不同视觉输入及任务条件下痉挛型偏瘫儿童平衡与下肢生物力学变化

doi:10.3969/j.issn.1006-9771.2026.03.011

摘要/Abstract

摘要：

目的探讨不同视觉输入及任务条件对痉挛型偏瘫儿童平衡功能与下肢生物力学特征的影响。

方法 2025年3月至7月，选取苏州大学附属儿童医院6~9岁痉挛型偏瘫儿童30例(偏瘫组)和健康儿童30例(对照组)，采用2(组别：偏瘫组/对照组)×2(任务：单任务/双任务)×2(视觉：睁眼/闭眼)混合试验设计。试验前1周，完成Fugl-Meyer评定量表下肢部分(FMA-LE)、儿童功能独立性评定量表(WeeFIM)和韦氏儿童智力量表(WISC-Ⅳ)评价。使用三维步态分析系统和足底压力测试系统采集时空参数步速、步长、步频、步宽，运动学参数髋/膝/踝关节角度，动力学参数前足负荷比、压力中心(CoP)偏移量，计算双任务成本(DTC)。

结果时空参数显示，双任务及闭眼条件下偏瘫组步速、步长降低，步宽增大，组别、任务、视觉对步速、步长、步宽交互效应显著(F > 4.886, P < 0.05)。运动学参数显示，双任务时偏瘫组髋关节屈曲角度增大、踝关节背屈角度减小，闭眼时膝关节屈曲角度增大，三者对各关节角度交互效应显著(F > 4.876, P < 0.05)。动力学参数显示，双任务及闭眼条件下，偏瘫组前足负荷比、CoP前后偏移量降低，CoP侧向偏移量增大，三者对CoP偏移量交互效应显著(F > 4.355, P < 0.05)。除睁眼步频DTC外，偏瘫组DTC均显著高于对照组(|t| > 14.393, P < 0.001)。相关性分析显示，FMA-LE评分与DTC呈强负相关(|r| > 0.731, P < 0.01)，WeeFIM评分、工作记忆指数与步速、步频DTC呈中等负相关(|r| > 0.462, P < 0.05)。

结论痉挛型偏瘫儿童的步态和平衡受双任务和视觉的双重影响。视觉剥夺与双任务叠加显著加剧其步态异常。DTC与运动功能、工作记忆有较强的相关性。

关键词: 痉挛型偏瘫, 儿童, 生物力学, 双任务, 视觉输入, 平衡功能

Abstract:

Objective To investigate the effect of different visual inputs and task conditions on balance function and lower limb biomechanical characteristics in children with spastic hemiplegia.

Methods From March to July, 2025, 30 children aged six to nine years old with spastic hemiplegia (hemiplegia group) and 30 healthy children (control group) were selected. A 2×2×2 mixed experimental design was employed, involving groups (hemiplegia vs. healthy), tasks (single-task vs. dual-task), and vision (eyes open vs. eyes closed). One week before test, they were evaluated with Fugl-Meyer Assessment-Lower Extremities (FMA-LE), Wee Function Independent Measurement (WeeFIM) and Wechsler Intelligence Scale for Children, Fourth Edition (WISC-Ⅳ). A 3D gait analysis system and a plantar pressure testing system were used to collect spatio-temporal parameters of walking speed, stride length, cadence and step width, kinematic parameters of hip/knee/ankle joint angles, kinetic parameters of forefoot loading ratio, center of pressure (CoP) displacement, while dual-task cost (DTC) was caculated.

Results Spatio-temporal parameters showed that under dual-task and eyes-closed conditions, walking speed and stride length decreased while step width increased in the hemiplegia group. Significant interaction effects among group, task, and vision were observed for speed, stride length, and step width (F > 4.886, P < 0.05). Kinematic parameters indicated that during dual-tasks, the hemiplegia group exhibited increased hip flexion and decreased ankle dorsiflexion; under eyes-closed conditions, knee flexion increased. The interaction of the three factors significantly affected all joint angles (F > 4.876, P < 0.05). Kinetic parameters showed that under dual-task and eyes-closed conditions, the forefoot loading ratio and anteroposterior CoP displacement decreased, while mediolateral CoP displacement increased. The interaction of the three factors significantly affected CoP displacement (F > 4.355, P < 0.05). All the DTC was significantly higher in the hemiplegia group than in the control group, except DTC of the cadence (|t| > 14.393, P < 0.001). Correlation analysis revealed that the score of FMA-LE was strongly negatively correlated with DTC (|r|> 0.731, P < 0.01). The Functional Independence Measure for Children and Working Memory Index showed moderate negative correlations with the DTC of walking speed and cadence (|r|> 0.462, P < 0.05).

