脑卒中偏瘫患者步态特征及其与STREAM量表下肢运动部分评分间的相关性分析

Gait characteristics and their correlation with lower limb motor scores of STREAM scale in stroke patient with hemiplegia

脑卒中偏瘫患者的步态异常会严重影响其日常生活活动能力。步态分析作为定量评估方法已广泛应用于步态异常的科学研究,但步态分析数据繁杂,如何高效且规范化进行偏瘫患者的下肢运动功能的临床评估仍有待研究。目的探究脑卒中偏瘫患者步态特征,并通过步态特征及脑卒中康复运动评价(STREAM)量表下肢运动部分评分的相关性分析筛选出一些步态的定量指标为偏瘫患者的下肢运动功能的临床评估和诊断提供规范化数据。方法 选择2021年5月至2022年6月在安徽医科大学第二附属医院康复医学科接受治疗的脑卒中后偏瘫患者21例为卒中组,其中男性12例,女性9例;年龄14~77岁,平均年龄49.29岁;身高153~181 cm,平均身高168.90 cm;体质量53~94 kg,平均体质量69.88岁;其中脑出血恢复期患者9例,脑梗死恢复期患者12例。选取同时间段自愿参与该研究的健康者21例作为健康组,其中男性11例,女性10例;年龄24~71岁,平均年龄49.14岁;身高155~183 cm,平均身高167.67 cm;体质量48~80 kg,平均体质量65.95 kg。应用步态分析系统及运动障碍数字化测试平台分别采集两组受试者步态参数,对采集的数据进行统计分析,并对STREAM量表下肢运动部分评分与卒中组各指标进行相关性分析。结果 卒中组步幅小于健康组,步宽、触地时长百分比大于健康组,步速小于健康组,步相角大于健康组,差异均有统计学意义(P <0.05);两组T区、M1区、M2区足底压力占比差异均无统计学意义(P> 0.05);卒中组MF区压力占比较健康组高,差异有显著统计学意义(P <0.01);卒中组HEEL区压力占比较健康组低,差异有统计学意义(P <0.05);卒中组在COP-X、COP-Y方向的偏移值均高于健康组,差异均有统计学意义(P <0.05);卒中组患侧峰值屈髋角度较健康组减少,差异有统计学意义(P <0.05);卒中组患侧峰值屈膝角度较健康组减少,差异有统计学意义(P <0.05);卒中组患者STREAM量表下肢运动部分评分为(12.81±3.14)分。Person相关性分析显示STREAM量表下肢运动部分评分与步速、步幅、触地时长百分比、峰值屈膝角度、峰值屈髋角度呈正相关(P <0.05),与COP-X、COP-Y呈负相关(P <0.05);STREAM量表下肢运动部分评分与步相角、步宽无相关性(P> 0.05)。结论 与健康人比较,脑卒中偏瘫患者步态特征具有显著改变。主要表现为足跟处负重减少、外侧缘负重增多,平衡差,患侧下肢屈髋屈膝不足,步行能力降低。步态分析的一些指标与STREAM量表下肢运动部分评分间具有显著相关性。故可作为评价脑卒中偏瘫患者步行能力的重要定量分析指标。

The abnormal gait of stroke patient with hemiplegia often seriously affects ability of their daily life. As a quantitative evaluation method, gait analysis has been widely used in scientific research of abnormal gait, but those data are complicated. Thus, efficient and standardized clinical evaluation of the lower limb motor function of hemiplegia patients still needs to be studied. Objective To explore the gait characteristics of stroke patients with hemiplegia, screen out some quantitative indicators of gait by correlation analysis of gait characteristics and lower limb motor scores of stroke rehabilitation exercise assessment(STREAM), and provide standardized data for clinical evaluation and diagnosis of lower limb motor function in hemiplegic patients. Methods From May 2021 to June 2022, 21 patients with hemiplegia after stroke were set as stroke group,which included 12 males and 9 females, aged 14-77 years old with mean age of 49.29 years old;height was 153-181 cm with mean height of 168.90 cm;body mass was 53-94 kg with mean of 69.88 kg;9 patients with cerebral hemorrhage recovery and 12 with cerebral infarction recovery. At the same time, 21 volunteers were selected as healthy group, which included11 males and 10 females, aged 24-71 years old with mean age of 49.14 years old;height was 155-183 cm with mean height of167.67 cm;body mass was 48-80 kg with mean mass of 65.95 kg. The gait analysis system and movement disorder digital test platform were used to collect gait parameters of 2 groups. Then, those collected data were statistically analyzed and correlation between STREAM lower limb movement score and indicators of stroke group was analyzed. Results Compared with healthy group,the step length of stroke group was shorter(P<0.05), percentage of step width and touchdown time were greater(P<0.05), step speed was slower(P<0.05), and foot angle was significant better than that of healthy group, and the differences were statistically significant(P<0.05). There were no significant differences in proportions of plantar pressure at T area, M1 area and M2 area between 2 groups(P>0.05);In stroke group, the proportion of plantar pressure at MF area was significantly higher than that in healthy group( P<0. 05);the proportion of plantar pressure at HEEL area was statistically significantly lower than that in healthy group(P<0.05). The offset values of COP-X and COP-Y in stroke group were statistically significantly higher than those in healthy group(P<0.05), and peak hip flexion angle and peak knee flexion angle in stroke group were statistically significantly lower than those in healthy group(P<0.05). In stroke group,the score of lower limb movement of STREAM scale was(12.81 ±3.14) scores. Person correlation analysis showed that STREAM lower limb motor score was positively correlated with gait speed,step length, percentage of touchdown time, peak knee flexion angle and peak hip flexion angle(P<0.05), and negatively correlated with COP-X and COP-Y(P<0.05), while it had no correlation with step angle and step width(P>0.05). Conclusion It is demonstrated that compared with healthy person, the gait characteristics of stroke patients with hemiplegia showed significant changes. The main manifestations are decreased weight-bearing at heel, increased weight-bearing at lateral margin, poor balance,insufficient flexion of hip and knee at affected side, and decreased walking ability. Some indexes of gait analysis have significant correlation with STREAM lower limb motor score, which could be used as important quantitative analysis indexes to evaluate the walking ability of stroke patients with hemiplegia.