视觉剥夺训练联合本体感觉训练对脑卒中偏瘫患者平衡功能的效果

doi:10.3969/j.issn.1006-9771.2025.03.002

《中国康复理论与实践》 ›› 2025, Vol. 31 ›› Issue (3): 254-263.doi: 10.3969/j.issn.1006-9771.2025.03.002

视觉剥夺训练联合本体感觉训练对脑卒中偏瘫患者平衡功能的效果

苏盼盼¹^,², 叶朋², 卢倩², 何川², 陆晓¹()

1.南京医科大学康复医学院，江苏南京市 211166
2.江苏盛泽医院康复医学科，江苏苏州市 215228

收稿日期:2024-12-04 修回日期:2025-02-08 出版日期:2025-03-25 发布日期:2025-03-25
通讯作者: 陆晓(1972-)，女，汉族，主任医师，博士研究生导师，主要研究方向：神经康复，E-mail：luxiao1972@163.com。
作者简介:苏盼盼(1988-)，女，汉族，江苏淮安市人，硕士研究生，副主任技师，主要研究方向：神经康复。
基金资助:
苏州市科技局医学应用基础研究项目(SKY2023033)

Effect of visual deprivation training combined with proprioceptive training on balance in hemiplegic patients after stroke

SU Panpan¹^,², YE Peng², LU Qian², HE Chuan², LU Xiao¹()

1. Rehabilitation Medicine College of Nanjing Medical University, Nanjing, Jiangsu 211166, China
2. Department of Rehabilitation Medicine, Jiangsu Shengze Hospital, Suzhou, Jiangsu 215228, China

Received:2024-12-04 Revised:2025-02-08 Published:2025-03-25 Online:2025-03-25
Contact: LU Xiao, E-mail: luxiao1972@163.com
Supported by:
Suzhou Science and Technology Bureau Medical Applications Basic Research Project(SKY2023033)

摘要/Abstract

摘要：

目的探讨视觉剥夺训练联合本体感觉训练对脑卒中偏瘫患者平衡功能的效果。

方法 2022年5月至2024年3月，江苏盛泽医院脑卒中偏瘫患者80例，随机分为对照组(n = 20)、本体训练组(n = 20)、视觉剥夺组(n = 20)和联合组(n = 20)。各组均予常规康复训练，本体训练组增加本体感觉训练，视觉剥夺组增加视觉剥夺训练，联合组则增加视觉剥夺训练和本体感觉训练，共4周。治疗前后，采用ProKin平衡测试与训练系统、Berg平衡量表(BBS)、Fugl-Meyer评定量表下肢部分(FMA-LE)、10米步行测试(10MWT)和功能性步态测试(FGA)进行评定。

结果前后和左右平均运动速度组内效应(F > 96.618, P < 0.001)和交互效应(F > 5.444, P < 0.01)均显著。睁、闭眼运动椭圆面积和运动长度组内效应(F > 177.671, P < 0.001)、组间效应(F > 3.761, P < 0.05)和交互效应(F > 7.555, P < 0.001)均显著。10MWT时间，BBS、FMA-LE和FGA评分组内效应(F > 221.902, P < 0.001)和交互效应(F > 7.586, P < 0.001)均显著；FGA评分组间效应显著(F = 5.258, P < 0.01)。两两比较显示，联合组和视觉剥夺组各项指标均优于对照组(P < 0.05)；除睁眼前后、闭眼左右平均运动速度和睁眼运动长度外，本体训练组其他指标均优于对照组(P < 0.05)；联合组各项指标均优于视觉剥夺组和本体训练组(P < 0.05)；视觉剥夺组与本体训练组各项指标无显著性差异(P > 0.05)。

结论视觉剥夺训练和本体感觉训练均可有效促进脑卒中偏瘫患者的平衡功能、下肢运动功能和步行能力恢复，联合使用疗效更佳。

关键词: 脑卒中, 偏瘫, 视觉剥夺, 本体感觉训练, 平衡, 运动, 步行

Abstract:

Objective To explore the effect of visual deprivation training combined with proprioceptive training on balance function of hemiplegic patients after stroke.

