平衡评估训练系统对脑卒中后平衡功能的康复效果

doi:10.3969/j.issn.1006-9771.2021.07.004

摘要/Abstract

摘要：

目的探讨脑卒中后平衡功能障碍患者应用Huber 360神经肌肉控制训练与评估系统(Huber 360)的效果。

方法 2020年1月至11月,首次发病的脑卒中患者16例随机分为对照组(n = 8)和试验组(n = 8)。两组均接受常规运动功能训练3周,试验组同时采用Huber 360进行训练。训练前后,采用Berg平衡量表、Huber 360、10米步行测试和计时起立-行走测试进行评定。

结果训练后,两组各项指标均改善(t > 1.368, P < 0.05),试验组优于对照组(t > 2.230, P < 0.05)。

结论 Huber 360能进一步改善脑卒中患者平衡功能。

关键词: 脑卒中, 平衡, 评定, 康复

Abstract:

Objective To investigate the effects of Huber 360 neuromuscular control training and evaluation system (Huber 360) on balance dysfunction for patients with stroke.

Methods From January to November, 2020, 16 patients with stroke were randomly assigned to control group (n = 8) and observation group (n = 8). Both groups received routine motor function training, while the observation group accepted Huber 360 training in addition, for three weeks. They were assessed with Berg Balance Scale, Huber 360, 10-meter Walking Test and Timed 'Up & Go' Test before and after training.

Results All the indexes improved after training in both groups (t > 1.368, P < 0.05), and improved more in the observation group than in the control group (t > 2.230, P < 0.05).

Conclusion Huber 360 can promote the recovery of balance for stroke patients.

Key words: stroke, balance, assessment, rehabilitation

中图分类号:

R743.3

何蕾,柴双双,陈亚平. 平衡评估训练系统对脑卒中后平衡功能的康复效果[J]. 《中国康复理论与实践》, 2021, 27(7): 760-764.

HE Lei,CHAI Shuang-shuang,CHEN Ya-ping. Effect of Balance Training with Balance Assessment Training System on Balance after Stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(7): 760-764.

