防跌倒综合训练对老年帕金森病患者早期姿势控制障碍的影响

关键词：跌倒  老年  帕金森病  早期  姿势控制训练

Keywords:elderly  fall  Parkinson's disease  early-stage  postural control training

摘要：

      摘要 目的：探索防跌倒综合训练方案对老年帕金森病（Parkinson's disease，PD）患者早期姿势控制障碍的影响。 方法：35例早期PD患者，随机分为：常规训练组18例、防跌倒训练组17例。两组均接受常规药物治疗、常规功能训练（肌力训练、有氧运动），防跌倒训练组在此基础上增加基于中枢调控机制的姿势控制训练，均5次/周，共8周。分别于治疗前、治疗8周后，采用动静态平衡测试训练系统对PD患者进行感觉统合测试（sensory organization test，SOT）、平衡稳定极限测试（limits of stability，LOS），以及起立行走测试（timed up and go test，TUG）、统一帕金森病评分量表-Ⅲ（unified Parkinson’s disease rating scale Ⅲ，UPDRS-Ⅲ）和帕金森病问卷-39（Parkinson’s disease questionnaire 39，PDQ-39）的评估。 结果：组内比较：防跌倒训练组治疗后的SOT总分、SOT本体感觉、SOT前庭感觉及向前、向后、向左、向右的最大偏移（max excursions，MXE）均显著高于治疗前（P<0.05），SOT视觉依赖、SOT视觉较治疗前无显著性差异（P>0.05）；常规训练组治疗前后的SOT总分、SOT本体感觉、SOT视觉依赖、SOT前庭感觉及SOT视觉比较均无显著性差异（P>0.05）；常规训练组治疗后的向左的MXE显著高于治疗前（P<0.05），向前、向后、向右的MXE较治疗前均无显著性差异（P>0.05）；常规训练组、防跌倒训练组治疗后的TUG用时、UPDRS-Ⅲ评分和PDQ-39评分均显著低于治疗前（P<0.05）。组间比较：防跌倒训练组治疗后SOT总分、SOT前庭感觉高于常规训练组（P<0.05，P<0.01）；防跌倒训练组治疗后的TUG用时少于常规训练组（P<0.05）；两组间治疗前各指标比较均无显著性差异（P>0.05）；两组间治疗后的SOT本体感觉、SOT视觉依赖、SOT视觉及向前、向后、向左、向右的MXE、UPDRS-Ⅲ评分、PDQ-39评分比较均无显著性差异（P>0.05）。 结论：本研究制定的针对早期PD患者的防跌倒综合训练方案可显著改善该类患者与平衡相关的感觉统合、本体感觉和前庭功能，提高LOS的MXE，但对其功能性移动能力、运动功能和生存质量的影响仍不明确，且该方案对早期PD患者姿势控制障碍的远期疗效及对伴有认知障碍的PD患者姿势控制障碍的疗效仍需进一步探索。

Abstract:

      Abstract Objective： To explore the impact of a comprehensive fall prevention training program on early postural control disorders in elderly patients with Parkinson's disease （PD）. Method： Thirty-five early PD patients were randomized into two groups： a conventional training group（n=18） and a fall prevention training group（n=17）. Both groups received standard pharmacological therapy and routine functional training， which included strength training and aerobic exercise. The fall prevention training group additionally received posture control training based on central regulatory mechanisms. All the training were conducted 5 sessions per week over an 8-week period. Assessments were performed using a dynamic and static balance training system prior to the program and again after 8 weeks of intervention. The evaluation comprised the sensory organization test（SOT），limits of stability（LOS）， and timed up and go test（TUG）， as well as the unified Parkinson’s disease rating scale Ⅲ（UPDRS-Ⅲ） and Parkinson’s disease questionnaire 39（PDQ-39）. Result： Within-group comparisons： the total SOT score， SOT proprioception， SOT vestibular function， and the max excursions （MXE） in forward， backward， leftward， and rightward directions in the fall prevention training group were significantly higher after treatment （P<0.05）. The visual dependency and visual scores of the SOT in the fall prevention training group did not show significant differences compared to before treatment （P>0.05）. In the conventional training group， there were no significant differences in total SOT scores， SOT proprioception， SOT visual dependence， SOT vestibular function， or visual scores before and after treatment （P>0.05）. The leftward MXE in the conventional training group showed a significant increase after treatment （P<0.05）， while there were no significant differences in forward， backward， and rightward MXE （P>0.05）. Both groups exhibited significant decreased TUG， UPDRS-Ⅲ， and PDQ-39 scores after treatment （P<0.05）. Between-group comparisons： the total SOT score and vestibular function score in the fall prevention training group was higher than in the conventional training group after treatment （P<0.05，P<0.01）. The TUG score in the fall prevention training group was lower than in the conventional training group after treatment （P<0.05）. Prior to treatment， there were no significant differences in all indicators between the two groups （P>0.05）. There were no significant differences in SOT proprioception， SOT visual dependence， SOT visual scores， MXE in forward， backward， leftward， and rightward directions， UPDRS-Ⅲ， and PDQ-39 after treatment between the two groups （P>0.05）. Conclusion： The fall prevention training program designed for early PD patients in this study can significantly improve the balance-related sensory integration， proprioception， and vestibular function in these patients， enhance their MXE in LOS. However， the effects on functional mobility， motor function， and quality of life remain unclear. Further studies are needed to explore the long-term efficacy of this training program on early postural control disorders in PD patients and its effects on PD patients with cognitive impairments.