Methods A total of 80 stroke patients with hemiplegia in Jiangsu Shengze Hospital were selected from May, 2022 to March, 2024, and randomly divided into control group (n= 20), proprioceptive training group (n= 20), visual deprivation group (n= 20) and combined group (n= 20). All the groups received routine rehabilitation training, while the proprioceptive training group added proprioceptive training, the visual deprivation group added balance training under visual deprivation, and the combined group added visual deprivation training and proprioceptive training, for four weeks. They were assessed with ProKin Balance Test and Training System, Berg Balance Scale (BBS), 10-metre walking test (10MWT), Fugl-Meyer Assessment-Lower Extremities (FMA-LE) and Functional Gait Assessment (FGA) before and after treatment.

Results The intra-group effect (F >96.618, P < 0.001) and interaction effect (F >5.444, P < 0.01) were significant in mean longitudinal velocity and mean horizontal velocity. The intra-group effect (F >177.671, P < 0.001), inter-group effect (F >3.761, P < 0.05) and interaction effect (F >7.555, P < 0.001) were significant in movement ellipse area and movement length both with eyes open and closed. The intra-group effect (F >221.902, P < 0.001) and interaction effect (F >7.586, P < 0.001) were significant in the time of 10MWT, and the scores of BBS, FMA-LE and FGA; and the inter-group effect were significant in FGA score (F =5.258, P < 0.01). Post Hoc test showed that all the indicators were better in the combined group and the visual deprivation group than in the control group (P < 0.05); as well as in the proprioceptive training group than in the control group (P < 0.05) except mean longitudinal velocity with eyes open, mean horizontal velocity with eyes closed, and movement length with eyes open; while all the indicators were better in the combined group than both in the visual deprivation group and the proprioceptive training group (P < 0.05); there was no significant difference between the visual deprivation group and the proprioceptive training group for all the indicators (P > 0.05).

Conclusion Both visual deprivation training and proprioceptive training can improve balance, lower limb motor function and walking of hemiplegic stroke patients, and the combination is more effective.

Key words: stroke, hemiplegia, visual deprivation, proprioceptive training, balance, motor function, walking

中图分类号:

R743.3

苏盼盼, 叶朋, 卢倩, 何川, 陆晓. 视觉剥夺训练联合本体感觉训练对脑卒中偏瘫患者平衡功能的效果[J]. 《中国康复理论与实践》, 2025, 31(3): 254-263.

SU Panpan, YE Peng, LU Qian, HE Chuan, LU Xiao. Effect of visual deprivation training combined with proprioceptive training on balance in hemiplegic patients after stroke[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(3): 254-263.

图/表 7

表1

表2

表3

表4

平衡测试参数的事后LSD差异检验结果"

