踝关节扰动训练对脑卒中偏瘫患者步行时动态平衡和步态特征的影响

关键词：脑卒中  踝关节扰动训练  踝关节功能训练  步行  平衡  步态周期  足底压力中心

Keywords:stroke  ankle perturbation training  ankle functional training  walking  balance  gait cycle  center of pressure

摘要：

      摘要 目的：探究踝关节扰动训练对脑卒中偏瘫患者动态平衡及步态特征的临床疗效。 方法：2023年8月至2024年5月，于滨州医学院附属医院康复医学科招募符合纳入标准的脑卒中偏瘫患者32例，随机分为2组，对照组在常规康复治疗（conventional rehabilitation training， CRT)的基础上增加踝关节功能训练（ankle functional training， AFT)，30min/d，5次/周，共4周；试验组在对照组的基础上增加踝关节扰动训练（ankle perturbation training， APT)，30min/d，5次/周，共4周。在治疗前和治疗4周后分别用Berg平衡量表（Berg balance scale， BBS)、计时起立-行走测试（time up and go test， TUGT)及Zebris足底压力平板采集步行时的步态时空参数、足底压力中心（center of pressure， COP)移动轨迹等参数。COP可以用于评估患者的动态平衡能力。观察两组患者在治疗前后动态平衡及步态特征的相关指标。 结果：治疗前，两组受试者的各项指标均无显著性差异（P＞0.05)；治疗4周后两组患者的动态平衡及相关步态参数均得到显著改善（除健侧步态线长度外)，其中Berg平衡量表、计时起立-行走测试、患侧步态线长度、患侧单支撑线长度及内外侧位移组间比较均具有显著性差异（P＜0.05)，步长、跨步长、步速及步频的组间差异不显著（P＞0.05)。 结论：踝关节扰动训练可以有效改善脑卒中偏瘫患者的平衡功能及步行能力，在改善平衡功能参数方面显著优于踝关节功能训练。

Abstract:

      Abstract Objective： To investigate the clinical efficacy of ankle perturbation training (APT) on dynamic balance and gait characteristics in hemiplegic stroke patients. Method： From August 2023 to May 2024， 32 hemiplegic stroke patients who met the inclusion criteria were recruited from the Department of Rehabilitation Medicine of the Affiliated Hospital of Binzhou Medical university. Participants were randomly assigned to two groups: the control group received conventional rehabilitation training (CRT) supplemented with ankle functional training (AFT) for 30 minutes per day, 5 days per week, for 4 weeks, the experimental group underwent APT in addition to the control group regimen. Dynamic balance and gait parameters, including spatio-temporal gait parameters, center of pressure （COP)， and movement trajectory were collected by Berg balance scale （BBS)， time up and go test （TUGT) and Zebris plantar pressure plate before and after 4 weeks of treatment， respectively. COP was used to assess the dynamic balance. Result： Before treatment， there was no significant difference between the two groups（P＞0.05). After 4 weeks of treatment，the dynamic balance and related gait parameters in both group were significantly improved in BBS score，TUGT，gait line length on the affected side，single-support line length on the affected side and medial- lateral displacement were significantly different between the groups（P＜0.05). However, no significant differences were found between the groups for step length， stride length， stride speed, or stride frequency（P＞0.05). Conclusion： Ankle perturbation training can effectively improve balance function and walking ability in hemiplegic patients with stroke， and is superior to ankle functional training in improving balance function parameters.