视觉反馈平衡训练联合数字化跑台对脑梗死患者步行功能的效果

doi:10.3969/j.issn.1006-9771.2025.10.013

Abstract

Abstract:

Objective To explore the effect of visual balance training combined with digital treadmill intervention on walking function in patients with ischemic stroke.
Methods From July, 2023 to December, 2024, 90 patients with ischemic stroke in Gansu Provincial Hospital were randomly divided into control group (n = 30), treadmill group (n = 30) and combined group (n = 30). All groups received routine rehabilitation treatment, while the treadmill group added digital treadmill training, and the combined group added visual feedback balance training and digital treadmill training, for four weeks. All groups were assessed with Berg Balance Scale (BBS), Pro-Kin visual feedback balance training system, Tinetti Performance-Oriented Mobility Assessment (POMA), digital treadmill system, Timed Up and Go Test (TUGT), Fugl-Meyer Assessment-Lower Extremities (FMA-LE), Functional Ambulation Category (FAC) and modified Barthel Index (MBI) before and after intervention.
Results The effects of intra-group (F > 147.291, P < 0.001), inter-group (F > 4.919, P < 0.05) and interaction (F > 18.386, P < 0.001) were all significant for the indicators including BBS score, length trajectory and elliptical area of eyes open or closed, POMA score, step length, hip and knee range of motion on the healthy and affected side, TUGT time, FMA-LE score, and MBI score. Post-hoc tests showed that after treatment, all the above indicators improved in each group (P < 0.01), and they were the best in the combined group, followed by the treadmill group (P < 0.05). After treatment, the FAC grades improved in all the groups (|Z| > 1.971, P < 0.05), and it was better in the combined group than in the control group (P < 0.01).
Conclusion Visual feedback balance training combined with digital treadmill intervention can improve balance function, walking ability and activities of daily living in patients with ischemic stroke, which is more effective than treadmill training alone.

Key words: ischemic stroke, visual feedback balance training, digital treadmill, walking function

CLC Number:

R743.32

ZHAO Weijing, YOU Hong, TANG Zuohong, LI Yongping, WEN Mingming, LIU Hong, BAO Juan. Effect of visual feedback balance training combined with digital treadmill intervention on walking function in patients with ischemic stroke[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(10): 1214-1226.

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组别	n	性别(男/女)/n	偏瘫侧(左/右)/n	年龄/岁	病程/d	MoCA评分	体质量指数/(kg·m^-2)
对照组	30	16/14	18/12	67.07±7.01	103.93±33.83	26.97±1.47	23.70±2.49
跑台组	30	12/18	14/16	65.30±6.37	110.80±36.41	27.00±1.62	23.68±3.09
联合组	30	13/17	19/11	65.96±7.20	112.60±34.90	27.33±1.65	24.27±2.78
χ²/F值		1.165	1.900	1.073	1.159	0.493	2.013
P值		0.559	0.387	0.397	0.331	0.612	0.800

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评分		对照组	30	34.03	2.98	40.20	3.02
		跑台组	30	33.73	3.02	42.87	4.27
		联合组	30	33.53	3.81	46.67	3.55
Pro-Kin平衡测试	运动长度轨迹(睁眼)/mm	对照组	30	644.40	79.57	565.47	80.06
		跑台组	30	649.13	76.88	507.33	47.06
		联合组	30	649.93	76.55	441.37	29.59
	运动长度轨迹(闭眼)/mm	对照组	30	1180.77	146.94	1036.93	124.49
		跑台组	30	1177.00	112.04	949.33	85.59
		联合组	30	1128.33	118.51	843.67	105.85
	运动椭圆面积(睁眼)/mm²	对照组	30	1504.57	137.62	1341.13	145.63
		跑台组	30	1492.10	137.56	1210.03	117.28
		联合组	30	1506.90	143.01	1118.13	115.10
	运动椭圆面积(闭眼)/mm²	对照组	30	2001.50	116.71	1855.10	107.93
		跑台组	30	2016.50	219.30	1678.07	251.91
		联合组	30	2004.63	236.66	1421.50	192.24

