座椅前倾对脑卒中患者坐-站转移能力的影响及脑网络研究

doi:10.3969/j.issn.1006-9771.2026.09.008

《中国康复理论与实践》 ›› 2026, Vol. 32 ›› Issue (9): 1061-1067.doi: 10.3969/j.issn.1006-9771.2026.09.008

座椅前倾对脑卒中患者坐-站转移能力的影响及脑网络研究

沈小花, 陈芳元, 荣积峰, 饶彪琴, 孔令轩, 田威, 陈志群, 李丽()

上海市第一康复医院，上海市 200090

收稿日期:2026-04-28 修回日期:2026-08-07 接受日期:2026-08-10 出版日期:2026-09-25 发布日期:2026-09-20
通讯作者: 李丽(1984-)，女，汉族，山东枣庄市人，博士，副主任医师，主要研究方向：神经系统疾病的康复。E-mail： 58698030@qq.com
作者简介:沈小花(1984-)，女，汉族，江苏扬州市人，主管技师，主要研究方向：近红外及表面肌电在神经康复中的应用。
基金资助:
杨浦区卫生健康委员会面上项目(YPM202313);杨浦区卫生健康委员会面上项目(YPM202406)

Effect of anterior seat inclination on sit-to-stand ability in patients with stroke and related brain network

Shen Xiaohua, Chen Fangyuan, Rong Jifeng, Rao Biaoqin, Kong Lingxuan, Tian Wei, Chen Zhiqun, Li Li()

The First Rehabilitation Hospital of Shanghai, Shanghai 200090, China

Received:2026-04-28 Revised:2026-08-07 Accepted:2026-08-10 Published:2026-09-25 Online:2026-09-20
Contact: Li Li, E-mail: 58698030@qq.com
Supported by:
General Project of Science and Technology Commission & Health Commission of Yangpu District, Shanghai(YPM202313);General Project of Science and Technology Commission & Health Commission of Yangpu District, Shanghai(YPM202406)

摘要/Abstract

摘要：

目的观察座椅前倾对脑卒中患者坐-站转移(STS)能力和平衡功能的影响，并基于功能性近红外光谱(fNIRS)探讨其训练前后脑功能连接的变化。

方法 2024年1月至2025年12月，选取上海市第一康复医院脑卒中偏瘫患者43例，随机分为对照组(n = 21)和试验组(n = 22)。对照组给予常规康复联合平椅STS训练，试验组给予常规康复联合座椅前倾20° STS训练，干预2周。分别于训练前后进行5次坐立测试(FTSST)和Berg平衡量表(BBS)评定，采用fNIRS检测前额叶皮质(PFC)、初级运动皮质(M1)、初级躯体感觉皮质(S1)、前运动皮质(PMC)的脑血氧变化并分析功能连接强度。

结果训练后，两组FTSST用时均较训练前明显缩短(t > 3.469, P < 0.01)，且试验组短于对照组(t = -2.065, P < 0.05)；两组BBS评分均较前明显升高(|Z| > 4.019, P < 0.01)，试验组高于对照组(Z = -2.250, P < 0.05)。fNIRS数据显示，试验组训练后左侧M1 (LM1)与右侧PFC、LM1与右侧S1的FC强度均高于训练前(t > 3.311, P < 0.05)。

结论座椅前倾条件下STS训练可增强相关脑区功能连接，有利于改善脑卒中患者STS能力和平衡功能。

关键词: 脑卒中, 坐-站转移, 座椅前倾, 功能性近红外光谱, 脑功能网络

Abstract:

Objective To observe the clinical effect of anterior seat inclination on sit-to-stand (STS) ability and balance function in patients with stroke, as well as brain functional connectivity based on functional near-infrared spectroscopy (fNIRS).

Methods From January, 2024 to December, 2025, 43 patients with stroke were randomly divided into control group (n = 21) and experimental group (n= 22). The control group received conventional rehabilitation combined with STS training on a flat seat, while the experimental group received conventional rehabilitation plus STS training with a 20° anterior seat inclination, for two weeks. Five-times sit-to-stand test (FTSST) and Berg Balance Scale (BBS) were assessed before and after training. fNIRS was used to detect changes in cerebral blood oxygenation in the prefrontal cortex (PFC), primary motor cortex (M1), primary somatosensory cortex (S1) and premotor cortex (PMC), and to analyze functional connectivity strength.

Results After training, FTSST time shortened in both groups (t > 3.469, P < 0.01), and was shorter in the experimental group than in the control group (t = -2.065, P < 0.05); BBS scores increased in both groups (|Z| > 4.019, P< 0.01), and was higher in the experimental group than in the control group (Z = -2.250, P < 0.05). fNIRS showed that after training, the functional connectivity strength between the left M1 and the right PFC increased, as well as between the left M1 and the right S1 in the experimental group (t > 3.311, P< 0.05).

