老年人本体感觉、足底触觉和肌肉力量与姿势稳定性的关系

doi:10.3969/j.issn.1006-9771.2022.04.001

摘要/Abstract

摘要：

目的探讨本体感觉、足底触觉以及肌肉力量对动态和静态姿势稳定性的影响。方法 2020年6月至11月,共纳入164例老年人。本体感觉测试仪测试右侧膝关节屈伸和踝关节背屈/跖屈的本体感觉阈值;单丝法测量拇趾、第1和第5跖骨、足跟、足弓的足底触觉;等速肌力测试系统测量踝关节跖屈与背屈以及髋关节外展的肌肉力量。采用Berg平衡量表(BBS)评分和足底压力中心(COP)分别测量动态和静态姿势稳定性。采用因子分析和多元线性回归分析来探索每个因子与姿势稳定结果之间的关系。结果本体感觉与BBS评分(r=-0.449, P<0.001)、COP在内外侧方向的均方根(RMS) (r=0.254, P=0.004)明显相关。足底触觉与COP前后方向的RMS明显相关(r=0.281, P=0.002)。肌肉力量与BBS评分显著相关(r=0.493, P<0.001)。结论本体感觉和肌肉力量与动态姿势稳定性相关,本体感觉和足底触觉与静态姿势稳定性相关。

关键词: 姿势控制, 动态平衡, 身体稳定性, 运动觉, 足底触觉

Abstract:

Objective To explore the impacts of proprioception, cutaneous sensitivity and strength on dynamic and static postural stability.Methods From June to November, 2020, a total of 164 elderly participated in this study. Independent parameters included proprioception of knee flexion/extension and ankle dorsi/plantar flexion with proprioception measurement; the cutaneous sensitivity of great toe, first and fifth metatarsals, arch, and heel with monofilament; and strength of ankle dorsi/plantar flexion and hip abduction with isokinetic test. The Berg Balance Scale (BBS) and center of pressure (COP)-based postural stability tests were conducted to represent dynamic and static postural stability. Exploratory factor and multivariable linear regression analyses were used to explore the relationship of each generated factor to postural stability outcomes.Results Proprioception was significantly correlated to the score of BBS (r=-0.449, P<0.001) and the root mean square (RMS) of COP in mediolateral direction (r=0.254, P=0.004). Cutaneous sensitivity was significantly correlated to the RMS of COP in the anteroposterior direction (r=0.281, P=0.002). Strength was significantly correlated to the score of BBS (r=0.493, P<0.001).Conclusion Proprioception and strength are related to dynamic postural stability, while proprioception and cutaneous sensitivity are associated with static postural stability.

Key words: postural control, dynamic balance, body stability, kinesthesia, plantar sensation

王琪,毛敏,孙威,宋祺鹏. 老年人本体感觉、足底触觉和肌肉力量与姿势稳定性的关系[J]. 《中国康复理论与实践》, 2022, 28(4): 373-378.

WANG Qi,MAO Min,SUN Wei,SONG Qipeng. Relationship of proprioception, cutaneous sensitivity and strength to postural stability among older adults[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(4): 373-378.