变量		效应	平方和	自由度	均方	F值	P值
BBS评分		组内	4042.272	1	4042.272	555.091	< 0.001
		组间	270.811	2	135.406	8.048	0.001
		组内×组间	366.678	2	183.339	25.176	< 0.001
Pro-Kin平衡测试	运动长度轨迹(睁眼)	组内	921492.450	1	921492.450	488.873	< 0.001
		组间	105781.544	2	52890.772	7.230	0.001
		组内×组间	126074. 033	2	63037.017	33.443	< 0.001
	运动长度轨迹(闭眼)	组内	2152773.470	1	2152773.470	714.398	< 0.001
		组间	462675.678	2	231337.839	9.484	< 0.001
		组内×组间	150555.278	2	75277.639	24.981	< 0.001
	运动椭圆面积(睁眼)	组内	3480004.360	1	3480004.360	595.614	< 0.001
		组间	376247.878	2	188123.939	6.341	0.003
		组内×组间	381169.344	2	190584.672	32.619	< 0.001
	运动椭圆面积(闭眼)	组内	5702764.010	1	5702764.010	438.568	< 0.001
		组间	1418064.030	2	709032.017	11.150	< 0.001
		组内×组间	1437454.480	2	718727.239	55.273	< 0.001

变量		组别	治疗前后平均差值	平均值差标准差	P值	95%CI
变量		组别	治疗前后平均差值	平均值差标准差	P值	下限	上限
BBS评分		对照组	6.167	1.578	< 0.001	5.578	6.756
		跑台组	9.133	4.732	< 0.001	7.366	10.900
		联合组	13.133	4.337	< 0.001	11.514	14.753
Pro-Kin平衡测试	运动长度轨迹(睁眼)	对照组	536.367	157.624	< 0.001	477.509	595.224
		跑台组	-141.800	57.135	< 0.001	-163.135	-120.465
		联合组	-208.567	77.893	< 0.001	-237.652	-179.481
	运动长度轨迹(闭眼)	对照组	471.467	129.604	< 0.001	423.072	519.861
		跑台组	-227.667	73.268	< 0.001	-255.025	-200.308
		联合组	-284.667	94.351	< 0.001	-319.898	-249.435
	运动椭圆面积(睁眼)	对照组	496.933	186.561	< 0.001	427.270	566.596
		跑台组	-282.067	103.042	< 0.001	-320.543	-243.590
		联合组	-583.133	130.690	< 0.001	-437.567	-339.966
	运动椭圆面积(闭眼)	对照组	513.967	180.149	< 0.001	446.698	581.236
		跑台组	-338.433	174.551	< 0.001	-403.612	-273.255
		联合组	-583.133	201.914	< 0.001	-658.529	-507.737

变量		组别		平均值差	P值	95%CI
变量		组别		平均值差	P值	下限	上限
BBS评分		对照组	跑台组	-2.667	0.006	-4.537	-0.797
		对照组	联合组	-6.467	< 0.001	-8.337	-4.597
		跑台组	联合组	-3.800	< 0.001	-5.670	-1.930
Pro-Kin平衡测试	运动长度轨迹(睁眼)	对照组	跑台组	58.133	< 0.001	29.255	87.012
		对照组	联合组	124.100	< 0.001	95.222	152.978
		跑台组	联合组	65.967	< 0.001	37.088	94.845
	运动长度轨迹(闭眼)	对照组	跑台组	87.600	0.002	32.944	142.256
		对照组	联合组	193.267	< 0.001	138.611	247.922
		跑台组	联合组	105.667	< 0.001	51.011	160.322
	运动椭圆面积(睁眼)	对照组	跑台组	131.100	< 0.001	66.034	196.166
		对照组	联合组	223.000	< 0.001	157.934	288.066
		跑台组	联合组	91.900	0.006	26.834	156.966
	运动椭圆面积(闭眼)	对照组	跑台组	177.033	0.001	77.845	276.222
		对照组	联合组	433.600	< 0.001	334.411	532.789
		跑台组	联合组	256.567	< 0.001	157.378	355.756