Conclusion The gait and balance of children with spastic hemiplegia are concurrently influenced by dual-tasking and visual input. The superposition of visual deprivation and dual-tasks significantly exacerbates gait abnormalities. Furthermore, is strongly correlated with motor function and working memory.

Key words: spastic hemiplegia, children, biomechanics, dual task, visual input, balance

中图分类号:

R742.3

梁冠军, 徐欢岚, 张何威, 张大力, 顾琴, 李明娣. 不同视觉输入及任务条件下痉挛型偏瘫儿童平衡与下肢生物力学变化[J]. 《中国康复理论与实践》, 2026, 32(3): 345-355.

LIANG Guanjun, XU Huanlan, ZHANG Hewei, ZHANG Dali, GU Qin, LI Mingdi. Changes in balance and lower limb biomechanics of spastic hemiplegia under different visual deprivation and task conditions[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(3): 345-355.

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参考文献 41

[1]	PATEL D R, BOVID K M, RAUSCH R, et al. Cerebral palsy in children: a clinical practice review[J]. Curr Probl Pediatr Adolesc Health Care, 2024, 54(11): 101673.
[2]	苑爱云, 罗光金, 于晓明, 等. 双任务平板训练对痉挛型偏瘫脑性瘫痪患儿运动功能的影响[J]. 中华实用儿科临床杂志, 2022, 37(15): 1167-1171.
	YUAN A Y, LUO G J, YU X M, et al. The effect of dual-task tablet training on motor function in children with spastic hemiplegic cerebral palsy[J]. Chin J Appl Clin Pediatr, 2022, 37(15): 1167-1171.
[3]	YA-CHING H. Influence of accuracy constraints on bimanual coordination and gait performance in children with unilateral spastic cerebral palsy[J]. Gait Posture, 2019, 68: 106-110. doi: 10.1016/j.gaitpost.2018.11.012
[4]	WALICKA-CUPRYS K, RACHWAL M, GUZIK A, et al. Body balance of children and youths with visual impairment (pilot study)[J]. Int J Environ Res Public Health, 2022, 19(17): 11095. doi: 10.3390/ijerph191711095
[5]	MICHAUD L, DESJARDINS D, PERREAULT A, et al. Visual biofeedback and postural control: exploring potential implicit visual integration[J]. J Mot Behav, 2025, 57(5): 554-567. doi: 10.1080/00222895.2025.2523448
[6]	GANDOLFI M, FIORIO M, GEROIN C, et al. Dual tasking affects gait performance but not automaticity in functional gait disorders: a new diagnostic biomarker[J]. Parkinsonism Relat Disord, 2023, 108: 105291. doi: 10.1016/j.parkreldis.2023.105291
[7]	WANG L, YU G, CHEN Y. Effects of dual-task training on chronic ankle instability: a systematic review and meta-analysis[J]. BMC Musculoskelet Disord, 2023, 24(1): 814. doi: 10.1186/s12891-023-06944-3
[8]	PAVAO S L, LIMA C R G, SATO T O, et al. Association between the level of attention and dual-task costs on postural sway and cognitive yield in children, adolescents, and young adults[J]. Int J Dev Neurosci, 2021, 81(3): 229-237. doi: 10.1002/jdn.10092 pmid: 33448019
[9]	VERMETTE M J, PRINCE F, BHERER L, et al. Concentrating to avoid falling: interaction between peripheral sensory and central attentional demands during a postural stability limit task in sedentary seniors[J]. Geroscience, 2024, 46(1): 1181-1200. doi: 10.1007/s11357-023-00860-z
[10]	朱婷, 郑洁皎, 丁建伟, 等. 注意力分配对双重任务模型平衡和计算能力的影响[J]. 中国康复理论与实践, 2019, 25(4): 439-443. doi: 10.3969/j.issn.1006-9771.2019.04.013
	ZHU T, ZHENG J J, DING J W, et al. The effect of attention allocation on the balance and computational ability of dual-task models[J]. Chin J Rehabil Theory Pract, 2019, 25(4): 439-443.
[11]	RAHMAN R A A, HANAPIAH F A, NIKMAT A W, et al. Effects of concurrent tasks on gait performance in children with traumatic brain injury versus children with typical development[J]. Ann Rehabil Med, 2021, 45(3): 186-196. doi: 10.5535/arm.21004 pmid: 34126668
[12]	李晓捷, 唐久来, 马丙祥. 中国脑性瘫痪康复指南(2022)第一章:概论[J]. 中华实用儿科临床志, 2022, 37(12): 887-892.
