临床研究

基于反重力跑台训练系统的双重运动任务训练对脑卒中患者平衡功能的效果

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  • 1.中山大学附属第三医院康复医学科,广东广州市 510530;
    2.中山大学附属第三医院粤东医院康复医学科,广东梅州市 514000
蔡庆(1985-),女,汉族,江西赣州市人,硕士,康复治疗师,主要研究方向:神经康复、激光运动医学。

收稿日期: 2018-09-10

  修回日期: 2018-10-22

  网络出版日期: 2018-12-26

基金资助

1.国家自然科学基金青年基金项目(No. 81301674); 2.中央高校基本业务费专项资金项目(No. 12ykpy45)

Effects of Dual-task Motor Training with Anti-gravity Treadmill on Motor and Balance after Stroke

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  • 1. Department of Rehabilitation, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510530, China;
    2. Department of Rehabilitation, Yuedong Hospital of Sun Yat-Sen University, Meizhou, Guangdong 514000, China

Received date: 2018-09-10

  Revised date: 2018-10-22

  Online published: 2018-12-26

Supported by

Supported by National Natural Science Foundation of China (Youth) (No. 81301674) and Fundamental Research Funds for the Central Universities (No. 12ykpy45)

摘要

目的 观察采用反重力跑台训练系统进行双重运动任务训练对脑卒中患者运动及平衡功能的影响。方法 2016年1月至2017年6月,脑卒中偏瘫患者30例随机为对照组(n = 15)和试验组(n = 15)。两组均接受常规物理治疗,对照组进行反重力跑台步行训练,试验组利用反重力跑台训练系统进行双重运动任务训练,共4周。训练前后采用平衡功能检测训练系统评定平衡功能,同时采用Fugl-Meyer评定量表下肢部分(FMA-L)、Berg平衡量表(BBS)和改良Barthel指数(MBI)进行评定。结果 训练后,试验组X方向最大动摇径(Rx)、Y方向最大动摇径(Ry)和包络面积(RecArea)均显著下降(t > 4.719, P < 0.001),对照组RecArea显著下降(t = 5.069, P < 0.001),试验组Ry和RecArea低于对照组(t > 2.288, P < 0.05)。治疗后,两组FMA-L、BBS和MBI评分均显著改善(t > 7.316, P < 0.001),试验组优于对照组(t > 2.322, P < 0.05)。结论 双重运动任务训练有助于脑卒中偏瘫患者运动及平衡功能恢复,提高日常生活活动能力。

本文引用格式

蔡庆, 谢丽君, 赵绿玉, 叶鹏瑛, 苏敏芝, 张淑娴, 高惠刚, 胡昔权, 陈曦 . 基于反重力跑台训练系统的双重运动任务训练对脑卒中患者平衡功能的效果[J]. 中国康复理论与实践, 2018 , 24(11) : 1315 -1319 . DOI: 10.3969/j.issn.1006-9771.2018.11.011

Abstract

Objective To observe the effects of dual-task motor training on motor and balance function for stroke patients. Methods From January, 2016 to June, 2017, 30 patients with stroke were assigned randomly into control group (n = 15) and treatment group (n = 15). Both groups accepted routine physical therapy, the control group accepted anti-gravity treadmill training, while the treatment group accepted dual-task training with anti-gravity treadmill, for four weeks. They were measured with balance training and evaluation system, and assessed with Fugl-Meyer Assessment-lower extremity (FMA-L), Berg Balance Scale (BBS) and modified Barthel Index (MBI), before and after treatment. Results The range of swaying on X axial (Rx) and Y axial (Ry), as well as rectangle area (RecArea) decreased after treatment in the treatment group (t > 4.719, P < 0.001), while RecArea decreased in the control group (t = 5.069, P < 0.001). Ry and RecArea were less in the treatment group than in the control group (t > 2.288, P < 0.05). The scores of FMA-L, BBS and MBI improved after treatment in both groups (t > 7.316, P < 0.001), and improved more in the treatment group than in the control group (t > 2.322, P < 0.05). Conclusion The dual-task training via anti-gravity treadmill may improve motor and balance function in stroke patients, and promote the activities of daily living.

