临床观察

下肢开链增重法对脑卒中患者位置觉和步态对称性的即刻影响

  • 冉军 ,
  • 刘华卫 ,
  • 赵亦超 ,
  • 赖梅金 ,
  • 梅雨 ,
  • 何雅琳 ,
  • 徐燕 ,
  • 姚加佳 ,
  • 孙奕
展开
  • 上海市养志康复医院(上海市阳光康复中心)物理疗法科,上海市 201619。
冉军(1988-),男,汉族,四川达州市人,硕士研究生,中级治疗师,主要研究方向:神经物理治疗。

收稿日期: 2017-03-13

  修回日期: 2017-06-07

  网络出版日期: 2017-08-24

基金资助

上海市残联优青课题(No.2014KFB01YQ)。 

Immediate Effects of Lower Limb with Open Chain Weight-adding on Joint Position Sense and Gait Symmetry in Stroke Patients 

  • RAN Jun ,
  • LIU Hua-wei ,
  • ZHAO Yi-chao ,
  • LAI Mei-jin ,
  • MEI Yu ,
  • HE Ya-lin ,
  • XU Yan ,
  • YAO Jia-jia ,
  • SUN Yi
Expand
  • Shanghai Sunshine Rehabilitation Center, Shanghai, 201619, China

Received date: 2017-03-13

  Revised date: 2017-06-07

  Online published: 2017-08-24

摘要

目的 研究下肢开链增重对脑卒中患者位置觉和步态对称性的即刻影响。方法 2016年1月至2017年1月,选取本院脑卒中患者39例,分别在增重前后进行下肢位置觉测评,包括主动定位-主动复位(ARAP)和被动定位-被动复位(PRPP)测评,记录目标角度与复位角度差值;以及步态测评,记录足偏角对称性、步长对称性、单腿支撑相时长对称性。结果 下肢增重后,髋直腿抬高PRPP位置觉无改善(t=0.832, P=0.832),ARAP位置觉改善(t=3.158, P=0.011);足偏角对称性无改善(t=-0.704, P=0.483),步长对称性改善(t=2.022, P=0.041),单腿支撑相对称性无改善(t=0.381, P=0.702)。结论 下肢开链增重可以改善脑卒中患者的下肢主动位置觉和步长对称性。

本文引用格式

冉军 , 刘华卫 , 赵亦超 , 赖梅金 , 梅雨 , 何雅琳 , 徐燕 , 姚加佳 , 孙奕 . 下肢开链增重法对脑卒中患者位置觉和步态对称性的即刻影响[J]. 中国康复理论与实践, 2017 , 23(8) : 950 -954 . DOI: 10.3969/j.issn.1006-9771.2017.08.017

Abstract

Objective To investigate the immediate effects of lower limb with open chain weight-adding on joint position sense and gait symmetry in stroke patients. Methods From January, 2016 to January, 2017, 39 stroke patients were included. Their joint position sense and gait symmetry were compared before and after weight-adding. The joint position senses of active reproduction of active positioning (ARAP) and passive reproduction of passive positioning (PRPP) were assessed during lower limb straight leg raise. The gait symmetry was also assessed and three indexes were recorded including the symmetry of foot rotation angle, step length and percentage of single leg support phase. Results After weight-adding, the position sense of PRPP did not improve (t=0.832, P=0.832), nor of the symmetry of foot rotation angle (t=-0.704, P=0.483) and percentage of single leg support phase (t=0.381, P=0.702); the position sense of ARAP improved (t=3.158, P=0.011), as well as the symmetry of step length (t=2.022, P=0.041). Conclusion The lower limb with open chain weight-adding could improve the active joint position sense and symmetry of step length.