变量	状态	组别		平均值差	P值	95%CI
变量	状态	组别		平均值差	P值	下限	上限
前后平均运动速度	睁眼	对照组	本体训练组	2.333	0.072	-0.217	4.883
		对照组	视觉剥夺组	2.983	0.022	0.433	5.533
		对照组	联合组	5.583	< 0.001	3.033	8.134
		本体训练组	视觉剥夺组	0.650	0.613	-1.901	3.201
		本体训练组	联合组	3.251	0.013	0.701	5.801
		视觉剥夺组	联合组	2.601	0.046	0.051	5.151
	闭眼	对照组	本体训练组	6.741	< 0.001	3.877	9.604
		对照组	视觉剥夺组	9.048	< 0.001	6.185	11.912
		对照组	联合组	12.280	< 0.001	9.419	15.146
		本体训练组	视觉剥夺组	2.308	0.113	-0.555	5.171
		本体训练组	联合组	5.542	< 0.001	2.679	8.405
		视觉剥夺组	联合组	3.234	0.027	0.371	6.097
左右平均运动速度	睁眼	对照组	本体训练组	1.742	0.033	0.144	3.339
		对照组	视觉剥夺组	2.634	0.002	1.036	4.231
		对照组	联合组	4.675	< 0.001	3.077	6.273
		本体训练组	视觉剥夺组	0.892	0.270	-0.706	2.490
		本体训练组	联合组	2.934	< 0.001	1.336	4.531
		视觉剥夺组	联合组	2.042	0.013	0.444	3.639
	闭眼	对照组	本体训练组	1.884	0.125	-0.532	4.302
		对照组	视觉剥夺组	3.466	0.006	1.051	5.883
		对照组	联合组	5.867	< 0.001	3.451	8.284
		本体训练组	视觉剥夺组	1.583	0.196	-0.834	3.999
		本体训练组	联合组	3.983	0.002	1.567	6.399
		视觉剥夺组	联合组	2.401	0.047	-0.015	4.817
运动椭圆面积	睁眼	对照组	本体训练组	143.758	0.017	26.987	260.530
		对照组	视觉剥夺组	211.566	0.001	94.795	328.338
		对照组	联合组	390.299	< 0.001	273.528	507.071
		本体训练组	视觉剥夺组	67.808	0.251	-48.963	184.579
		本体训练组	联合组	246.541	< 0.001	129.769	363.312
		视觉剥夺组	联合组	178.733	0.003	61.962	295.504
	闭眼	对照组	本体训练组	293.734	0.003	101.492	485.976
		对照组	视觉剥夺组	374.066	< 0.001	181.824	566.308
		对照组	联合组	653.467	< 0.001	461.225	845.709
		本体训练组	视觉剥夺组	80.332	0.408	-111.909	272.574
		本体训练组	联合组	359.733	< 0.001	167.491	551.975
		视觉剥夺组	联合组	279.401	0.005	87.159	471.643
运动长度	睁眼	对照组	本体训练组	101.567	0.058	-3.702	206.835
		对照组	视觉剥夺组	187.599	0.001	82.331	292.868
		对照组	联合组	325.716	< 0.001	220.448	430.985
		本体训练组	视觉剥夺组	86.033	0.108	-19.235	191.301
		本体训练组	联合组	224.151	< 0.001	118.882	329.418
		视觉剥夺组	联合组	138.117	0.011	32.849	243.385
	闭眼	对照组	本体训练组	255.325	0.003	92.446	418.204
		对照组	视觉剥夺组	393.415	< 0.001	230.536	556.295
		对照组	联合组	606.699	< 0.001	443.821	769.579
		本体训练组	视觉剥夺组	138.091	0.095	-24.789	300.969
		本体训练组	联合组	351.374	< 0.001	188.495	514.254
		视觉剥夺组	联合组	213.284	0.011	50.405	376.163

表4

表5

表6

表7

参考文献 41

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组别	n	性别(男/女)/n	年龄/岁	病程/月	卒中类型(梗死/出血)/n	偏瘫侧(左/右)/n
对照组	20	15/5	57.60±10.73	3.20±1.15	17/3	13/7
本体训练组	20	16/4	58.95±7.37	3.25±1.34	14/6	15/5
视觉剥夺组	20	12/8	60.01±12.64	3.71±0.75	14/6	10/10
联合组	20	13/7	57.90±13.05	3.65±0.93	15/5	11/9
χ²/F值		2.381	0.195	1.198	1.600	3.107
P值		0.497	0.910	0.316	0.659	0.375