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参考文献 46

[1]	PRESZNER-DOMJAN A, NAGY E, SZĺVER E, et al. When does mechanical plantar stimulation promote sensory re-weighing: standing on a firm or compliant surface?[J]. Eur J Appl Physiol, 2012, 112(8):2979-2987. doi: 10.1007/s00421-011-2277-5
[2]	MENZ H B, MORRIS M E, LORD S R. Foot and ankle characteristics associated with impaired balance and functional ability in older people[J]. J Gerontol A Biol Sci Med Sci, 2005, 60(12):1546-1552. doi: 10.1093/gerona/60.12.1546
[3]	RIBEIOR F, OLIVEIRA J. Aging effects on joint proprioception: the role of physical activity in proprioception preservation[J]. Eur Rev Aging Phys Activity, 2007, 4(2):71-76. doi: 10.1007/s11556-007-0026-x
[4]	HAYASHI R, MIYAKE A, WATANABE S. The functional role of sensory inputs from the foot: stabilizing human standing posture during voluntary and vibration-induced body sway[J]. Neurosci Res, 1988, 5(3):203-213. doi: 10.1016/0168-0102(88)90049-1
[5]	PIJNAPPELS M, VAN DER BURG P J, REEVES N D, et al. Identification of elderly fallers by muscle strength measures[J]. Eur J Appl Physiol, 2008, 102(5):585-592. doi: 10.1007/s00421-007-0613-6
[6]	ROBBINS S, WAKED E, MCCLARAN J. Proprioception and stability: foot position awareness as a function of age and footwear[J]. Age Ageing, 1995, 24(1):67-72. doi: 10.1093/ageing/24.1.67
[7]	YOU S H. Joint position sense in elderly fallers: a preliminary investigation of the validity and reliability of the SENSERite measure[J]. Arch Phys Med Rehabil, 2005, 86(2):346-352. doi: 10.1016/j.apmr.2004.01.035
[8]	CRUZ-ALMEIDA Y, BLACK M L, CHRISTOU E A, et al. Site-specific differences in the association between plantar tactile perception and mobility function in older adults[J]. Front Aging Neurosci, 2014, 6:68.
[9]	徐欣, 温子星. 人体动态稳定性控制理论在老年人防跌倒中的应用[J]. 中国康复理论与实践, 2017, 23(11):1254-1257.
	XU X, WEN Z X. Concept of dynamic stability in old people for fall prevention (review)[J]. Chin J Rehabil Theory Pract, 2017, 23(11):1254-1257.
[10]	ZHANG C, SUN W, YU B, et al. Effects of exercise on ankle proprioception in adult women during 16 weeks of training and eight weeks of detraining[J]. Res Sports Med, 2015, 23(1):102-113. doi: 10.1080/15438627.2014.915835
[11]	MACHADO Á S, DA SILVA C B, DA ROCHA E S, et al. Effects of plantar foot sensitivity manipulation on postural control of young adult and elderly[J]. Rev Bras Reumatol Engl Ed, 2017, 57(1):30-36.
[12]	RUBENSTEIN L Z. Falls in older people: epidemiology, risk factors and strategies for prevention[J]. Age Ageing, 2006, 35(Suppl 2): ii37-ii41. doi: 10.1093/ageing/afj018
[13]	KESKIN D, BORMAN P, ERSOZ M, et al. The risk factors related to falling in elderly females[J]. Geriatr Nurs, 2008, 29(1):58-63. doi: 10.1016/j.gerinurse.2007.06.001
[14]	AMBROSE A F, PAUL G, HAUSDORFF J M. Risk factors for falls among older adults: a review of the literature[J]. Maturitas, 2013, 75(1):51-61. doi: 10.1016/j.maturitas.2013.02.009
[15]	BILLOT M, HANDRIGAN G A, SIMONEAU M, et al. Short term alteration of balance control after a reduction of plantar mechanoreceptor sensation through cooling[J]. Neurosci Lett, 2013, 535:40-44. doi: 10.1016/j.neulet.2012.11.022
[16]	UNVER B, AKBAS E. Effects of plantar sensitivity on balance and mobility in community-dwelling older adults: a Turkish study[J]. Australas J Ageing, 2018, 37(4):288-292. doi: 10.1111/ajag.12558
[17]	CUEVAS-TRISAN R. Balance problems and fall risks in the elderly[J]. Clin Geriatr Med, 2019, 35(2):173-183.
[18]	SHUMWAY-COOK A, BALDWIN M, POLISSAR N L, et al. Predicting the probability for falls in community-dwelling older adults[J]. Phys Ther, 1997, 77(8):812-819. doi: 10.1093/ptj/77.8.812
[19]	SHEN M, CHE S, YE D, et al. Effects of backward walking on knee proprioception after ACL reconstruction[J]. Physiother Theory Pract, 2021, 37(10):1109-1116. doi: 10.1080/09593985.2019.1681040
[20]	SADEGHI H, HAKIM M N, HAMID T A, et al. The effect of exergaming on knee proprioception in older men: a randomized controlled trial[J]. Arch Gerontol Geriatr, 2017, 69:144-150. doi: 10.1016/j.archger.2016.11.009
[21]	LI L, MANOR B. Long term Tai Chi exercise improves physical performance among people with peripheral neuropathy[J]. Am J Chin Med, 2010, 38(3):449-459. doi: 10.1142/S0192415X1000797X
[22]	KORCHI K, NOE F, BRU N, et al. Optimization of the effects of physical activity on plantar sensation and postural control with barefoot exercises in institutionalized older adults: a pilot study[J]. J Aging Phys Act, 2019, 27(4):452-465.
[23]	CEPEDA C C, LODOVICO A, FOWLER N, et al. Effect of an eight-week ballroom dancing program on muscle architecture in older adults females[J]. J Aging Phys Act, 2015, 23(4):607-612.