Conclusion STS training with anterior seat inclination can enhance functional connectivity in relevant brain regions, which may contribute to improvements of STS ability and balance function in patients with stroke.

Key words: stroke, sit-to-stand transition, seat inclination, functional near-infrared spectroscopy, brain functional networks

中图分类号:

R743.3

沈小花, 陈芳元, 荣积峰, 饶彪琴, 孔令轩, 田威, 陈志群, 李丽. 座椅前倾对脑卒中患者坐-站转移能力的影响及脑网络研究[J]. 《中国康复理论与实践》, 2026, 32(9): 1061-1067.

Shen Xiaohua, Chen Fangyuan, Rong Jifeng, Rao Biaoqin, Kong Lingxuan, Tian Wei, Chen Zhiqun, Li Li. Effect of anterior seat inclination on sit-to-stand ability in patients with stroke and related brain network[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(9): 1061-1067.

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参考文献 28

[1]	Gerstl J V E, Blitz S E, Qu Q R, et al. Global, regional, and national economic consequences of stroke[J]. Stroke, 2023, 54(9): 2380-2389.
[2]	Pollock A, Gray C, Culham E, et al. Interventions for improving sit-to-stand ability following stroke[J]. Cochrane Database Syst Rev, 2014, 2014(5): CD007232.
[3]	周哲, 沈夏锋, 沈小花, 等. 椅面前倾对脑卒中偏瘫患者坐-站转移的影响[J]. 中国康复理论与实践, 2020, 26(7): 825-829.
	Zhou Z, Shen X F, Shen X H, et al. Effect of chair inclination forward on sit-to-stand for hemiplegics after stroke[J]. Chin J Rehabil Theory Pract, 2020, 26(7): 825-829.
[4]	Zhao Y N, Han P P, Zhang X Y, et al. Applications of functional near-infrared spectroscopy (fNIRS) neuroimaging during rehabilitation following stroke: a review[J]. Med Sci Monit, 2024, 30: e943785.
[5]	中华医学会神经病学分会. 中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志, 2019, 52(9): 710-715.
	Chinese Society of Neurology, Chinese Stroke Society. Diagnostic criteria of cerebrovascular diseases in China (version 2019)[J]. Chin J Neurol, 2019, 52(9): 710-715.
[6]	Ng J C M, Ho M W K. Does self-initiated sit-to-stand training with an assistive device regain the independence of sit-to-stand in stroke patient? A single-blinded randomized controlled trial [J]. J Rehabil Assist Technol Eng, 2020, 7: 2055668319866053.
[7]	刘立明, 瓮长水, 王娜, 等. 5次坐立试验对老年人运动功能的评估价值[J]. 中国康复理论与实践, 2010, 16(4): 359-361.
	Liu L M, Weng C S, Wang N, et al. Five-times sit-to-stand test on physical performance for older people[J]. Chin J Rehabil Theory Pract, 2010, 16(4): 359-361.
[8]	瓮长水, 王军, 王刚, 等. Berg平衡量表在脑卒中患者中的内在信度和同时效度[J]. 中国康复医学杂志, 2007, 22(8): 688-690, 717.
	Weng C S, Wang J, Wang G, et al. Assessments of internal reliability and concurrent validity of Berg Balance Scale in stroke patients[J]. Chin J Rehabil Med, 2007, 22(8): 688-690, 717.
[9]	陆佳敏, 闫思念, 陈逸浩, 等. 脑卒中后认知障碍患者静息态脑网络特征的功能性近红外光谱研究[J]. 中国康复理论与实践, 2022, 28(4): 447-452.
	Lu J M, Yan S N, Chen Y H, et al. Characteristics of resting brain network for patients with cognitive impairment after stroke using functional near-infrared spectroscopy[J]. Chin J Rehabil Theory Pract, 2022, 28(4): 447-452.
[10]	姜林鸿, 刘晓丹, 孙萍萍, 等. 运动想象训练对卒中后患者上肢运动功能恢复的影响及静息态fNIRS脑网络特征研究[J]. 中国康复医学杂志, 2023, 38(11): 1505-1513.
	Jiang L H, Liu X D, Sun P P, et al. Effects of motor imagery training on the recovery of upper extremity motor function in poststroke patients and characteristics of resting-state fNIRS brain network[J]. Chin J Rehabil Med, 2023, 38(11): 1505-1513.
[11]	Logan A, Freeman J, Kent B, et al. Standing Practice In Rehabilitation Early after stroke (SPIRES): a functional standing frame programme (prolonged standing and repeated sit to stand) to improve function and quality of life and reduce neuromuscular impairment in people with severe sub-acute stroke: a protocol for a feasibility randomised controlled trial[J]. Pilot Feasibility Stud, 2018, 4: 66. doi: 10.1186/s40814-018-0254-z
