基于现实环境的功能性训练对慢性期脑卒中患者的步行和平衡功能的影响

Effects of functional training in realistic environment on walking and balance function in chronic stroke patients

目的:探讨基于现实环境的功能性训练对慢性期脑卒中患者的步行与平衡功能的影响。方法:将21例符合纳入标准的慢性期脑卒中患者随机分为试验组(10例)和对照组(11例)。试验组患者在常规治疗区内的任务导向性训练的基础上进行基于现实环境的功能性训练;对照组患者进行常规治疗区内的任务导向性训练。两组患者的训练均为40min/次,2次/d,5d/周,共治疗8周。在治疗前及治疗进行的第4周和第8周采用10m步行测试、Berg平衡量表测试、6min步行测试和功能性移动分级对患者进行评估。结果:在第4周及第8周的评估中,除对照组患者在第4周的功能性移动分级外,两组患者的各项评分均较治疗前有显著提高(P<0.05)。在第4周的评分中两组患者的各项评分差异均无显著性意义(P>0.017);在第8周的评估中试验组患者的除功能性移动分级评分外其余3项评估的分值均显著高于对照组(P<0.017)。结论:对于慢性期脑卒中患者,基于现实环境的功能性训练比常规治疗区内的任务导向性训练能更有效的改善其步速、平衡和行走距离,促进患者回归家庭,融入社区。

Objective： To explore the effect of functional training in realistic environment on walking and balance function in chronic stroke patients. Method：Twenty-one chronic stroke patients were randomized to treatment group（10 patients） and control group （I1 patients）.The patients in treatment group were given functional training in realistic environment on the ba- sis of task-oriented training. While the patients in control group were given task-oriented training only. Both groups received 2 sessions of training per day, each session 40min, 5d/week for 8 weeks. The 10-meter walk test（10 MWT）, Berg balance sale（BBS）, six-minute walk test（6 MWT）, functional ambulation classification（FAC） scale were used to assess the patients＇ function level before treatment and at the 4th and 8th week of treatment. Result： At the 4th and 8th week assessment, all the scores of both groups increased significantly than that be- fore treatment（P〈0.05）, except the FAC score at the 4th week assessment of control group. No significant dif- ference was found at the 4th week assessments of two groups（P〉0.017）;but the scores of 10 MWT, BBS and 6 MWT were significantly higher（P〈0.017） in treatment group than in control group at the 8th week assess- ments except the FAC score of experimental group. Conclusion：The functional training in realistic environment is more effective in improving the walking velocity,balance and walking distance than the conventional indoor task-oriented training. It can help the chronic post- stroke patients return to their family and community.