基于ICF脑卒中核心分类组合评价轨道减重步行训练对脑卒中患者下肢运动功能康复的效果

doi:10.3969/j.issn.1006-9771.2022.06.005

摘要/Abstract

摘要：

目的采用《国际功能、残疾和健康分类》(ICF)脑卒中核心分类组合评价轨道减重步行训练对脑卒中患者下肢运动功能康复的效果。方法 2021年4月至10月,太和医院武当山院区15例脑卒中患者进行轨道减重步行训练,每次30 min,每天1次,每周5 d,共4周,治疗前后采用Fugl-Meyer评定量表下肢部分(FMA-LE)、Berg平衡量表(BBS)、6分钟步行试验(6MWT)、ICF脑卒中核心分类组合步态部分以及三维步态分析进行评定。结果干预后,脑卒中患者在ICF脑卒中核心分类组合步态功能限定值、FMA-LE评分、BBS评分、6MWT距离、步速、步态对称性、髋膝关节最大活动角度均明显提高(|t| > 4.141, P < 0.01)。结论轨道减重步行可以改善脑卒中患者下肢运动功能及步态。

关键词: 国际功能、残疾和健康分类, 核心分类组合, 脑卒中, 轨道减重步行训练, 步态

Abstract:

Objective To evaluate the effect of track body weight support walking training on lower limb motor function in stroke patients using International Classification of Functioning, Disability and Health (ICF) Core Sets for Stroke. Methods From April to October, 2021, 15 stroke patients from Wudang Mountain Hospital received track body weight support walking training everyday for 30 minutes, five times a week for four weeks. Before and after treatment, they were evaluated with Fugl-Meyer Assessment-Lower Extremities (FMA-LE), Berg Balance Scale (BBS), 6-minute Walking Test (6MWT), ICF Core Set for Stroke (gait), and three-dimensional gait analysis. Results After treatment, the ICF gait function qualifier, FMA-LE score, BBS score, the distance of 6MWT, gait speed, gait symmetry and and the maximum motion angle of hip and knee increased (|t| > 4.141, P < 0.01). Conclusion Track body weight support walking training could improve the lower limb motor function and gait of stroke patients.

Key words: International Classification of Functioning, Disability and Health, Core Set, stroke, track body weight support walking training, gait

中图分类号:

R743.3

柴丽,王梅. 基于ICF脑卒中核心分类组合评价轨道减重步行训练对脑卒中患者下肢运动功能康复的效果[J]. 《中国康复理论与实践》, 2022, 28(6): 653-658.

CHAI Li,WANG Mei. Effect of track body weight support walking training on lower limb motor function in stroke patients: based on ICF Core Set for Stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(6): 653-658.

图/表 2

表2

下肢运动功能评估指标、涉及的功能以及ICF编码"