[12]	McDonald C, Mayor J J V, Lennon O. Neurophysiological insights into sit-to-stand post stroke[J]. Front Neurosci, 2025, 19: 1646498. doi: 10.3389/fnins.2025.1646498
[13]	黄旭, 孟庆华, 鲍春雨, 等. 中风偏瘫患者坐-站转移过程中的生物力学分析[J]. 医用生物力学, 2021, 36(3): 479-484.
	Huang X, Meng Q H, Bao C Y, et al. Biomechanical analysis of stroke hemiplegic patients during sit-to-stand transfer[J]. J Med Biomech, 2021, 36(3): 479-484.
[14]	De Sousa D G, Harvey L A, Dorsch S, et al. Two weeks of intensive sit-to-stand training in addition to usual care improves sit-to-stand ability in people who are unable to stand up independently after stroke: a randomised trial[J]. J Physiother, 2019, 65(3): 152-158.
[15]	Amala S, Chippala P. Effect of sit-to-stand training on balance, muscle strength, and activities of daily living in patients with stroke: a randomised controlled trial[J]. J Clin Diagn Res, 2024, 18(2): 5-8.
[16]	Josop N A, Mohd Nordin N A, Ahmad M A. Evaluating the effectiveness of different prescriptions of sit-to-stand training in post-stroke rehabilitation: a systematic review and meta-analysis[J]. Medicine, 2025, 104(45): e45625. doi: 10.1097/MD.0000000000045625
[17]	Harington T, Comley-White N, Roos R. Energy expenditure and effort of patients with stroke during sit to stand: a pilot study[J]. S Afr J Physiother, 2024, 80(1): 1-6.
[18]	吴雪娇, 郑洁皎, 夏汶, 等. 脑卒中偏瘫患者坐-站转移生物力学分析研究进展[J]. 中国康复理论与实践, 2018, 24(3): 290-295.
	Wu X J, Zheng J J, Xia W, et al. Advance in biomechanical analysis of sit-to-stand movement in hemiplegic stroke patients (review)[J]. Chin J Rehabil Theory Pract, 2018, 24(3): 290-295.
[19]	刘孟, 倪朝民, 陈进, 等. 早期坐-站转移训练对亚急性脑卒中偏瘫患者平衡功能的影响[J]. 中国康复, 2015, 30(5): 335-338.
	Liu M, Ni C M, Chen J, et al. Balance outcomes after early sit-to-stand training in subacute stroke patients[J]. Chin J Rehabil, 2015, 30(5): 335-338.
[20]	江帆, 朱其凤, 付水生. 强化坐-站训练对脑卒中患者平衡、步行及日常生活活动能力的影响[J]. 广西医科大学学报, 2017, 34(8): 1209-1212.
	Jiang F, Zhu Q F, Fu S S. The effects of intensive sit-to-stand training on activities of daily living in patients with stroke[J]. J Guangxi Med Univ, 2017, 34(8): 1209-1212.
[21]	Onursal Kılınç Ö, De Ridder R, Kılınç M, et al. Trunk and lower extremity biomechanics during sit-to-stand after stroke: a systematic review[J]. Ann Phys Rehabil Med, 2023, 66(3): 101676. doi: 10.1016/j.rehab.2022.101676
[22]	Boukadida A, Piotte F, Dehail P, et al. Determinants of sit-to-stand tasks in individuals with hemiparesis post stroke: a review[J]. Ann Phys Rehabil Med, 2015, 58(3): 167-172.
[23]	Suriyaamarit D, Boonyong S. Comparison of the effects of chair height and anterior seat inclination on sit-to-stand ability in children with spastic diplegic cerebral palsy[J]. J Biomech, 2020, 113: 110098. doi: 10.1016/j.jbiomech.2020.110098
[24]	Hamaoui A, Hassaïne M, Zanone P G. Sitting on a sloping seat does not reduce the strain sustained by the postural chain[J]. PLoS One, 2015, 10(1): e0116353. doi: 10.1371/journal.pone.0116353
[25]	Qi Y, Xu Y, Wang H, et al. Network reorganization for neurophysiological and behavioral recovery following stroke[J]. Cent Nerv Syst Agents Med Chem, 2024, 24(2): 117-128.
[26]	Bhattacharjee S, Kashyap R, Abualait T, et al. The role of primary motor cortex: more than movement execution[J]. J Mot Behav, 2021, 53(2): 258-274.
[27]	Ariani G, Pruszynski J A, Diedrichsen J. Motor planning brings human primary somatosensory cortex into action-specific preparatory states[J]. eLife, 2022, 11: e69517.
[28]	Liang J, Huang J, Luo Z, et al. Brain network mechanism on cognitive control task in the elderly with brain aging: a functional near infrared spectroscopy study[J]. Front Hum Neurosci, 2023, 17: 1154798. doi: 10.3389/fnhum.2023.1154798