参考文献

[1] Al-Yahya E, Dawes H, Smith L, et al.Cognitive motor interference while walking: a systematic review and meta-analysis[J]. Neurosci Biobehav Rev, 2011, 35(3): 715-728.
[2] Yang YR, Chen YC, Lee CS, et al.Dual-task-related gait changes in individuals with stroke[J]. Gait Posture, 2007, 25(2): 185-190.
[3] Patel PJ, Bhatt T.Fall risk during opposing stance perturbations among healthy adults and chronic stroke survivors[J]. Exp Brain Res, 2018, 236(2): 619-628.
[4] 全国第四届脑血管病学术会议. 脑卒中患者临床神经功能缺损程度评分标准(1995)[J]. 中华神经科杂志, 1996, 29(6): 381-383.
[5] 袁英,吴东宇,汪洁,等. 经颅直流电刺激改善小脑卒中后共济失调的疗效观察[J]. 中国康复医学杂志, 2014, 29(7): 666-667.
[6] Lathan C, Myler A, Bagwell J, et al.Pressure-controlled treadmill training in chronic stroke: a case study with AlterG[J]. J Neurol Phys Ther, 2015, 39(2): 127-133.
[7] Salot P, Patel P, Bhatt T.Reactive balance in individuals with chronic stroke: biomechanical factors related to perturbation-induced backward falling[J]. Phys Ther, 2016, 96(3): 338-347.
[8] 谢凌锋,林志峰,黄杰,等. 动态人体重心和支撑面积监测下平衡训练对脑卒中偏瘫患者平衡能力的影响[J]. 中国康复医学杂志, 2016, 31(10): 1094-1095.
[9] de Kam D, Kamphuis JF, Weerdesteyn V, et al. The effect of weight-bearing asymmetry on dynamic postural stability in people with chronic stroke[J]. Gait Posture, 2017, 53: 5-10.
[10] 王斌,王静. 减重步行训练在国内的应用进展[J]. 中国康复医学杂志, 2010, 25(8): 815-818.
[11] Covarrubias-Escudero F, Rivera-Lillo G, Torres-Castro R, et al.Effects of body weight-support treadmill training on postural sway and gait independence in patients with chronic spinal cord injury[J]. J Spinal Cord Med, 2017, 23: 1-12.
[12] Ruthruff E, Pashler HE, Klaassen A.Processing bottlenecks in dual-task performance: structural limitation or strategic postponement ?[J]. Psychon Bull Rev, 2001, 8(1): 73-80.
[13] Fischer R, Plessow F.Efficient multitasking: parallel versus serial processing of multiple tasks[J]. Front Psychol, 2015, 6: 1366.
[14] Liu YC, Yang YR, Tsai YA, et al.Cognitive and motor dual task gait training improve dual task gait performance after stroke–A randomized controlled pilot trial[J]. Sci Rep, 2017, 7(1): 4070.
[15] Management of Stroke Rehabilitation Working Group. VA/DOD Clinical Practice Guideline for the Management of Stroke Rehabilitation[J]. J Rehabil Res Dev, 2010, 47(9): 1-43.
[16] Saxena A, Granot A.Use of an anti-gravity treadmill in the rehabilitation of the operated achilles tendon: a pilot study[J]. J Foot Ankle Surg, 2011, 50(5): 558-561.
[17] Strobach T, Torsten S.Mechanisms of practice-related reductions of dual-task interference with simple tasks: data and theory[J]. Adv Cogn Psychol, 2017, 13(1): 28-41.
[18] 吴凡,绳宇. 应用双重任务筛查轻度认知障碍的研究进展[J]. 护理学杂志, 2017, 32(13): 105-106.
[19] Kelly VE, Eusterbrock AJ, Shumway-Cook A.Factors influencing dynamic prioritization during dual-task walking in healthy young adults[J]. Gait Posture, 2013, 37(1): 131-134.
[20] Ruffieux J, Keller M, Lauber B, et al.Changes in standing and walking performance under dual-task conditions across the lifespan[J]. Sports Med, 2015, 45(12): 1739-1758.
[21] Boisgontier MP, Beets IA, Duysens J, et al.Age-related differences in attentional cost associated with postural dual tasks: increased recruitment of generic cognitive resources in older adults[J]. Neurosci Biobehav Rev, 2013, 37(8): 1824-1837.
[22] Horak FB, Henry SM, Shumway-Cook A.Postural perturbations: new insights for treatment of balance disorders[J]. Phys Ther, 1997, 77(9): 517-533.
[23] 林夏妃,丘卫红,窦祖林. 脑卒中后平衡功能障碍的研究进展[J]. 中国康复医学杂志, 2011, 26(2): 191-194.
[24] Srivastava A, Taly AB, Gupta A, et al.Body weight-supported treadmill training for retraining gait among chronic stroke survivors: a randomized controlled study[J]. Ann Phys Rehabil Med, 2016, 59(4): 235-241.
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