变量	状态	组别	n	治疗前		治疗后
变量	状态	组别	n	均值	标准差	均值	标准差
前后平均运动速度/(mm·s^-1)	睁眼	对照组	20	18.45	5.84	15.08	3.45
		本体训练组	20	18.14	8.51	12.75	5.71
		视觉剥夺组	20	17.78	7.35	12.05	3.45
		联合组	20	19.82	9.11	9.49	3.03
	闭眼	对照组	20	30.18	5.06	27.69	4.09
		本体训练组	20	32.02	11.19	20.96	5.87
		视觉剥夺组	20	30.82	9.74	18.65	3.48
		联合组	20	31.05	11.21	15.42	4.41
左右平均运动速度/(mm·s^-1)	睁眼	对照组	20	14.70	2.89	13.09	2.59
		本体训练组	20	15.67	3.63	11.36	2.84
		视觉剥夺组	20	14.90	4.01	10.47	2.17
		联合组	20	15.03	4.84	8.42	2.49
	闭眼	对照组	20	20.05	3.05	18.97	3.22
		本体训练组	20	21.86	7.07	17.08	4.56
		视觉剥夺组	20	20.83	6.27	15.50	4.26
		联合组	20	21.91	8.24	13.10	3.08
运动椭圆面积/mm²	睁眼	对照组	20	1041.54	153.95	800.38	102.05
		本体训练组	20	979.02	438.27	656.62	286.54
		视觉剥夺组	20	901.46	262.99	588.82	159.68
		联合组	20	992.45	256.43	410.08	139.57
	闭眼	对照组	20	1604.93	311.33	1446.07	336.88
		本体训练组	20	1618.81	524.25	1152.33	368.36
		视觉剥夺组	20	1714.11	478.76	1072.01	263.77
		联合组	20	1523.12	491.19	792.60	232.21
运动长度/mm	睁眼	对照组	20	1125.15	150.28	775.27	114.62
		本体训练组	20	1119.88	332.85	673.69	226.95
		视觉剥夺组	20	977.37	256.57	587.67	157.89
		联合组	20	1072.75	307.51	449.55	148.88
	闭眼	对照组	20	1659.80	243.02	1402.90	298.89
		本体训练组	20	1647.79	288.52	1147.58	293.09
		视觉剥夺组	20	1522.89	362.37	1009.48	190.73
		联合组	20	1587.68	399.41	796.20	236.43

变量	状态		平方和	自由度	均方	F值	P值
前后平均运动速度	睁眼	组内	1532.335	1	1532.335	96.618	< 0.001
		组间	104.697	3	34.899	0.568	0.638
		组内×组间	259.020	3	86.340	5.444	0.002
	闭眼	组内	4271.042	1	4271.042	156.688	< 0.001
		组间	722.078	3	240.693	2.791	0.051
		组内×组间	936.124	3	312.041	11.448	< 0.001
左右平均运动速度	睁眼	组内	718.383	1	718.383	214.347	< 0.001
		组间	111.802	3	37.267	2.030	0.117
		组内×组间	125.824	3	41.941	12.514	< 0.001
	闭眼	组内	999.850	1	999.850	101.486	< 0.001
		组间	118.266	3	39.422	0.849	0.472
		组内×组间	300.090	3	100.030	10.153	< 0.001
运动椭圆面积	睁眼	组内	5318482.245	1	5318482.245	229.783	< 0.001
		组间	1106099.311	3	368699.770	3.728	0.015
		组内×组间	671420.108	3	223806.703	9.669	< 0.001
	闭眼	组内	9979635.379	1	9979635.379	178.180	< 0.001
		组间	2795024.526	3	931674.842	3.761	0.014
		组内×组间	1908288.769	3	636096.256	11.357	< 0.001
运动长度	睁眼	组内	8180971.854	1	8180971.854	424.792	< 0.001
		组间	986283.186	3	328761.062	4.004	0.011
		组内×组间	436514.427	3	145504.809	7.555	< 0.001
	闭眼	组内	10629723.410	1	10629723.410	177.671	< 0.001
		组间	2685057.951	3	895019.317	7.760	< 0.001
		组内×组间	1432780.813	3	477593.604	7.983	< 0.001

