早期康复对缺血性脑卒中患者足底压力分布的影响

Effects of early rehabilitation on plantar pressure distribution of ischemic stroke patients

目的:观察早期康复对缺血性脑卒中患者足底压力分布的影响,以探讨缺血性脑卒中患者的康复方法和技术。方法:选择15例缺血性脑卒中患者。所有患者均在常规药物治疗的基础上给予康复治疗,内容包括:早期康复程序、肌肉控制能力训练、平衡训练和步态训练等。分别于治疗前24h及治疗后1个月采用Zebris测力板测试足底10个区域(大拇趾、第2—5脚趾、第1—5跖骨、足中部、足跟外侧、足跟内侧)压力峰值的变化,采用Fugl-Meyer下肢运动功能评分量表、Berg平衡量表、修订Barthel指数评分量表评定运动功能。结果:①足底各区域压力平均峰值:治疗后患足各区域压力均有上升,与治疗前比较,以第1跖骨、第3跖骨、足中部和足跟内侧压力上升尤为明显,差异有显著性意义(P<0.01);治疗后健足压力峰值依次出现在足跟内侧、足中部、足跟外侧,其次是第一跖骨,较治疗前压力均有所下降,其中以足跟中部和足跟内侧压力下降明显,差异有显著性意义(P<0.05)。②平衡参数:患者治疗后压力中心轨迹总长度短于治疗之前,治疗前后差异有显著性意义(P=0.05);包络椭圆面积,治疗后数值小于治疗之前,治疗前后差异有显著性意义(P=0.01);压力中心轨迹总长度与包络椭圆面积之比,治疗前比值为2.5±0.4,治疗后比值为0.9±0.2,差异有显著性意义(P<0.01)。③功能评分:治疗后患者下肢运动功能、平衡功能、日常生活活动能力评分均明显提高,差异有显著性意义(P<0.01)。结论:早期康复治疗可明显改善缺血性脑卒中患者的下肢功能和足底压力分布;足底压力测量能为缺血性脑卒中康复治疗提供参考方案。

Objective： To observe the effects of early rehabilitation on plantar pressure distribution of ischemic stroke patients and explore a better method and technique of rehabilitation for ischemic stroke patients. Method： Fifteen ischemic stroke patients were selected. All patients were treated with rountine medicine and rehabilitation therapy. The rehabilitation therapy was started after 48 hours＇ steady of neural syndrome and vital sign, and mainly included early rehabilitation programme,training of muscle controlling ability, balance training and gait exercitation. Before and 1 month after rehabilitation therapy, Zebris force platform was used to measure the variation of the pressure peak values of 10 areas（GT,2-5LT,1MTH, 2MTH,3MTH,4MTH,5MTH, MF, MH,LH）.Meanwhile, Fugl-Meyer assessment（FMA）, Berg balance scale（BBS） and modified Barthel index（MBI） were used to evaluate patients＇ motor function. Result： ①The plantar pressure of hemiplegic side increased after treatment, compared with before treatment and the pressures of the first, third metatarsal bone,midfoot,and medial heel were significantly larger, there were significant differences（P〈0.01）. Compared with before treatment after treatment the peak values of pressure of unaffected side decreased significantly and orderly from medial heel to midfoot,lateral heel and the first metatarsal, in which the peak values of pressure of midheel and medial heel decreased obviously, there were significant differences（P〈0.05）.②After treatment total track lengths of center of force（COF） were significantly shorter than before treatment（P=0.05）; meanwhile ellipse areas of envelopments were smaller, compared with before treatment,there were a significant differences（P=0.01）;the ratio of total track lengths of COF and ellipse areas of envelopments before treatment was 2.5±0.4,while it was 0.9±0.2 after treatment, there was significant difference （P〈0.01）. ③The scores of MFA,BBS,MBI improved obviously after treatment, there were significant differences between before and after treatment（P〈0.01）. Conclusion： Early rehabilitation therapy could significantly improve lower extremity function and plantar pressure distribution of ischemia stroke patients; Plantar pressure measurement could provide a reference for rehabilitation therapy in ischemia stroke patients.