组最短，健侧组最长，患侧组短于健侧组(P < 0.05)；患侧360°转向时间(F = 4.134, P = 0.019)和转向步数(F = 5.611, P = 0.003)均为患侧组最多，健侧组最少，患侧组多于健侧组(P < 0.05)。Morse跌倒量表评分患侧组最高，健侧组最低(H = 8.192, P = 0.017)，患侧组高于健侧组(P < 0.05)。

结论 步行转弯时自发转向患侧的脑卒中患者通常平衡功能较差，跌倒风险较高。

关键词: 脑卒中, 转向, 认知, 平衡, 跌倒

Abstract:

Objective To investigate the relationship among spontaneous turning direction, balance ability and fall risk in patients with stroke during walking.

Methods From December, 2021 to November, 2022, 94 patients with stroke were recruited from Beijing Bo'ai Hospital. They were assessed with simple Timed 'Up and Go' Test (TUGT, TUGT1), TUGT with a cup in hand (TUGT2), and TUGT with calculation task (TUGT3). The spontaneous turning directions at the turn point were recorded, and the patients were divided into no-same group (n = 34) and same group, and the same group was further divided into affected group (n = 33) and unaffected group (n = 27), according to the spontaneous turning direction. After a spontaneous turning of each TUGT, the patients were asked to finish another TUGT turning to the opposite direction. And then, they were assessed with single leg standing test, Functional Reach Test (FRT), 360° turning test and the Morse Fall Scale (MFS).

Results There were the most patients with left hemiplegia in the affected group (χ2 = 7.995, P < 0.05). The time of TUGT1, TUGT2 and TUGT3 was the most in the affected group and the least in the unaffected group (F > 4.009, P < 0.05), and it was more in the affected group than in the unaffected group as post-hoc test (P < 0.05). The one leg standing time (H= 9.403, P= 0.009) and FRT distance (F = 4.300, P = 0.016) were the least in the affected group and the most in the unaffected group, and it was less in the affected group than in the unaffected group as post-hoc test (P < 0.05). The turning time (F= 4.134, P = 0.019) and turning steps (F= 5.611, P = 0.003) were the most in the affected group and the least in the unaffected group, and it was more in the affected group than in the unaffected group as post-hoc test (P < 0.05). The score of MFS was the most in the affected group and the least in the unaffected group (H = 8.192, P = 0.017), and it was more in the affected group than in the unaffected group as post-hoc test (P < 0.05).

Conclusion The stroke patients spontaneously turning to the affected side during walking usually are poorer in balance function, and in a risk of fall.

Key words: stroke, turning, cognition, balance, fall

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