两阶段康复训练方法促进脑卒中偏瘫患者步行能力的恢复

Two-stage rehabilitative training in the recovery of walking ability in stroke patients with hemiplegia

目的:探讨两阶段康复训练(早期基础康复+减重步行训练)对脑梗死患者步行能力和日常生活活动能力恢复的影响。方法:脑梗死患者为1999-02/2002-12湛江中心人民医院收治,共68例,按患者意愿分为康复组和对照组各34例。对照组患者在神经内科药物治疗的基础上,由家属进行被动运动和日常生活能力训练。康复组患者进行两段康复训练:第1阶段在药物治疗基础上,接受早期基础康复训练,包括体位训练、按摩和被动运动、关节活动和坐位平衡训练;当患者恢复部分坐位、站位平衡后进行第2阶段减重步行训练,包括减重坐位平衡、减重站立及减重平板步行训练。采用功能性步行量表评估患者的步行能力(0～Ⅳ级,评级越高,步行能力越好),采用Barthel指数(共10项,每项10分,评分越高,日常生活自理能力越强)评定患者日常生活能力。首次评定在发病1周病情稳定后进行,再次评定于治疗后10周进行。结果:按意向处理分析,68例患者均进入结果分析。①功能性步行量表分级:康复组治疗前0级6例,I级11例,Ⅱ级9例,Ⅲ级5例,Ⅳ级3例;治疗后I级2例,Ⅱ级3例,Ⅲ级10例,Ⅳ级10例,Ⅴ级9例。对照组治疗前0级6例,I级9例,Ⅱ级10例,Ⅲ级5例,Ⅳ级4例;治疗后0级1例,I级7例,Ⅱ级8例,Ⅲ级13例,Ⅳ级5例。康复组治疗后步行能力较治疗前显著提高(P<0.05),对照组治疗前后无差异(P>0.05)。②Barthel指数:康复组治疗后评分较治疗前显著提高(P<0.05),对照组治疗前后无差异(P>0.05)。结论:第1阶段早期康复训练,促进了患肢和躯干的肌力及运动功能的恢复,第2阶段减重步行训练,将步行中负重、迈步、平衡三要素有机结合起来,促进了正常步态模式的建立,从而有利于行走功能的恢复。

AIM:To investigate the effects of twostage rehabilitative training(early basic rehabilitation+weightsupported walking training) on the recovery of walking ability and the activities of daily life in patients with cerebral infarction. METHODS:Sixtyeight patients with cerebral infarction,who were treated in Zhanjiang Central People's Hospital between February 1999 and December 2002,were willingly divided into rehabilitation group(n=34) and control group(n=34).In the control group,patients received trainings of passive exercise and activities of daily life on the basis of neurological drug therapy; In the rehabilitation group,the twostage rehabilitative training was given: For the first stage, based on drug therapy,the patients received early basic rehabilitative training,including posture training,massage and passive exercise, joint motion and balance training of sitting position;When the balance of sitting and standing positions was partly recovered, the patients received the weightsupported walking training for the second stage,including trainings of weightsupported sitting balance,weightsupported standing and weightsupported treadmill training.The walking ability of the patients was assessed with functional walking scale(0 to Ⅳgrades;The higher the grade,the better the walking ability);The activities of daily life of the patients were evaluated with Barthel index(10 items,10 points for each item;The higher the scores,the better their selfcare ability of daily life).They were firstly assessed when the disease condition was steady (1 week after the attack),and reexamined 10 weeks after treatment.RESULTS:According to intentiontotreat analysis,all the 68 patients were involved in the analysis of results.①Grading of functional walking scale: In the rehabilitation group,grade 0 was in 6 cases,grade I in 11 cases,grade Ⅱin 9 cases,grade Ⅲin 5 cases and grade Ⅳin 3 cases before treatment; And grade I was in 2 cases, grade Ⅱin 3 cases,grade Ⅲin 10 cases and grade Ⅳin 10 cases after treatment; In the control group,grade 0 was in 6 cases, grade I in 9 cases,grade Ⅱin 10 cases,grade Ⅲin 5 cases and grade Ⅳin 4 cases before treatment,and grade 0 was in 1 case,grade I in 7 cases,grade Ⅱin 8 cases,grade Ⅲin 13 cases and grade Ⅳin 5 cases after treatment.Compared with before treatment,the walking ability after treatment was significantly improved in the rehabilitation group(P< 0.05),but had no changes in the control group(P >0.05).CONCLUSION:The early rehabilitative training in the first stage accelerates the muscle power of the affected limb and trunk,and the recovery of motor function;The weightsupported walking training in the second stage organically combines the 3 factors of loading,stepping forward and balance,and it promote the establishment of normal gait mode,so that it is good for the recovery of walking function.