图/表 10

表1

表2

表3

表4

表5

表6

表7

表8

表9

表10

参考文献 39

[1]	ULLAH S, AL-ATWI M K, QURESHI A Z, et al. Falls in individuals with stroke during inpatient rehabilitation at a tertiary care hospital in Saudi Arabia[J]. Neurosciences, 2019, 24(2):130-136. doi: 10.17712/nsj.2019.2.20180032
[2]	ULLAH S, QURESHI A Z, ULLAH R, et al. Medical complications during inpatient stroke rehabilitation at a tertiary care rehabilitation hospital in Riyadh, Saudi Arabia[J]. J Liaquat Univ Med Health Sci, 2018, 17(2):66-70.
[3]	LEE S A, CHA H G. The effects of high frequency transcutaneous nerve stimulation on spasticity, proprioception, strength, and balance in patients with stroke: a randomized controlled trial[J]. J Magnetics, 2019, 24(2):322-327. doi: 10.4283/JMAG.2019.24.2.322
[4]	SOYUER F, OZTURKA A. The effect of spasticity, sense and walking aids in falls of people after chronic stroke[J]. Disabil Rehabil, 2007, 29(9):679-687. doi: 10.1080/09638280600925860
[5]	WEI T S, LIU P T, CHANG L W, et al. Gait asymmetry, ankle spasticity, and depression as independent predictors of falls in ambulatory stroke patients[J]. PLoS One, 2017, 12(5):e0177136. doi: 10.1371/journal.pone.0177136
[6]	KONGWATTANAKUL K, HIENGKAEW V, JALAYONDEJA C, et al. A structural equation model of falls at home in individuals with chronic stroke, based on the international classification of function, disability, and health[J]. PLoS One, 2020, 15(4):e0231491. doi: 10.1371/journal.pone.0231491
[7]	CHAN P P, SI TOU J I, TSE M M, et al. Reliability and validity of the timed up and go test with a motor task in people with chronic stroke[J]. Arch Phys Med Rehabil, 2017, 98(11):2213-2220. doi: 10.1016/j.apmr.2017.03.008
[8]	RAFSTEN L, MEIRELLES C, DANIELSSON A, et al. Impaired motor function in the affected arm predicts impaired postural balance after stroke: a cross sectional study[J]. Front Neurol, 2019, 21(10):912.
[9]	SUTTIWONG J, VONGSIRINAVARAT M, HIENGKAEW V. Predictors of community participation among individuals with first stroke: a Thailand study[J]. Ann Rehabil Med, 2018, 42(5):660-669. doi: 10.5535/arm.2018.42.5.660
[10]	THILARAJAH S, MENTIPLAY B F, BOWER K J, et al. Factors associated with poststroke physical activity: a systematic review and meta-analysis[J]. Arch Phys MedRehabil, 2018, 99(9):1876-1889.
[11]	CLELAND B T, ARSHAD H, MADHAVAN S. Concurrent validity of the GAITRite electronic walkway and the 10-m walk test for measurement of walking speed after stroke[J]. Gait Posture, 2019, 68:458-460. doi: 10.1016/j.gaitpost.2018.12.035
[12]	TYSON S F, HANLEY M, CHILLALA J, et al. The relationship between balance, disability, and recovery after stroke: predictive validity of the Brunel Balance Assessment[J]. Neurorehabil Neural Repair, 2007, 21(4):341-346. doi: 10.1177/1545968306296966
[13]	KOLLEN B, VAN DE PORT I, LINDEMAN E, et al. Predicting improvement in gait after stroke: a longitudinal prospective study[J]. Stroke, 2005, 36(12):2676-2680. doi: 10.1161/01.STR.0000190839.29234.50
[14]	ULLAH S, AL-ATWI M K, QURESHI A Z, et al. Falls in individuals with stroke during inpatient rehabilitation at a tertiary care hospital in Saudi Arabia[J]. Neurosciences (Riyadh), 2019, 24(2):130-136.
[15]	GEURTS A C, DE HAART M, VAN NES I J, et al. A review of standing balance recovery from stroke[J]. Gait Posture, 2005, 22(3):267-281. doi: 10.1016/j.gaitpost.2004.10.002
[16]	ALESSANDRO L, OLMOS L E, BONAMICO L, et al. Multidisciplinary rehabilitation for adult patients with stroke[J]. Medicina (B Aires), 2020, 80(1):54-68.
[17]	HA S Y, HAN J H, KO Y J, et al. Ankle exercise with functional electrical stimulation affects spasticity and balance in stroke patients[J]. J Exerc Rehabil, 2020, 16(6):496-502. doi: 10.12965/jer.2040780.390
[18]	ALGHADIR A H, AL-EISA E S, ANWER S, et al. Reliability, validity, and responsiveness of three scales for measuring balance in patients with chronic stroke[J]. BMC Neurol, 2018, 18(1):141-148. doi: 10.1186/s12883-018-1146-9
[19]	PERSSON C U, HANSSON P O, SUNNERHAGEN K S. Clinical tests performed in acute stroke identify the risk of falling during the first year: Postural Stroke Study in Gothenburg (POSTGOT)[J]. J Rehabil Med, 2011, 43(4):348-353. doi: 10.2340/16501977-0677
[20]	PODSIADLO D, RICHARDSON S. The Timed "Up & Go": a test of basic functional mobility for frail elderly persons[J]. J Am Geriatr Soc, 1991, 39(2):142-148. doi: 10.1111/jgs.1991.39.issue-2
[21]	MOZAFFARIAN D, BENJAMIN E J, GO A S, et al. Executive Summary: Heart Disease and Stroke Statistics–2016 Update: a report from the American Heart Association[J]. Circulation, 2016, 133(4):447-454. doi: 10.1161/CIR.0000000000000366
[22]	VENKATASUBBA RAO C P, SUAREZ J I. Management of stroke in the neurocritical care unit[J]. Continuum (Minneap Minn), 2018, 24(6):1658-1682.
[23]	BATCHELOR F A, MACKINTOSH S F, SAID C M, et al. Falls after stroke[J]. Int J Stroke, 2012, 7(6):482-490. doi: 10.1111/j.1747-4949.2012.00796.x
[24]	SCHMID A A, VAN PUYMBRORCK M, KNIS K, et al. Fear of falling among people who have sustained a stroke: a 6-month longitudinal pilot study[J]. Am J Occup Ther, 2015, 65(2):125-132. doi: 10.5014/ajot.2011.000737
[25]	STANMORE E K, OLDHAM J, SKELTON D A, et al. Fall incidence and outcomes of falls in a prospective study of adults with rheumatoid arthritis[J]. Arthritis Care Res (Hoboken), 2013, 65(5):737-744. doi: 10.1002/acr.21892
[26]	POUWELS S, LAAMOHAMED A, LEUFKENS B, et al. Risk of hip/femur fracture after stroke: a populationbased case-control study[J]. Stroke, 2009, 40:3281-3285. doi: 10.1161/STROKEAHA.109.554055
[27]	ALMOUSA S, LAMPRIANIDOU E, KITSOULIS G. The effectiveness of stabilising exercises in pelvic girdle pain during pregnancy and after delivery: a systematic review[J]. Physiother Res Int, 2018, 23(1):e1699. doi: 10.1002/pri.v23.1
[28]	PELLERNO L, GIANNONI P, MARINELLI L, et al. Effects of continuous visual feedback during sitting balance training in chronic stroke survivors[J]. J Neuroeng Rehabil, 2017, 14(1):107-121. doi: 10.1186/s12984-017-0316-0
[29]	BONAN I V, COLLE F M, GUICHARD J P, et al. Reliance on visual information after stroke. Part I: balance on dynamic posturography[J]. Arch Phys Med Rehabil, 2004, 85(2):268-273. doi: 10.1016/j.apmr.2003.06.017
[30]	BONAN I V, YELNIK A P, COLLE F M, et al. Reliance on visual information after stroke. Part II: Effectiveness of a balance rehabilitation program with visual cue deprivation after stroke: a randomized controlles trial[J]. Arch Phys Med Rehabil, 2004, 85(2):274-278. doi: 10.1016/j.apmr.2003.06.016
[31]	WIM S, NOLAN H, STIJN V, et al. Sensory information and the perception of verticality in post-stroke patients. Another point of view in sensory reweighting strategies[J]. PLoS One, 2018, 13(6):e0199098. doi: 10.1371/journal.pone.0199098
[32]	VAN DUIJNHOVEN H J R, ROELOFS J M B, DEN BOER J J, et al. Perturbation-based balance training to improve step quality in the chronic phase after stroke: a proof-of-concept study[J]. Front Neurol, 2018, 9(22):980-992. doi: 10.3389/fneur.2018.00980
[33]	ZAREPOUR M, JADGAL M S, MORADI Z, et al. Assessment of fear of falling and its relation to balance in elderly people of Urmia[J]. Caspian J Health Res, 2020, 5(2):23-27. doi: 10.29252/cjhr.5.2.23
[34]	LANGHORNE P, COUPAR F, POLLOCK A. Motor recovery after stroke: a systematic review[J]. Lancet Neurol, 2009, 8(8):741-754. doi: 10.1016/S1474-4422(09)70150-4
[35]	VAN CRIEKINGE T, TRUIJEN S, SCHRODER J, et al. The effectiveness of trunk training on trunk control, sitting and standing balance and mobility post-stroke: a systematic review and meta-analysis[J]. Clin Rehabil, 2019, 33(6):992-1002. doi: 10.1177/0269215519830159
[36]	SCHMID A A, VAN PUYMBROECK M, ALTENBURGER P A, et al. Balance and balance self-efficacy are associated with activity and participation after stroke: a cross-sectional study in people with chronic stroke[J]. Arch Phys Med Rehabil, 2012, 93(6):1101-1107. doi: 10.1016/j.apmr.2012.01.020
[37]	BANDURA A. Self-efficacy: toward a unifying theory of behavioral change[J]. Psychol Rev, 1977, 84(2):191-215. doi: 10.1037/0033-295X.84.2.191
[38]	LETAFATKAR A, NAZARZADEH M, HADADNEZHAD M, et al. The efficacy of a HUBER exercise system mediated sensorimotor training protocol on proprioceptive system, lumbar movement control and quality of life in patients with chronic non-specific low back pain[J]. J Back Musculoskelet Rehabil, 2017, 30(4):767-778. doi: 10.3233/BMR-150404
[39]	GUIRAUD T, LABRUNÉE M, BESNIER F, et al. Whole-body strength training with Huber Motion Lab and traditional strength training in cardiac rehabilitation: a randomized controlled study[J]. Ann Phys Rehabil Med, 2017, 60(1):20-26. doi: 10.1016/j.rehab.2016.07.385