	LI X J, TANG J L, MA B X. Chapter 1: Introduction of the rehabilitation guidelines for cerebral palsy in China (2022)[J]. Chin J Appl Clin Pediatr, 2022, 37(12): 887-892.
[13]	徐欢岚, 梁冠军, 张何威, 等. 早期卧位踏车训练对造血干细胞移植患儿平衡能力和功能独立性的影响[J]. 中华物理医学与康复杂志, 2024, 46(3): 232-236.
	XU H L, LIANG G J, ZHANG H W, et al. The impact of early position cycling training on balance ability and functional independence in children undergoing hematopoietic stem cell transplantation[J]. Chin J Phys Med Rehabil, 2024, 46(3): 232-236.
[14]	娄普, 李文霞, 耿香菊, 等. 上肢多关节机器人训练对痉挛型偏瘫脑瘫患儿上肢运动功能及日常生活活动能力的影响[J]. 中华物理医学与康复杂志, 2022, 44(8): 712-714.
	LOU P, LI W X, GENG X J, et al. The impact of multi-joint robot training on upper limb motor function and activities of daily living in children with spastic hemiplegic cerebral palsy[J]. Chin J Phys Med Rehabil, 2022, 44(8): 712-714.
[15]	王志芳, 张倩, 杨媞媞, 等. 我国中小学生智力水平分布特点[J]. 中华疾病控制杂志, 2024, 28(6): 714-720.
	WANG Z F, ZHANG Q, YANG Y Y, et al. Distribution characteristics of intelligence level among primary and secondary school students in China[J]. Chin J Dis Contr Prev, 2024, 28(6): 714-720.
[16]	ZHOU J, CATTANEO G, YU W, et al. The age-related contribution of cognitive function to dual-task gait in middle-aged adults in Spain: observations from a population-based study[J]. Lancet Health Longev, 2023, 4(3): e98-e106. doi: 10.1016/S2666-7568(23)00009-0
[17]	KOWALSKI E, CATELLI D S, LAMONTAGNE M. Side does not matter in healthy young and older individuals: examining the importance of how we match limbs during gait studies[J]. Gait Posture, 2019, 67: 133-136. doi: 10.1016/j.gaitpost.2018.10.008
[18]	GIBSON M E, STORK N. Gait disorders[J]. Prim Care, 2021, 48(3): 395-415. doi: 10.1016/j.pop.2021.04.004 pmid: 34311847
[19]	OKUR E O, ARIK M I, OKUR I, et al. Dual-task training effect on gait parameters in children with spastic diplegic cerebral palsy: preliminary results of a self-controlled study[J]. Gait Posture, 2022, 94: 45-50. doi: 10.1016/j.gaitpost.2022.02.020 pmid: 35247824
[20]	SADEGHI S, HAJILOU B, ROHBANFARD H. The effect of cognitive and motor dual tasks on the synergy of lower limb muscles during walking[J]. Motor Control, 2025, 29(2): 145-156. doi: 10.1123/mc.2024-0080
[21]	CORTES-PEREZ I, CASTILLO-PINTOR M L Á, BARRIONUEVO-BERZOSA R, et al. Dual-task training interventions for cerebral palsy: a systematic review and meta-analysis of effects on postural balance and walking speed[J]. Medicina (Kaunas), 2025, 61(8): 1415.
[22]	KATZ-LEURER M, ROTEM H, MEYER S. Effect of concurrent cognitive tasks on temporo-spatial parameters of gait among children with cerebral palsy and typically developed controls[J]. Dev Neurorehabil, 2014, 17(6): 363-367. doi: 10.3109/17518423.2013.810676
[23]	PIITULAINEN H, KULMALA J, MAENPAA H, et al. The gait is less stable in children with cerebral palsy in normal and dual-task gait compared to typically developed peers[J]. J Biomech, 2021, 117: 110244. doi: 10.1016/j.jbiomech.2021.110244
[24]	BAEK C Y, CHANG W N, PARK B Y, et al. Effects of dual-task gait treadmill training on gait ability, dual-task interference, and fall efficacy in people with stroke: a randomized controlled trial[J]. Phys Ther, 2021, 101(6): pzab067.
[25]	赵盼超, 纪仲秋, 姜桂萍, 等. 不同任务干扰对儿童早期步态特征和任务成本的影响[J]. 中国康复理论与实践, 2023, 29(9): 1072-1082. doi: 10.3969/j.issn.1006-9771.2023.09.011
	ZHAO P C, JI Z Q, JIANG G P, et al. The impact of different task interference on early childhood gait characteristics and task costs[J]. Chin J Rehabil Theory Pract, 2023, 29(9): 1072-1082.
[26]	PALLUEL E, CHAUVEL G, BOURG V, et al. Effects of dual tasking on postural and gait performances in children with cerebral palsy and healthy children[J]. Int J Dev Neurosci, 2019, 79: 54-64. doi: 10.1016/j.ijdevneu.2019.10.008 pmid: 31722225
