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

Abstract

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

CLC Number:

R743.3

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.

Figures/Tables 7

Table 1

Table 2

Table 3

Table 4

Post hoc LSD test results of balance test parameters"

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

Table 4

Table 5

Table 6

Table 7

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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

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