主观垂直感知障碍对脑卒中患者功能影响的回顾性研究

doi:10.3969/j.issn.1006-9771.2024.01.009

Abstract

Abstract:

Objective To explore the impact of subjective vertical perception impairment after stroke on visuospatial cognition, balance, walking and activities of daily living, to investigate the mediating role of visuospatial cognition and lateropulsion.

Methods From February to December, 2023, 96 stroke patients were selected from the Rehabilitation Medicine Center of the First Affiliated Hospital of Nanjing Medical University. They were divided into vertical perception impairment group (n = 53) and non-vertical perception impairment group (n = 43). They were assessed with National Institutes of Health Stroke Scale (NIHSS), the Scale for Contraversive Pushing (SCP), Burke Lateropulsion Scale (BLS), Line Bisection Test (LBT), Line Cancellation Test (LCT), Star Cancellation Test (SCT), Subjective Visual Vertical (SVV), Berg Balance Scale (BBS), Holden Functional Ambulation Categories (FAC) and Barthel Index (BI).

Results Scores of SVV orientation, SVV uncertainty, NIHSS, SCT, SCP, BLS, BBS, FAC and BI were worse in the vertical perception impairment group than in the non-vertical perception impairment group (|t| > 2.414, Z = -3.481, P< 0.05). Scores of SVV were correlated with SCT, BLS and BBS (|r| ≥ 0.273, P< 0.05). After controlling for age and gender, SVV orientation score did not directly impact BBS score (β= -0.011, P =0.920). However, it exerted a partial mediating effect through BLS (effect = -0.173, 95%CI -0.278 to -0.076) and a chain-mediated effect through SCT and BLS (effect = -0.073, 95%CI -0.137 to -0.027), impacting BBS score.

Conclusion Subjective vertical perception impairment results in poorer visuospatial cognition, balance, walking and activities of daily living in stroke patients. This influence on balance function is mediated through the mediating effects of visuospatial cognition and lateropulsion.

Key words: stroke, subjective vertical perception impairment, balance, visuospatial cognition, activities of daily living, mediating effects

CLC Number:

R743.3

WANG Haoyi, SHI Yawei, LU Jun, XU Guangxu. Impact of subjective vertical perception impairment on function in stroke patients: a retrospective study[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 68-73.

Figures/Tables 6

Table 1

Table 2

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Table 5

Figure 1

References 33

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变量	垂直感知障碍组 (n = 53)	非垂直感知障碍组 (n = 43)	χ²/t值	P值
性别(男/女)/n	36/17	32/11	0.485	0.486
年龄/岁	59.58±8.99	58.79±8.38	0.444	0.658
卒中部位(幕上/幕下)/n	40/13	36/7	1.313	0.252
卒中性质(梗死/出血)/n	27/26	21/22	0.042	1.000
损伤侧(左/右)/n	5/48	3/40	0.000	0.665
病程/d	50.80±34.56	53.67±34.12	-0.407	0.685

变量	垂直感知障碍组(n = 53)	非垂直感知障碍组(n = 43)	t/Z值	P值
SVV方向性	4.32±1.77	2.03±0.87	8.263	< 0.001
SVV稳定性	1.96±0.95	1.46±0.85	2.664	0.009
NIHSS	8.11±3.59	6.26±2.40	3.025	0.003
LBT	9.00±9.11	5.87±6.70	1.877	0.064
LCT	4.34±4.54	2.72±3.55	1.960	0.053
SCT	8.19±7.07	4.26±4.29	3.358	0.001
BLS	6.17±3.65	3.51±3.41	3.655	< 0.001
SCP	1.83±1.10	1.12±1.08	3.185	0.002
BBS	18.77±14.13	25.98±15.03	-2.414	0.018
FAC	39.92(2115.50)	59.08(2540.50)	-3.481	< 0.001
BI	49.72±19.23	60.70±17.75	-2.880	0.005

变量	NIHSS	LBT	LCT	SCT	SVV方向性	SVV稳定性	BLS	SCP	Berg	FAC	BI
NIHSS	1
LBT	0.266^b	1
LCT	0.337^b	0.315^b	1
SCT	0.353^b	0.347^b	0.524^b	1
SVV方向性	0.256^a	0.287^b	0.233^a	0.457^b	1
SVV稳定性	0.135	0.236^a	0.196	0.222^a	0.555^b	1
BLS	0.236^a	0.092	0.244^a	0.569^b	0.578^b	0.304^b	1
SCP	0.035	0.000	0.081	0.444^b	0.521^b	0.228^a	0.772^b	1
Berg	-0.313^b	-0.241^a	-0.019	-0.398^b	-0.273^b	-0.316^b	-0.503^b	-0.360	1
FAC	-0.403^b	-0.301^b	-0.088	-0.252^a	-0.369^b	-0.162	-0.532^b	-0.360^b	0.676^b	1
BI	-0.333^b	-0.255^a	0.104	-0.295^b	-0.276^b	-0.302^a	-0.481^b	-0.326	0.843^b	0.774^b	1

结局变量	预测变量	β	t值	P值	R	R²	F值	P值
SCT	SVV方向性	0.434	4.710	< 0.001	0.539	0.291	12.575	< 0.001
	年龄	0.295	3.255	0.002
	性别	-0.058	-0.619	0.538
BLS	SVV方向性	0.372	4.153	< 0.001	0.684	0.468	20.010	< 0.001
	SCT	0.363	3.994	< 0.001
	年龄	0.063	0.750	0.455
	性别	0.107	1.296	0.198
BBS	SVV方向性	-0.011	-0.100	0.920	0.589	0.347	9.547	< 0.001
	SCT	-0.104	-0.948	0.346
	BLS	-0.465	-3.979	< 0.001
	年龄	-0.182	-1.953	0.054
	性别	0.263	2.843	0.006

项目	效应值	SE	95%CI	占总中介效应比例(%)
总效应	-2.457	0.807	-4.060~-0.854	-
直接效应	-0.089	0.885	-1.846~1.669	-
总中介效应(标准化)	-0.291	0.052	-0.388~-0.185	100.00
SVV方向性-SCT-BBS	0.045	0.048	-0.146~0.046	15.53
SVV方向性-BLS-BBS	-0.173	0.052	-0.278~-0.076	59.33
SVV方向性-SCT-BLS-BBS	-0.073	0.028	-0.137~-0.027	25.15

Impact of subjective vertical perception impairment on function in stroke patients: a retrospective study

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