[27]	WIST S, CARCREFF L, BRUIJN S M, et al. Gait stability in ambulant children with cerebral palsy during dual tasks[J]. PLoS One, 2022, 17(6): e0270145. doi: 10.1371/journal.pone.0270145
[28]	ROOSTAEI M, RAJI P, MORONE G, et al. The effect of dual-task conditions on gait and balance performance in children with cerebral palsy: a systematic review and meta-analysis of observational studies[J]. J Bodyw Mov Ther, 2021, 26: 448-462. doi: 10.1016/j.jbmt.2020.12.011 pmid: 33992282
[29]	ZHAO P, MA K, JI Z, et al. Effects of task interference on kinematics and dual-task cost of running in early childhood[J]. Sensors, 2024, 24(5): 1534. doi: 10.3390/s24051534
[30]	SURKAR S M, HOFFMAN R M, HARBOURNE R, et al. Cognitive-motor interference heightens the prefrontal cortical activation and deteriorates the task performance in children with hemiplegic cerebral palsy[J]. Arch Phys Med Rehabil, 2021, 102(2): 225-232. doi: 10.1016/j.apmr.2020.08.014
[31]	RUBSAM M, GIROLAMI G L, BHATT T. Heterogeneity of tasks and outcome measures in dual tasking studies in children with cerebral palsy: a scoping review[J]. Phys Ther, 2024, 104(1): pzad151.
[32]	CHAM R, IERSON J M, BAILES A H, et al. Attention and sensory integration for postural control in young adults with autism spectrum disorders[J]. Exp Brain Res, 2021, 239(5): 1417-1426. doi: 10.1007/s00221-021-06058-z pmid: 33675379
[33]	SINNO S, DUMAS G, MALLINSON A, et al. Changes in the sensory weighting strategies in balance control throughout maturation in children[J]. J Am Acad Audiol, 2021, 32(2): 122-136. doi: 10.1055/s-0040-1718706 pmid: 33296934
[34]	SÁ C D S C, BOFFINO C C, RAMOS R T, et al. Development of postural control and maturation of sensory systems in children of different ages: a cross-sectional study[J]. Braz J Phys Ther, 2018, 22(1): 70-76. doi: 10.1016/j.bjpt.2017.10.006
[35]	RAFIQUE SA, NORTHWAY N. Reliance on visual feedback from ocular accommodation on motor skills in children with developmental coordination disorder and typically developing controls[J]. Hum Mov Sci, 2021, 76: 102767. doi: 10.1016/j.humov.2021.102767
[36]	杨志勇, 何彦璐, 董文红, 等. 基于多中心研究的学龄前儿童静态平衡发展变化趋势分析[J]. 中国儿童保健杂志, 2025, 33(3): 265-270.
	YANG Z Y, HE Y L, DONG W H, et al. Analysis of the developmental trends of preschool children's static balance based on multicenter research[J]. Chin J Child Health Care, 2025, 33(3): 265-270.
[37]	丰有燕, 权宏磊, 郑洁皎. 可变优先级认知-运动双任务训练对老年脑卒中患者平衡功能的影响[J]. 中国康复医学杂志, 2022, 37(6): 754-759.
	FENG Y Y, QUAN H L, ZHENG J J. The effect of variable priority cognitive-motor dual-task training on balance function in elderly stroke patients[J]. Chin J Rehabil Med, 2022, 37(6): 754-759.
[38]	CARCREFF L, FLUSS J, ALLALI G, et al. The effects of dual tasks on gait in children with cerebral palsy[J]. Gait Posture, 2019, 70: 148-155. doi: S0966-6362(18)31494-2 pmid: 30875601
[39]	RETHWILM R, BOHM H, HAASE M, et al. Dynamic stability in cerebral palsy during walking and running: predictors and regulation strategies[J]. Gait Posture, 2021, 84: 329-334. doi: 10.1016/j.gaitpost.2020.12.031 pmid: 33445142
[40]	PIN T W. Effectiveness of interactive computer play on balance and postural control for children with cerebral palsy: a systematic review[J]. Gait Posture, 2019, 73: 126-139. doi: S0966-6362(18)31790-9 pmid: 31323621
[41]	SZTURM T, PARMAR S T, MEHTA K, et al. Game-based dual-task exercise program for children with cerebral palsy: blending balance, visuomotor and cognitive training: feasibility randomized control trial[J]. Sensors (Basel), 2022, 22(3): 761. doi: 10.3390/s22030761