Effect of visual feedback balance training combined with digital treadmill intervention on walking function in patients with ischemic stroke

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变量		效应	平方和	自由度	均方	F值	P值
POMA评分		组内	653.606	1	653.606	310.081	< 0.001
		组间	89.200	2	44.600	4.919	0.009
		组内×组间	77.511	2	38.756	18.386	< 0.001
数字化跑台步态测试	步长	组内	2246.493	1	2246.493	286.667	< 0.001
		组间	257.485	2	128.742	6.429	0.002
		组内×组间	608.467	2	304.233	38.822	< 0.001
	髋关节活动度(健侧)	组内	2980.705	1	2980.705	389.461	< 0.001
		组间	583.208	2	291.604	8.407	< 0.001
		组内×组间	902.488	2	451.244	58.960	< 0.001
	髋关节活动度(患侧)	组内	3566.141	1	3566.141	381.110	< 0.001
		组间	846.133	2	423.066	19.319	< 0.001
		组内×组间	558.799	2	279.399	29.859	< 0.001
	膝关节活动度(健侧)	组内	3473.369	1	3473.369	147.291	< 0.001
		组间	936.110	2	468.055	5.818	0.004
		组内×组间	1233.736	2	616.868	26.159	< 0.001
	膝关节活动度(患侧)	组内	4158.247	1	4158.247	458.711	< 0.001
		组间	669.148	2	334.574	13.776	< 0.001
		组内×组间	544.895	2	272.447	30.055	< 0.001

变量	效应	平方和	自由度	均方	F值	P值
TUGT	组内	3382.687	1	3382.687	348.839	< 0.001
	组间	918.911	2	459.456	10.850	< 0.001
	组内×组间	553.652	2	276.826	28.548	< 0.001
FMA-LE评分	组内	1400.022	1	1400.022	458.534	< 0.001
	组间	275.678	2	137.839	10.893	< 0.001
	组内×组间	314.344	2	157.172	51.477	< 0.001

组别	n	治疗前/n						治疗后/n						Z值	P值
组别	n	0	1	2	3	4	5	0	1	2	3	4	5	Z值	P值
对照组	30	0	0	10	12	8	0	0	0	5	10	15	0	-1.971	0.049
跑台组	30	0	0	9	17	4	0	0	0	2	9	18	1	-3.986	< 0.001
联合组	30	0	0	6	16	8	0	0	0	0	5	21	4	-4.605	< 0.001
H值		1.620						11.108
P值		0.445						0.004

组别		平均秩	U值	Z值	P值	Bonferroni校正P值
对照组	跑台组	27.83/33.17	530.000	1.322	0.186	0.056
对照组	联合组	24.08/36.92	642.500	3.248	0.001	0.003
跑台组	联合组	26.48/34.52	570.500	2.111	0.035	0.057

效应	平方和	自由度	均方	F值	P值
组内	30160.556	1	30160.556	373.918	< 0.001
组间	2958.611	2	1479.306	9.623	< 0.001
组内×组间	3721.944	2	1860.972	23.072	< 0.001

