综合视听觉训练改善帕金森病患者足底压力分布

Effects of Visual and Auditory Cues on Static and Dynamic Plantar Pressure Pattern in Parkinson's Disease

【目的】探讨帕金森病(PD)患者足底压力分布特点及综合视听觉训练对足底压力的影响。【方法】选择原发性帕金森病患者25例(Hoehn and Yahr分级1.5-3级),其中男性15例,女性10例,平均年龄(62±11)岁。每位受试者在综合视听觉训练前、训练1周后、训练3月后分别进行静态和动态足底压力的测定,统计分析其特点及训练前后的变化情况。【结果】双侧静态足底压力训练前排序为:8区>7区>4区>5区>3区>6区>1区>2区,训练1周后及3月后变化为:8区>7区>4区>5区>6区>3区>1区>2区,且症状较重侧拇趾部及第5中足骨部压力显著下降,身体重心向后调整,症状较重侧足中心漂移范围显著减小(P<0.05);动态足底压力测定中,训练前症状较重侧足跟着地期占支撑期0.3%,训练1周后及3月后分别上升为2.2%和5.8%,即患者步行状态下重心后移,足跟着地期在整个步行周期中所占比例显著提高(P<0.05)。【结论】帕金森病患者足底压力分布特点为重心前移且两侧漂移范围大,行走时足跟着地不明显。综合视听觉训练可改善患者静态及动态足底压力分布,使重心稳定且后移,强化了步行中足跟落地,对于患者步行能力的改善有重要意义。

[Objective] To explore the characteristics of plantar pressure distribution in Parkinson Disease （PD） patients and potential effect of visual and auditory cues on static and dynamic plantar pressure. [Methods] Gaitview was used to collect the static and dynamic plantar pressure of 25 PD patients （Hoehn and Yahr： 1.5-3） ： 15 males and 10 females with average age of 62 ＋ 11, before, at 1-week and 3-month follow-up of the rehabilitation program based on visual and auditory cues. The characteristics of the pressure distribution and the changes at different time points were investigated and analyzed. [ Results ] For bilateral static assessment before the training, the plantar pressure ranked as Zone 8〉Zone 7〉Zone 4〉Zone 5〉Zone 3〉Zone 6〉Zone l〉Zone 2. However, a significant declines of hallux and the fifth metatarsal bone pressure of the severe side, together with the dynamic range of the severe side were found at 1-week and 3-month follow-up as Zone 8〉Zone 3 〉Zone 4〉Zone 5 〉Zone 6〉Zone 3 〉Zone 1 〉Zone 2 （P 〈 0.05 ）. For dynamic assessment, there was also a significant increase in posterior distribution and the percent of heel-strike phrase of affected limb increased to 2.2% and 5.8% at 1-week and 3-month compared with 0.3% before the training（P 〈 0.05）. [Conclusion] The parkinson disease leads to forward shift of center of gravity, increased drift area and loss of foot strike phrase. The visual and auditory cues provide significant improvements in static and dynamic pressure distribution, drift of center of gravity and foot strike phrase of walking.