组别	n	性别 (男/女)/n	年龄/岁	身高/cm	体质量/kg
对照组	30	16/14	7.84±0.32	125.46±1.36	26.16±0.76
偏瘫组	30	16/14	7.70±0.37	125.22±1.28	26.28±1.68
χ²/t/Z值		0.000	1.605	0.713	-0.366
P值		1.000	0.114	0.479	0.716

项目		平方和	自由度	均方	F值	P值
步速	组间	0.608	1	0.608	7.464	0.008
	任务	0.261	1	0.261	7.857	0.007
	视觉条件	0.311	1	0.311	4.831	0.032
	组间×任务	0.214	1	0.214	6.447	0.014
	组间×视觉条件	0.663	1	0.663	10.285	0.002
	任务×视觉条件	0.025	1	0.025	5.078	0.028
	组间×任务×视觉条件	0.024	1	0.024	4.886	0.031
步长	组间	1692.400	1	1692.400	6.152	0.016
	任务	217.500	1	217.500	4.606	0.036
	视觉条件	89.070	1	89.070	4.414	0.040
	组间×任务	244.000	1	244.000	5.167	0.027
	组间×视觉条件	77.737	1	77.737	3.852	0.055
	任务×视觉条件	12.410	1	12.410	4.500	0.038
	组间×任务×视觉条件	17.501	1	17.501	6.344	0.015
步频	组间	8760.417	1	8760.417	9.716	0.003
	任务	359.167	1	359.167	3.410	0.070
	视觉条件	272.473	1	272.473	3.874	0.054
	组间×任务	367.050	1	367.050	3.488	0.067
	组间×视觉条件	252.517	1	252.517	3.586	0.063
	任务×视觉条件	2.703	1	2.703	3.218	0.078
	组间×任务×视觉条件	1.790	1	1.790	2.131	0.150
步宽	组间	487.353	1	487.353	8.878	0.004
	任务	11.408	1	11.408	4.152	0.045
	视觉条件	120.108	1	120.108	9.482	0.003
	组间×任务	9.853	1	9.853	3.587	0.063
	组间×视觉条件	75.433	1	75.433	5.953	0.018
	任务×视觉条件	8.749	1	8.749	8.444	0.005
	组间×任务×视觉条件	9.213	1	9.213	8.893	0.004