[24]	LEE B A, OH D J. Effect of regular swimming exercise on the physical composition, strength, and blood lipid of middle-aged women[J]. J Exerc Rehabil, 2015, 11(5):266-271. doi: 10.12965/jer.150242
[25]	BULLO V, GOBBO S, VENDRAMIN B, et al. Nordic walking can be incorporated in the exercise prescription to increase aerobic capacity, strength, and quality of life for elderly: a systematic review and meta-analysis[J]. Rejuvenation Res, 2018, 21(2):141-161. doi: 10.1089/rej.2017.1921
[26]	RELPH N, HERRINGTON L. The effects of knee direction, physical activity and age on knee joint position sense[J]. Knee, 2016, 23(3):393-398. doi: 10.1016/j.knee.2016.02.018
[27]	SUN W, SONG Q, YU B, et al. Test-retest reliability of a new device for assessing ankle joint threshold to detect passive movement in healthy adults[J]. J Sports Sci, 2015, 33(16):1667-1674. doi: 10.1080/02640414.2014.1003589
[28]	BERG K O, WOOD-DAUPHINEE S L, WILLIAMS J I, et al. Measuring balance in the elderly: validation of an instrument[J]. Can J Public Health, 1992, 83(Suppl 2):S7-S11.
[29]	LI J X, XU D Q, HONG Y. Effects of 16-week Tai Chi intervention on postural stability and proprioception of knee and ankle in older people[J]. Age Ageing, 2008, 37(5):575-578. doi: 10.1093/ageing/afn109
[30]	SVOBODA Z, BIZOVSKA L, GONOSOVA Z, et al. Effect of aging on the association between ankle muscle strength and the control of bipedal stance[J]. PLoS One, 2019, 14(10):e0223434.
[31]	HENRY M, BAUDRY S. Age-related changes in leg proprioception: implications for postural control[J]. J Neurophysiol, 2019, 122(2):525-538. doi: 10.1152/jn.00067.2019
[32]	ZEHR E P, DUYSENS J. Regulation of arm and leg movement during human locomotion[J]. Neuroscientist, 2004, 10(4):347-361. doi: 10.1177/1073858404264680
[33]	ZHANG W, LOW L F, SCHWENK M, et al. Review of gait, cognition, and fall risks with implications for fall prevention in older adults with dementia[J]. Dement Geriatr Cogn Disord, 2019, 48(1-2):17-29. doi: 10.1159/000504340
[34]	张丽, 瓮长水, 王秋华, 等. 前庭感觉、本体感觉及视觉功能对老年人跌倒风险影响的因素分析[J]. 中国康复理论与实践, 2010, 16(1):16-18.
	ZHANG L, WENG C S, WANG Q H, et al. Effect of vestibular sense, proprioception, and vision on fall risk in elderly[J]. Chin J Rehabil Theory Pact, 2010, 16(1):16-18.
[35]	PROSKE U. What is the role of muscle receptors in proprioception?[J]. Muscle Nerve, 2005, 31(6):780-787. doi: 10.1002/mus.20330
[36]	COLLEDGE N R, CANTLEY P, PEASTON I, et al. Ageing and balance: the measurement of spontaneous sway by posturography[J]. Gerontology, 1994, 40(5):273-278. doi: 10.1159/000213596
[37]	MANOR B, LI L. Characteristics of functional gait among people with and without peripheral neuropathy[J]. Gait Posture, 2009, 30(2):253-256. doi: 10.1016/j.gaitpost.2009.04.011
[38]	江婉婷, 王兴, 王光旭, 等. 抗阻运动对中老年女性下肢肌肉力量及功能干预效果的Meta分析[J]. 首都体育学院学报, 2019, 31(3):272-280.
	JIANG W T, WANG X, WANG G X, et al. Effects of resistance training on low extremity muscle strength and function in middle-aged and elderly women: a meta-analysis[J]. J Capit Univ Phys Educ Sports, 2019, 31(3):272-280.
[39]	刘翠鲜, 沈志祥. 跌倒的流行病学特点及其危险因素[J]. 中国老年学杂志, 2012, 32(17):3837-3839.
	LIU C X, SHEN Z X. Chin J Gerontol, 2012, 32(17):3837-3839.
[40]	MORELAND J D, RICHARDSON J A, GOLDSMITH C H, et al. Muscle weakness and falls in older adults: a systematic review and meta-analysis[J]. J Am Geriatr Soc, 2004, 52(7):1121-1129. doi: 10.1111/j.1532-5415.2004.52310.x
[41]	YANG N P, HSU N W, LIN C H, et al. Relationship between muscle strength and fall episodes among the elderly: the Yilan study, Taiwan[J]. BMC Geriatr, 2018, 18(1):90. doi: 10.1186/s12877-018-0779-2
[42]	柏文喜, 曹红十, 王冰, 等. 老年人下肢肌力测量方法及其研究进展[J]. 中国老年学杂志, 2020, 40(20):4474-4477.
	BO W X, CAO H S, WANG B, et al. Chin J Gerontol, 2020, 40(20):4474-4477.
[43]	王晶晶. 老年人力量测评研究进展——基于"健康老龄化"背景下的功能发挥视角[J]. 体育科研, 2021, 42(2):68-77.
	WANG J J. Research progress on the muscle strength assessment in older adults: on the basis of the perspective of functional ability under healthy aging[J]. Sports Sci Res, 2021, 42(2):68-77.
[44]	GRANACHER U, ZAHNER L, GOLLHOFER A. Strength, power, and postural control in seniors: considerations for functional adaptations and for fall prevention[J]. Eur J Sport Sci, 2008, 8(6):325-340. doi: 10.1080/17461390802478066
[45]	LI L, ZHANG S, DOBSON J. The contribution of small and large sensory afferents to postural control in patients with peripheral neuropathy[J]. J Sport Health Sci, 2019, 8(3):218-227. doi: 10.1016/j.jshs.2018.09.010
[46]	MEYER P F, ODDSSON L I, DE LUCA C J. The role of plantar cutaneous sensation in unperturbed stance[J]. Exp Brain Res, 2004, 156(4):505-512. doi: 10.1007/s00221-003-1804-y