参考文献

[1] 方向华,王淳秀,梅利平,等. 脑卒中流行病学研究进展[J]. 中华流行病学杂志, 2011, 32(9): 847-853.
[2] Kim KJ, Heo M, Chun IA, et al. The relationship between stroke and quality of life in Korean adults: based on the 2010 Korean community health survey [J]. J Phys Ther Sci, 2015, 27(1): 309-312.
[3] Chen R, Hu Z, Chen RL, et al. Socioeconomic deprivation and survival after stroke in China: a systematic literature review and a new population-based cohort study [J]. BMJ Open, 2015, 5(1): e005688.
[4] 郭丽云,田泽丽,王潞萍,等. 任务导向性训练结合肌力训练对脑卒中后遗症期偏瘫患者运动功能的影响[J]. 中国康复医学杂志, 2013, 28(7): 642-644.
[5] 王俊,廖麟荣,杨振辉,等. 运动想象结合下肢康复机器人训练对脑卒中患者步行障碍的影响[J]. 中国康复医学杂志, 2015, 30(6): 542-546.
[6] 郄淑燕,王丛笑,张丽华,等. 功能性电刺激结合减重平板训练对脑卒中偏瘫患者步行能力的影响[J]. 中国康复医学杂志, 2015, 30(10): 1065-1067.
[7] 毛玉瑢,李乐,陈正宏,等. 脑卒中患者步行能力与下肢三维运动学及动力学相性分析[J]. 中国康复医学杂志, 2012, 27(5): 442-447.
[8] 董珍珍,丁岩,邢艳丽. 脑卒中后偏瘫患者膝关节控制障碍与本体感觉的研究现状[J]. 中国康复医学杂志, 2013, 28(11): 1079-1082.
[9] 杨念恩,李世昌,黄文英,等. 本体感觉差异性特点及其神经机制研究[J]. 体育科学, 2014, 34(4): 41-48.
[10] 张其亮,赵蕾,滕学仁. 保留残端前交叉韧带重建对膝关节本体感觉恢复的影响临床研究[J]. 中国运动医学杂志, 2015, 34(8): 739-743.
[11] Lin CH, Chiang SL, Lu LH, et al. Validity of an ankle joint motion and position sense measurement system and its application in healthy subjects and patients with ankle sprain [J]. Comput Methods Programs Biomed, 2016, 131: 89-96.
[12] Zabihhosseinian M, Holmes MW, Murphy B. Neck muscle fatigue alters upper limb proprioception [J]. Exp Brain Res, 2015, 233(5): 1663-1675.
[13] Arvin M, Hoozemans MJ, Burger BJ, et al. Effects of hip abductor muscle fatigue on gait control and hip position sense in healthy older adults [J]. Gait Posture, 2015, 42(4): 545-549.
[14] Proske U, Gandevia SC. The proprioceptive senses: their roles in signaling body shape, body position and movement, and muscle force [J]. Physiol Rev, 2012, 92(4): 1651-1697.
[15] Simon J, Garcia W, Docherty CL. The effect of kinesio tape on force sense in people with functional ankle instability [J]. Clin J Sport Med, 2014, 24(4): 289-294.
[16] Bang DH, Shin WS, Choi SJ, et al. Comparison of the effect of weight-bearing and non-weight-bearing positions on knee position sense in patients with chronic stroke [J]. J Phys Ther Sci, 2015, 27(4): 1203-1206.
[17] 吴毅,俞晓杰,胡永善,等. 膝关节骨关节炎患者的本体感觉及其与疼痛和功能障碍间的相关性研究[J]. 中华物理医学与康复杂志, 2007, 29(5): 334-338.
[18] 瓮长水. 脑卒中患者步行功能障碍评价[J]. 中国临床康复, 2002, 6(13): 1869-1871.
[19] 肖湘,毛玉瑢,赵江莉,等. 虚拟现实同步减重训练对脑梗死患者步态对称性及神经网络的影响[J]. 中国康复医学杂志, 2013, 28(12): 1104-1108.
[20] 张旻,马峥,江澜,等. 不同外侧楔形矫形鞋垫对内侧间室膝骨性关节炎患者步态的影响[J]. 中国康复, 2015, 30(1): 61-64.
[21] 武行华,倪朝民. 脑卒中偏瘫步态的运动控制特点与预防[J]. 中国临床康复, 2005, 9(29): 140-141.
[22] 时关芳,吴华,顾旭东,等. 运动反馈结合减重平板训练对脑卒中偏瘫患者步态恢复的影响[J]. 中华物理医学与康复杂志, 2016, 38(8): 612-614.
[23] 张峻霞,龚梦. 下坡步态失稳后的自适应平衡分析——坡度i=1:10 [J]. 中国科技论文, 2015, 10(10): 1144-1148.
[24] Beyaert C, Vasa R, Frykberg GE. Gait post-stroke: pathophysiology and rehabilitation strategies [J]. Neurophysiol Clin, 2015, 45(4-5): 335-355.
[25] Suh JH, Han SJ, Jeon SY, et al. Effect of rhythmic auditory stimulation on gait and balance in hemiplegic stroke patients [J]. NeuroRehabilitation, 2014, 34(1): 193-199.
文章导航

/