项目		平方和	自由度	均方	F值	P值
髋关节最大屈曲角度	组间	22020.484	1	22020.484	14.041	< 0.001
	任务	18.040	1	18.040	5.244	0.025
	视觉条件	14.457	1	14.457	5.486	0.019
	组间×任务	14.656	1	14.656	4.244	0.039
	组间×视觉条件	10.021	1	10.021	3.803	0.051
	任务×视觉条件	0.961	1	0.961	5.050	0.030
	组间×任务×视觉条件	1.098	1	1.098	5.773	0.016
膝关节最大屈曲角度	组间	4370.883	1	4370.883	5.424	0.023
	任务	51.270	1	51.270	3.014	0.074
	视觉条件	9.895	1	9.895	4.414	0.028
	组间×任务	61.650	1	61.650	3.622	0.057
	组间×视觉条件	8.243	1	8.243	3.679	0.055
	任务×视觉条件	4.417	1	4.417	4.752	0.028
	组间×任务×视觉条件	4.530	1	4.530	4.876	0.027
踝关节最大背屈角度	组间	1453.688	1	1453.688	6.708	0.012
	任务	25.740	1	25.740	4.674	0.035
	视觉条件	18.321	1	18.321	6.074	0.014
	组间×任务	24.263	1	24.263	4.404	0.036
	组间×视觉条件	13.429	1	13.429	4.450	0.035
	任务×视觉条件	6.278	1	6.278	4.006	0.045
	组间×任务×视觉条件	10.788	1	10.788	6.891	0.009

项目		平方和	自由度	均方	F值	P值
前足负荷比/%	组间	19934.972	1	19934.972	8.987	0.004
	任务	132.091	1	132.091	5.590	0.021
	视觉条件	50.622	1	50.622	6.206	0.016
	组间×任务	110.573	1	110.573	4.683	0.034
	组间×视觉条件	40.354	1	40.354	4.948	0.030
	任务×视觉条件	9.845	1	9.845	6.036	0.017
	组间×任务×视觉条件	5.988	1	5.988	3.687	0.057
CoP前后偏移量/mm	组间	22739.004	1	22739.004	15.676	< 0.001
	任务	452.443	1	452.443	6.100	0.016
	视觉条件	247.437	1	247.437	6.600	0.013
	组间×任务	352.602	1	352.602	4.753	0.033
	组间×视觉条件	190.546	1	190.546	5.083	0.028
	任务×视觉条件	37.203	1	37.203	6.404	0.014
	组间×任务×视觉条件	30.974	1	30.974	5.331	0.024
CoP侧向偏移量/mm	组间	4081.238	1	4081.238	12.343	< 0.001
	任务	152.898	1	152.898	6.510	0.013
	视觉条件	436.797	1	436.797	7.072	0.010
	组间×任务	99.318	1	99.318	4.227	0.044
	组间×视觉条件	309.178	1	309.178	5.007	0.029
	任务×视觉条件	90.178	1	90.178	5.806	0.019
	组间×任务×视觉条件	67.655	1	67.655	4.355	0.041

项目	视觉条件	对照组(n = 30)	偏瘫组(n = 30)	t值	P值
步速DTC	睁眼	6.36±0.65	9.54±0.64	-18.982	< 0.001
步速DTC	闭眼	4.86±0.48	12.78±0.63	-55.053	< 0.001
步长DTC	睁眼	6.62±0.59	10.06±0.69	-20.755	< 0.001
步长DTC	闭眼	10.46±0.57	15.29±0.70	-24.883	< 0.001
步频DTC	睁眼	3.48±0.78	4.41±0.83	-4.476	0.055
步频DTC	闭眼	4.89±0.41	6.65±0.53	-14.393	< 0.001