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[2]	WANG Xiaojun, WANG Hani, YU Hong, LI Yuanmei, ZHOU Yuda. Effect of high-definition transcranial direct current stimulation combined with upper limb robot on upper limb dysfunction after ischemic stroke [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(2): 218-224.
[3]	WANG Yue, ZHANG Tong, LIU Huilin, LIU Jianhua, ZHU Xiaomin, ZHAO Jun. Effect of external attentional focus strategy on walking function after stroke [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(10): 1206-1213.
[4]	YU Tingting, CAI Fuliang, MIAO Guihua, GU Chen, PENG Yuan. Effect of structured therapy and education based on personal strength on ischemic stroke: a randomized controlled trial [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(8): 965-971.
[5]	XU Dongyan, WANG Weining, PAN Li, LIU Gang, LIU Jiapeng, WU Yi, ZHU Yulian. Effect of enriched environment theory-based multisensory feedback gait training on walking function in stroke patients [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(5): 526-534.
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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
POMA评分		对照组	30	18.03	2.63	20.33	2.64
		跑台组	30	17.97	2.44	21.60	1.65
		联合组	30	18.13	1.87	23.63	2.72
数字化跑台步态测试	步长/cm	对照组	30	22.65	3.77	25.87	5.28
		跑台组	30	23.03	3.34	28.99	2.58
		联合组	30	21.16	3.95	33.18	2.82
	髋关节活动度(健侧)/°	对照组	30	26.11	4.96	29.50	4.50
		跑台组	30	25.15	5.14	32.04	4.91
		联合组	30	24.89	4.92	39.03	2.74
	髋关节活动度(患侧)/°	对照组	30	20.07	3.04	24.94	3.08
		跑台组	30	20.29	5.78	28.67	6.35
		联合组	30	21.03	3.94	34.49	4.17
	膝关节活动度(健侧)/°	对照组	30	31.77	8.02	34.03	11.04
		跑台组	30	32.06	6.35	41.07	5.42
		联合组	30	30.84	5.51	45.93	5.08
	膝关节活动度(患侧)/°	对照组	30	23.58	4.68	29.20	3.77
		跑台组	30	23.99	3.47	33.11	4.57
		联合组	30	24.06	3.08	38.16	4.64

变量		组别	治疗前后平均差值	平均值差标准差	P值	95%CI
变量		组别	治疗前后平均差值	平均值差标准差	P值	下限	上限
POMA评分		对照组	4.700	0.952	< 0.001	4.344	5.056
		跑台组	3.633	1.732	< 0.001	2.987	4.280
		联合组	5.500	2.910	< 0.001	4.414	6.586
数字化跑台步态测试	步长	对照组	3.220	4.709	0.001	1.462	4.978
		跑台组	5.957	2.734	< 0.001	4.936	6.978
		联合组	12.020	4.167	< 0.001	10.464	13.576
	髋关节活动度(健侧)	对照组	3.388	1.580	< 0.001	2.798	3.978
		跑台组	6.887	4.458	< 0.001	5.223	8.552
		联合组	14.141	4.853	< 0.001	12.329	15.953
	髋关节活动度(患侧)	对照组	4.871	2.820	< 0.001	3.818	5.923
		跑台组	8.381	4.289	< 0.001	6.779	9.982
		联合组	13.455	5.459	< 0.001	11.417	15.493
	膝关节活动度(健侧)	对照组	3.732	6.785	0.005	1.199	6.265
		跑台组	9.006	6.767	< 0.001	6.479	11.533
		联合组	15.085	4.044	< 0.001	13.575	16.595
	膝关节活动度(患侧)	对照组	5.617	2.511	< 0.001	4.679	6.555
		跑台组	9.123	4.894	< 0.001	7.296	10.950
		联合组	14.098	4.913	< 0.001	12.264	15.933

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
TUGT/s	对照组	30	45.92	5.15	41.43	5.62
	跑台组	30	46.43	4.88	37.80	4.86
	联合组	30	44.86	5.86	31.78	4.03
FMA-LE评分	对照组	30	14.90	2.52	17.63	2.27
	跑台组	30	15.07	2.73	19.97	3.11
	联合组	30	14.73	2.93	23.83	3.14

组别	n	治疗前		治疗后
组别	n	均值	标准差	均值	标准差
对照组	30	47.50	10.97	61.67	11.70
跑台组	30	45.50	3.98	72.67	10.56
联合组	30	46.33	9.90	82.67	6.40