项目	平均值/中位数	标准差	最小值	最大值
姿势稳定性
BBS评分	52.18	3.81	32.00	56.00
RMS COP_AP/mm	7.12	2.18	2.47	14.33
RMS COP_ML/mm	8.25	2.76	1.31	19.77
本体感觉/°
膝关节屈曲	3.00	2.32	0.80	15.52
膝关节伸展	3.32	2.62	0.67	17.47
踝关节背屈	4.11	3.76	0.52	16.18
踝关节趾屈	3.94	3.34	0.72	16.02
足底触觉(单丝规格)
大脚趾	4.31^a	0.25	2.83	6.65
第1跖骨	4.31^a	0.25	2.83	6.65
第5跖骨	4.31^a	0.25	2.83	6.65
足弓	4.31^a	0.25	2.83	6.65
足跟	4.56^a	0.25	2.83	6.65
肌肉力量/N•m•kg^-1
踝关节背屈	0.33	0.16	0.04	0.77
踝关节趾屈	0.80	0.28	0.12	1.88
髋关节外展	0.40	0.17	0.07	0.86

项目		因子1	因子2	因子3
本体感觉	膝关节屈曲	0.888	0.057	-0.127
	膝关节伸展	0.896	0.008	-0.130
	踝关节背屈	0.853	0.011	-0.278
	踝关节趾屈	0.877	0.150	-0.207
足底触觉	大脚趾	-0.008	0.737	-0.060
	第1跖骨	-0.061	0.551	0.022
	第5跖骨	0.122	0.793	0.066
	足弓	0.061	0.756	-0.086
	足跟	0.117	0.621	-0.072
肌肉力量	踝关节背屈	-0.237	-0.041	0.873
	踝关节趾屈	-0.194	-0.116	0.813
	髋关节外展	-0.152	0.038	0.806

变量	BBS评分		RMS COP_AP		RMS COP _ML
变量	r值	P值	r值	P值	r值	P值
本体感觉	-0.449	< 0.001	0.116	0.057	0.254	0.004
足底触觉	-0.044	0.569	0.281	0.002	0.136	0.121
肌肉力量	0.493	< 0.001	0.027	0.752	0.056	0.524