动态四点跪位训练对胸段脊髓损伤患者坐位平衡和日常生活独立性的影响

关键词：动态跪位训练  脊髓损伤  坐位平衡  日常生活独立性

Keywords:dynamic kneeling training  spinal cord injury  sitting balance  independence of daily life

摘要：

      摘要 目的：探讨动态四点跪位训练对胸段脊髓损伤患者坐位平衡和日常生活独立性的影响。 方法：将胸段脊髓损伤患者40例，随机分为观察组和对照组，每组各20例。观察组患者每日接受常规康复训练及动态四点跪位训练各20min，对照组患者接受相同时间的常规康复训练，两组患者持续训练8周。分别比较两组治疗前后坐位功能测试（function in sitting test，FIST）、四向延伸测试（the four-directional reach test， FDRT）、脊髓损伤神经学分类国际标准（international standards of neurological classification of spinal cord injury， ISNCSCI）量表中的感觉评分和脊髓损伤独立性（spinal cord independence measure Ⅲ， SCIM-Ⅲ）4个参数的变化。此外，基于FIST评分按损伤节段、病程和损伤程度进行亚组分析。 结果：康复治疗前两组的FIST、FDRT、ISNCSCI（感觉评分）、SCIM Ⅲ评分差异无显著性意义（P>0.05）。治疗8周后，两组患者的FIST评分和FDRT的四向伸展距离较治疗前有增加，差异具有显著性意义（P<0.05）。观察组FIST改善优于对照组（P<0.05），且运动完全性胸段脊髓损伤患者可能取得更大获益（P<0.05）。观察组治疗后FDRT中的向左伸和向右伸距离大于对照组（P<0.05），向前和向后距离与对照组比较则无明显差异。治疗后两组患者感觉评分有所增加，但无明显差异，SCIM Ⅲ评分较治疗前提高，且观察组改善优于对照组（P<0.05）。 结论：动态四点跪位训练可以改善胸段脊髓损伤患者的坐位平衡能力，提高日常生活的独立性。

Abstract:

      Abstract Objective： To investigate the effects of dynamic four-point kneeling training on sitting balance and independence of daily life in patients with thoracic spinal cord injury. Method： Forty patients with thoracic spinal cord injury were randomly divided into observation group or control group， with 20 cases in each group. Patients in the observation group received routine rehabilitation training and dynamic four-point kneeling training for 20 minutes daily， while patients in the control group received routine rehabilitation training for the same time， both groups continued training for 8 weeks. Function in sitting test （FIST）， The four-directional reach test （FDRT）， Sensory score of international standards of neurological classification of spinal cord injury（ISNCSCI） and four parameters of spinal cord independence measure Ⅲ （SCIM-Ⅲ） were evaluated before treatment and after 8 weeks， respectively. In addition， subgroups were analyzed by injury segment， disease duration， and degree of injury based on FIST scores. Result： There was no significant difference in FIST， FDRT， ISNCSCI （sensory score） and SCIM Ⅲ scores between the two groups before the intervention （P>0.05）. After 8 weeks of treatment， the FIST score and four-way extension distance of FDRT in the two groups increased compared with that before treatment， the difference was statistically significant （P<0.05）. The FIST improvement in the observation group was better than that in the control group （P<0.05）， and patients with motor complete thoracic spinal cord injury may achieve greater benefit （P<0.05）. The left extension and right extension distance of FDRT in the observation group after treatment was greater than that in the control group （P<0.05）. There was no significant difference between the forward and backward distances compared with the control group. After treatment， the sensory scores of the two groups were increased， but there was no significant difference， and the SCIM Ⅲ score was higher than that before treatment， and the improvement in the observation group was better than that in the control group （P<0.05）. Conclusion： Dynamic four-point kneeling training effectively improves sitting balance and independence in daily living in patients with thoracic spinal cord injury.