组别	n	性别(男/女)/n	年龄/岁	卒中类型(梗死/出血)/n	大脑半球受损(左/右)/n	病程/d
对照组	21	11/10	69.00(65.50, 72.50)	16/5	9/12	101.00(35.00, 158.50)
试验组	22	16/6	67.50(61.00, 71.00)	15/7	10/12	111.50(60.00, 187.25)
χ²/Z值		1.904	-0.887	0.343	0.029	0.620
P值		0.168	0.380	0.558	0.864	0.535

组别	n	测试	$\stackrel{-}{\mathit{x}}\pm \mathit{s}$	t值	P值
对照组	21	前测	24.819±8.209	3.469	0.002
		后测	22.236±6.462
试验组	22	前测	23.658±6.020	7.441	< 0.001
		后测	18.615±4.971
训练前两组均值差			-1.161±2.188	-0.531	0.599
训练后两组均值差			-3.620±1.753	-2.065	0.045

组别	n	测试	M(Q_L, Q_U)	Z值	P值
对照组	21	前测	27.00(22.00, 32.00)	-4.019	< 0.001
		后测	34.00(30.00, 41.50)
试验组	22	前测	32.50(22.50, 38.50)	-4.111	< 0.001
		后测	43.50(32.00, 48.25)
训练前两组差值				-1.460	0.144
训练后两组差值				-2.250	0.024

ROI-ROI	训练前	训练后	t值	P值
左PMC-右PMC	0.651±0.437	0.677±0.472	-0.321	0.962
左PMC-左S1	0.809±0.339	0.847±0.401	-0.639	0.921
左PMC-左PFC	0.579±0.370	0.531±0.334	0.797	0.921
左PMC-右PFC	0.531±0.329	0.465±0.283	1.434	0.563
左PMC-左M1	0.926±0.402	0.913±0.381	0.204	0.962
左PMC-右M1	0.708±0.464	0.711±0.435	-0.042	0.982
左PMC-右S1	0.646±0.377	0.581±0.418	1.384	0.563
右PMC-左S1	0.614±0.426	0.657±0.472	-0.544	0.921
右PMC-左PFC	0.532±0.354	0.540±0.319	-0.113	0.981
右PMC-右PFC	0.595±0.398	0.573±0.342	0.280	0.962
右PMC-左M1	0.718±0.557	0.639±0.484	0.808	0.921
右PMC-右M1	0.962±0.469	0.831±0.529	1.399	0.563
右PMC-右S1	0.794±0.456	0.740±0.464	0.671	0.921
左S1-左PFC	0.599±0.337	0.573±0.348	0.453	0.962
左S1-右PFC	0.554±0.309	0.522±0.330	0.591	0.921
左S1-左M1	0.915±0.383	0.840±0.381	1.156	0.663
左S1-右M1	0.732±0.454	0.812±0.390	-1.254	0.626
左S1-右S1	0.691±0.408	0.780±0.430	-1.578	0.563
左PFC-右PFC	0.641±0.357	0.651±0.286	-0.180	0.962
左PFC-左M1	0.581±0.342	0.454±0.317	2.942	0.073
左PFC-右M1	0.552±0.356	0.553±0.318	-0.023	0.981
左PFC-右S1	0.555±0.336	0.637±0.305	-1.814	0.563
右PFC-左M1	0.574±0.322	0.407±0.315	4.224	0.011
右PFC-右M1	0.586±0.340	0.552±0.333	0.548	0.921
右PFC-右S1	0.643±0.340	0.630±0.357	0.249	0.962
左M1-右M1	0.892±0.527	0.771±0.479	1.680	0.563
左M1-右S1	0.755±0.450	0.555±0.437	3.311	0.047
右M1-右S1	0.849±0.491	0.874±0.477	-0.388	0.962

座椅前倾对脑卒中患者坐-站转移能力的影响及脑网络研究

Effect of anterior seat inclination on sit-to-stand ability in patients with stroke and related brain network

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[15]	高惠刚, 刘远文, 秦煜玲, 胡昔权, 朱琳. 2020年至2025年足踝软体外骨骼机器人改善脑卒中患者步行功能的Scoping综述[J]. 《中国康复理论与实践》, 2026, 32(6): 645-652.