测量工具	内容	编码	类目名称	内容	编码	类目名称
FMA-LE	跟腱反射(仰卧位)	b7500	牵张反射	转移	d4103	坐下
	膝腱反射(仰卧位)	b7500	牵张反射		b7305	躯干肌肉的力量
	髋关节屈曲(仰卧位)	b7600	简单随意运动的控制		d4200	坐姿移动自身
	膝关节屈曲(仰卧位)	b7600	简单随意运动的控制	无支持闭目站立	b760	随意运动控制功能
	踝关节背曲(仰卧位)	b7600	简单随意运动的控制		b260	本体感受功能
	髋关节内收(仰卧位)	b7600	简单随意运动的控制		b235	前庭功能
	髋关节伸展(仰卧位)	b7600	简单随意运动的控制		d4154	保持站姿
	膝关节伸展(仰卧位)	b7600	简单随意运动的控制		b7305	躯干肌肉的力量
	踝关节跖屈(仰卧位)	b7600	简单随意运动的控制	双脚并拢无支持站立	b760	随意运动控制功能
	膝关节屈曲(坐位)	b7600	简单随意运动的控制		b260	本体感受功能
	踝关节背曲(坐位)	b7600	简单随意运动的控制		d4154	保持站姿
	膝关节屈曲(站立位)	b7600	简单随意运动的控制		b7305	躯干肌肉的力量
		b7603	手臂或腿的支撑功能	站立时上肢向前伸展并向前移动	b760	随意运动控制功能
		b7302	单侧身体肌肉的力量	站立时上肢向前伸展并向前移动	b260	本体感受功能
		b7305	躯干肌肉的力量		d4154	保持站姿
	踝关节背屈(站立位)	b7600	简单随意运动的控制		d4106	移动身体重心
		b7603	手臂或腿的支撑功能		d4452	伸
		b7302	单侧身体肌肉的力量		b7305	躯干肌肉的力量
		b7305	躯干肌肉的力量	站立位时从地面捡起	b760	随意运动控制功能
	膝部屈肌反射(坐位)	b7500	牵张反射		b260	本体感受功能
	膝腱反射(坐位)	b7500	牵张反射		d4101	蹲下
	跟腱反射(坐位)	b7500	牵张反射		d4105	屈身
	跟膝胫试验(震颤)	b7600	简单随意运动的控制		d4400	拾起
		b7602	随意运动的协调		d4154	保持站姿
		b7651	震颤		d4106	移动身体重心
	跟膝胫试验(辨距)	b7600	简单随意运动的控制		b7305	躯干肌肉的力量
		b7602	随意运动的协调	站立位转身向后看	b760	随意运动控制功能
	跟膝胫试验(速度)	b7600	简单随意运动的控制		b260	本体感受功能
		b7602	随意运动的协调		d4154	保持站姿
6MWT	地上标一条约30 m走道,在起始端和结束处及每隔3 m处标记,嘱患者沿步道往返行走,记录6 min行走距离	b7600	简单随意运动的控制		d4106	移动身体重心
		b770	步态功能		b7305	躯干肌肉的力量
		b455	运动耐受功能	转身360°	b760	随意运动控制功能
		d4500	短距离步行		b770	步态功能
		d4154	保持站姿		d4106	移动身体重心
		b7302	单侧身体肌肉的力量		d4500	短距离步行
		b7305	躯干肌肉的力量		b7305	躯干肌肉的力量
BBS	由坐位站起	b760	随意运动控制功能	无支持站立时将一只脚放于台阶或凳子上	b760	随意运动控制功能
		d4153	保持坐姿	无支持站立时将一只脚放于台阶或凳子上	d4106	移动身体重心
		d4104	站起		d4154	保持站姿
		d4154	保持站姿		b7305	躯干肌肉的力量
		b7305	躯干肌肉的力量		b7302	单侧身体肌肉的力量
	无支持站立	b760	随意运动控制功能	一只脚在前无支持站立	b760	随意运动控制功能
		d4154	保持站姿		b260	本体感受功能
		b7305	躯干肌肉的力量		d4154	保持站姿
	无靠背坐位	b760	随意运动控制功能		b7305	躯干肌肉的力量
		d4153	保持坐姿	单腿站立	b760	随意运动控制功能
		b7305	躯干肌肉的力量		b260	本体感受功能
	从站立位坐下	b760	随意运动控制功能		d4154	保持站姿
		d4154	保持站姿		d4106	移动身体重心
		d4103	坐下		b7305	躯干肌肉的力量
		b7305	躯干肌肉的力量		b7302	单侧身体肌肉的力量
		d4153	保持坐姿

表2

表3

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项目	干预前	干预后	差值	t值	P值
FMA-LE评分	16.53±3.85	26.0±3.82	-9.47±5.60	-6.557	< 0.001
BBS评分	33.73±5.62	43.6±5.28	-9.87±1.30	-29.350	< 0.001
6MWT距离/m	119.96±17.93	145.19±17.45	-25.23±18.54	-5.271	< 0.001
步速/m·s^-1	0.31±0.06	0.40±0.05	-0.09±0.02	-20.131	< 0.001
步态对称性
步长对称比	1.29±0.05	1.18±0.04	0.12±0.05	9.407	< 0.001
摆动相对称比	1.28±0.04	1.19±0.04	0.10±0.03	11.075	< 0.001
支撑相对称比	1.30±0.05	1.21±0.04	0.09±0.03	9.886	< 0.001
最大活动角度/°
屈髋	22.48±2.92	28.35±1.62	-5.87±2.63	-8.660	< 0.001
伸髋	4.21±0.71	8.41±0.85	-4.21±0.95	-17.103	< 0.001
屈膝	28.68±2.48	33.60±2.46	-4.91±2.35	-8.088	< 0.001
伸膝	8.64±1.19	6.62±1.20	2.02±1.08	7.280	< 0.001
踝背屈	4.06±1.29	4.12±1.27	-0.07±0.12	-2.081	0.056
踝跖屈	10.77±1.27	11.02±1.31	-0.25±0.49	-1.970	0.069
b770限定值	3.27±0.88	2.13±0.92	1.13±1.06	4.141	0.001