组别	n	性别(男/女, n)	年龄(岁)	病程(d)	类型(梗死/出血, n)	病灶侧(左/右, n)
对照组	8	5/3	50.75±8.80	70.00±29.67	7/1	5/3
试验组	8	6/2	56.75±7.74	78.75±18.33	6/2	4/4
χ²/t值		0.273	1.448	0.710	0.385	0.238
P值		0.602	0.170	0.490	0.535	0.626

组别	n	治疗前	治疗后	t值	P值
对照组	8	31.00±3.78	37.13±2.42	-8.249	< 0.001
试验组	8	31.38±3.02	41.50±3.07	-8.756	< 0.001
t值		0.219	3.167
P值		0.830	0.007

组别	n	治疗前	治疗后	t值	P值
对照组	8	1236.26±247.10	988.41±138.82	2.441	0.045
试验组	8	1249.85±309.57	790.69±66.70	3.548	0.009
t值		-0.097	3.631
P值		0.924	0.003

组别	n	治疗前	治疗后	t值	P值
对照组	8	491.29±84.71	356.233±35.90	3.745	0.007
试验组	8	478.29±109.28	300.27±39.87	3.495	0.010
t值		0.266	2.950
P值		0.794	0.011

组别	n	治疗前	治疗后	t值	P值
对照组	8	26.91±5.15	21.69±2.37	3.770	0.007
试验组	8	25.83±4.26	15.94±1.88	8.168	< 0.001
t值		0.456	5.372
P值		0.655	< 0.001