变量	组别	n	治疗前		治疗后
变量	组别	n	均值	标准差	均值	标准差
BBS	对照组	20	25.90	10.02	31.70	8.58
	本体训练组	20	26.40	10.71	36.35	6.97
	视觉剥夺组	20	26.95	7.72	37.85	5.61
	联合组	20	25.55	7.94	42.40	4.31
FMA-LE	对照组	20	15.85	5.21	19.65	4.29
	本体训练组	20	17.05	5.41	22.65	3.98
	视觉剥夺组	20	16.90	4.88	23.95	3.14
	联合组	20	16.45	3.61	26.40	3.72
10MWT/s	对照组	20	45.30	12.25	36.55	9.55
	本体训练组	20	43.16	15.93	30.37	10.93
	视觉剥夺组	20	43.45	17.34	28.99	8.93
	联合组	20	44.14	13.37	22.66	8.52
FGA	对照组	20	8.95	1.64	11.85	1.49
	本体训练组	20	7.85	1.46	12.95	1.66
	视觉剥夺组	20	8.70	2.05	13.85	1.81
	联合组	20	8.25	2.29	15.90	1.71

变量		平方和	自由度	均方	F值	P值
BBS	组内	4730.625	1	4730.625	426.359	< 0.001
	组间	566.625	3	188.875	1.623	0.191
	组内×组间	623.125	3	207.708	18.720	< 0.001
FMA-LE	组内	1742.400	1	1742.400	1034.954	< 0.001
	组间	288.825	3	96.275	2.665	0.054
	组内×组间	202.650	3	67.550	40.123	< 0.001
10MWT	组内	8257.290	1	8257.290	221.902	< 0.001
	组间	1155.267	3	385.089	1.403	0.248
	组内×组间	846.906	3	282.302	7.586	< 0.001
FGA	组内	1081.600	1	1081.600	694.564	< 0.001
	组间	77.825	3	25.942	5.258	0.002
	组内×组间	113.050	3	37.683	24.199	< 0.001

视觉剥夺训练联合本体感觉训练对脑卒中偏瘫患者平衡功能的效果

Effect of visual deprivation training combined with proprioceptive training on balance in hemiplegic patients after stroke

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变量	组别	组别	平均值差	P值	95%CI
变量	组别	组别	平均值差	P值	下限	上限
BBS	对照组	本体训练组	-4.650	0.028	-8.783	-0.517
	对照组	视觉剥夺组	-6.150	0.004	-10.283	-2.017
	对照组	联合组	-10.700	< 0.001	-14.833	-6.567
	本体训练组	视觉剥夺组	-1.501	0.472	-5.633	2.633
	本体训练组	联合组	-6.051	0.005	-10.183	-1.917
	视觉剥夺组	联合组	-4.550	0.031	-8.683	-0.417
FMA-LE	对照组	本体训练组	-3.001	0.015	-5.397	-0.603
	对照组	视觉剥夺组	-4.300	0.001	-6.697	-1.903
	对照组	联合组	-6.750	< 0.001	-9.147	-4.353
	本体训练组	视觉剥夺组	-1.300	0.283	-3.697	1.097
	本体训练组	联合组	-3.750	0.003	-6.147	-1.353
	视觉剥夺组	联合组	-2.450	0.045	-4.847	-0.053
10MWT	对照组	本体训练组	6.175	0.044	0.175	12.176
	对照组	视觉剥夺组	7.551	0.014	1.551	13.551
	对照组	联合组	13.889	< 0.001	7.888	19.889
	本体训练组	视觉剥夺组	1.376	0.649	-4.625	7.376
	本体训练组	联合组	7.713	0.012	1.713	13.713
	视觉剥夺组	联合组	6.337	0.039	0.337	12.338
FGA	对照组	本体训练组	-1.100	0.045	-2.176	-0.024
	对照组	视觉剥夺组	-2.001	< 0.001	-3.076	-0.924
	对照组	联合组	-4.050	< 0.001	-5.126	-2.974
	本体训练组	视觉剥夺组	-0.901	0.100	-1.976	0.176
	本体训练组	联合组	-2.950	< 0.001	-4.026	-1.874
	视觉剥夺组	联合组	-2.050	< 0.001	-3.126	-0.974