步歌在帕金森病患者康复中的应用研究

关键词：步歌  帕金森病  康复

Keywords:Ambulosono  Parkinson's disease  rehabilitation

摘要：

      摘要 目的：探讨步歌评定与步态训练系统在帕金森病患者康复训练中的疗效。 方法：选取2017年1月1日—2018年10月1日在浙江康复医疗中心的42例帕金森病患者，采用数字随机表法随机分为试验组21例、对照组21例，两组患者均接受神经内科常规治疗，同时进行常规康复训练（PT/OT），每人每天15min肌力训练，15min平衡训练，30min步态训练。试验组接受进行步歌步态训练，对照组仅接受视、听提示下的步态训练，每次步态训练为30min，每周5次康复训练，共3个月。对两组患者训练前后评测统一帕金森病分级量表第三部分（unified Parkinson Disease rating scale， part Ⅲ， UPDRS-Ⅲ）评分，起立—行走计时测试（timed up and go test， TUGT），步歌步行功能分级（walking function rating scale of Ambulosono， WFRSA）。 结果：两组患者性别、年龄、HOENHN-YAHR分级、简易精神状态量表（mini-mental state examination，MMSE）评分、训练前UPDRS-Ⅲ、TUGT、WFRSA比较，差异均无显著性意义（P>0.05）。训练前两组UPDRS-Ⅲ[试验组（17.76±5.92）分]，对照组（17.00±6.28）分，P>0.05），TUGT[试验组（10.76±3.56）s，对照组（13.73±8.76）s，P>0.05]，WFRSA[试验组（3.24±0.62）级，对照组（3.24±0.63）级，P>0.05]均无显著性差异。训练3个月后结果如下：UPDRS-Ⅲ（试验组12.81±3.08分，对照组16.95±6.20分），TUGT[试验组（7.87±2.60）s，对照组（13.48±9.06s），WFRSA（试验组（3.917±0.57）级，对照组（3.23±0.66）级]。训练后试验组UPDRS-Ⅲ（P＜0.05）、TUGT（P＜0.05）下降明显，WFRSA（P＜0.05）上升，存在显著性差异。对照组训练前后各数据UPDRS-Ⅲ（P>0.05）、TUGT（P>0.05）也有下降趋势，WFRSA（P>0.05）呈下降趋势，但训练前后并无显著性差异。训练后试验组与对照组对比各数据存在显著性差异（UPDRS-Ⅲ： P＜0.05，TUGT： P＜0.05，WFRSA： P＜0.05）。 结论：与传统康复训练相比较，步歌评定与步态训练系统能改善帕金森病患者的运动与步行功能。

Abstract:

      Abstract Objective： To explore the effect of Ambulosono evaluation and gait training system on rehabilitation of patients with Parkinson's disease. Method： Forty-two patients with Parkinson's disease from Jan. 1， 2017 to Oct. 1， 2018 in Zhejiang Rehabilitation Medical Center were randomly divided into treatment group (n=21) and control group (n=21). Both groups received routine treatment of neurologic medication and routine rehabilitation training (PT/OT). Each patient received 15 minutes of muscle strength training， 15 minutes of balance training， 30 minutes of gait training. The treatment group received gait training by Ambulosono. The control group received only gait training with visual and auditory cues， and each gait training lasted for 30 minutes. Rehabilitation training was five times a week for three months. The unified Parkinson Disease rating scale，part Ⅲ (UPDRS-Ⅲ) score， timed up and go test time(TUGT) and walking function rating scale of Ambulosono (WFRSA) were evaluated before and after training. The data were analyzed by SPSS 20.0 statistical analysis software. Result： There were no significant differences in gender， age， HOENHN-YAHR， mini-mental state examination(MMSE) score， between the two groups before training. There were no significant differences in UPDRS-Ⅲ(in the treatment group group： 17.76±5.92， control group： 17.00±6.28， P=0.688)， TUGT (treatment group： 10.76±3.56s， control group： 13.73±8.76s， P=0.089)， WFRSA (treatment group： 3.24±0.62， control group： 3.24±0.63， P=0.142) before training. After three months of training， UPDRS-Ⅲ score decreased in treatment group(17.76±5.92/12.81±3.08，P=0.002). The TUGT time decreased in the treatment group (10.76±3.56/7.87±2.60s, P=0.017)， WFRSA increased in the treatment group (3.24±0.62/3.92±0.57, P=0.000 While there were no significant differences in the control group before and after training. Conclusion： Compared with traditional rehabilitation training， training with Ambulosono evaluation and gait training system can significantly improve the walking function of patients with Parkinson's disease.