脑卒中偏瘫患者行走时足底压力特征的初步观察

An investigation of the plantar pressure during walking in hemiplegic patients with stroke

目的:研究脑卒中后偏瘫患者常速行走时的足底压力特点。方法:选取21例能独立行走的脑卒中慢性期偏瘫患者,17例健康中老年人,测量并分析其常速行走时双足的最大压力、冲量、支撑时间、着地、离地顺序等。结果:1最大压力、冲量:患者健侧中足及足跟、第2—5趾的压力较健康人大(P<0.05),第1趾压力较健康人小(P<0.05);患侧中足及足跟压力较健康人大(P<0.05),前足内侧、第1趾和第2—5趾压力较健康人小(P<0.05)。患者健患侧中足及足跟的冲量较健康人大(P<0.05),前足内侧冲量较健康人小(P<0.05)。患者健侧与患侧各区的足底压力、冲量差异无显著性(P>0.05)。2支撑相时间:患者健患侧足趾、中足及足跟的支撑时间较健康人延长(P<0.05),患者健侧与患侧的支撑时间无差异(P>0.05)。3着地和离地顺序:健康人表现为从足跟、中足至足趾的连续推进过程,脑卒中患者则无统一规律。4脑卒中偏瘫患者足底压力曲线形态异常。结论:慢性脑卒中偏瘫患者的健侧与患侧足底压力特征相同,前足的压力及冲量小于健康人,中足及足跟的压力及冲量大于健康人。慢性脑卒中偏瘫患者前足、中足及足跟的支撑时间较健康人增加。足的着地、离地顺序差异较大,无统一规律。足底压力曲线形态不规则。

Objective： To study the characteristics of plantar pressure during walking under preferred speed in hemiplegic stroke patients. Method： Twenty one chronic hemiplegic stroke patients who were able to walk without extra aid, and 17 healthy old men were asked to walk with their preferred speed. Outcome measures included the maximum plantar pressure, impulse, contact time, contact patterns of both feet. Result： （1）Maximum force, impulse： The maximum force of the midfoot and heel, toe Ⅱ-Ⅴ on the unaffected side of the patients were greater than that on the health group, while the toe I on the unaffected side of the patients were lower（both P〈0.05）. The maximum force of the affected midtbot and heel were greater, and that of the medial part of forefoot, toe Ⅰ, toe Ⅱ-Ⅴ were lower than the that of health group（P〈0.05）. The bilateral impulse of midfoot and heel in patients were greater and the bilateral medial part of forefoot were lower than that in health old men（P〈0.05）. The maximum force and impulse of the affected and unaffected sides in patients showed no significant difference. （2）Contact time： patients had longer contact time of toes and heel of both feet compared with the health old men（P〈0.05）. （3）Contact pattern： The foot contact pattern of hemiplegic stroke patients was irregular compared with the normal pattern in the health control group.（4）The hemiplegic patients had pathological GFR patterns.Conclusion： The plantar pressure of affected and unaffected foot during walking in chronic hemiplegic stroke patients was similar. Patients＇ maximum force and impulse of their forefoot were less than those in the healthy, and maximum force and impulse on the midfoot and heel of both sides were larger than those in the healthy. Patients had prolonged contact time on forefoot and heel; and had irregular foot contact pattern and abnormal ground reaction force pattems.