脑卒中患者双侧站立动态姿势控制能力与平衡及步行功能相关性研究

关键词：星状偏移平衡测试  姿势控制  平衡  步态  脑卒中

Keywords:star excursion balance test  postural control  balance  gait  stroke

摘要：

      摘要 目的：探讨脑卒中偏瘫患者双侧肢体姿势控制能力与其平衡及步行功能的相关性。 方法：2018年—2019年，随机选取中国康复研究中心住院的Brunnstrom Ⅳ期及以上脑卒中偏瘫患者38例。A、B两名测试者评定受试者双侧下肢分别支撑的星状偏移平衡测试（star excursion balance test，SEBT），测试者A隔天再次测量。测试者C评定Berg平衡量表、Active Balancer EAB-100平衡检测仪的(前方、后内侧、后外侧、外侧)稳定极限值、步行速度。对SEBT测试结果进行测试者内和测试者间信度统计，分析双侧下肢SEBT结果间差异，对首次测量SEBT结果及SEBT不对称值分别与平衡功能测试结果、步行速度结果进行相关性分析。 结果：SEBT的测试者内及测试者间信度较高（ICC=0.888—0.969，ICC=0.892—0.951）；双侧下肢SEBT测试结果间有显著性差异（t=2.278—8.813，P<0.05）；SEBT测试结果与Berg平衡量表评分（r=0.504—0.812，P<0.05）、Active Balancer EAB-100平衡检测仪的前方和中间外侧稳定极限值(r=0.406—0.671，P<0.05)及步行速度（r=0.463—0.563，P<0.05）呈显著性中高度正相关；SEBT不对称值与Berg平衡量表评分(r=﹣0.011—﹣0.154，P>0.05)无显著性相关关系；后外方向上SEBT不对称值与Active Balancer EAB-100平衡检测仪的前方、外侧稳定极限值(r=﹣0.380、﹣0.348，P＜0.05)呈有显著性低度相关关系；前方SEBT不对称值与步行速度呈显著性低度负相关关系(r=﹣0.385，P<0.05)。 结论：SEBT在脑卒中Brunnstrom Ⅳ期及以上患者的动态姿势控制评定中具有较高的重测信度，受试者双侧下肢姿势控制能力存在差异；双侧姿势控制与平衡（Berg平衡量表、Active balancer EAB-100 平衡检测仪）和步行功能（步行速度）有关，双侧姿势控制不对称性与平衡和步行功能有关，但相关性较低。

Abstract:

      Abstract Objective： To investigate the correlation between postural control ability and balance and walking function in stroke patients with hemiplegia. Method： A total of 38 stroke patients with hemiplegia at Brunnstrom stage Ⅳ and above were randomly selected from China Rehabilitation Research Center from 2018 to 2019. Tester A and B assessed the star excursion balance test (SEBT) of the subject with left or right leg support, with A taking the test again the next day. Tester C assessed the Berg balance scale,active balancer EAB-100 balance detector (anterior， posteromedial， posterolateral， lateral) stability limits and walk velocity.Test-retest reliability and intertester reliability were performed on the SEBT test results to analyze the differences between the SEBT results of bilateral lower extremities. Correlation analysis was conducted between the first measurement of SEBT results and the SEBT asymmetry values with balance function test results and walk velocity results， respectively. Result： The test-retest and intertester correlation of SEBT was good (ICC=0.888—0.969， ICC=0.892—0.951). There were significant differences in the SEBT results of bilateral lower extremities (t=2.278—8.813， P<0.05). SEBT was highly positively correlated with Berg scale score (r=0.504—0.812， P<0.05)，anterior and lateral stability limits of active balancer EAB-100 balance detector (r=0.406—0.671， P<0.05)，and walk velocity (r=0.463—0.563， P<0.05). There was no significant correlation between SEBT asymmetry and Berg scale score(r=﹣0.011—﹣0.154， P>0.05). There was a low correlation between the posterolateral of SEBT asymmetry and the anterior and lateral stability limits of active balancer EAB-100 balance detector (r=﹣0.380， ﹣0.348， P<0.05). There was a low negative correlation between anterior of SEBT asymmetry and walk velocity (r=﹣0.385， P<0.05). Conclusion： SEBT had high retestable reliability in dynamic postural control assessment in stroke patients at Brunnstrom stage Ⅳ and above， and there were differences in postural control ability of both lower extremities. Bilateral postural control was associated with balance (BBS， active balancer EAB-100 balance detector) and walking function (velocity). Bilateral postural control asymmetry was associated with balance and walking function， but the correlation was low.