足底压力分析在帕金森病患者运动训练中的应用

Plantar pressure measurement in patients with Parkinson's disease and targeted rehabilitation protocols

目的:通过研究帕金森病患者的静态和动态足底压力,客观分析帕金森病患者的足底压力分布特点和步态特点,进而针对性地提出康复治疗建议。方法:收集帕金森病患者30例,正常对照30例。每位受试者测定静态和动态足底压力,考量站立和行走过程中足底8区的压力分配和动态变化。结果:静态足底压力测定中,帕金森病组双足较正常对照组5区(第5跖骨部)压力明显增高(帕金森病患者足底5区压力分别为左侧(40.39±22.44)k Pa,右侧(30.40±13.12)k Pa;正常对照组分别为左侧(21.58±10.37)k Pa,右侧(20.77±9.08)k Pa,P<0.05),各区压力排位中帕金森病患者相比于正常对照组,第5跖骨(5区)、足掌中部(6区,即中足部)压力较第1跖骨(3区)靠前,表明患者重心更向两侧分散。步行过程中,帕金森病患者左足5区较3区排位靠前;脚跟着地时间明显缩短或缺乏足跟落地过程[帕金森病组脚跟着地时间占整个同侧足着地时间百分比左侧(0.82±2.03)%,右侧(1.62±3.15)%;正常对照组分别为左侧(4.80±2.94)%,右侧(6.31±6.25)%。P左侧=0.008,P右侧=0.02]。结论:帕金森病患者站立时重心不稳,向两侧漂移增大;行走时重心前倾缺乏足跟着地动作,促进了"慌张步态";步态训练中需要强调后跟先落地,克服重心前倾,进而从根本上改善"慌张步态"。足底压力测定有利于患者更直观理解自己的问题所在,便于医生定量分析患者步态障碍的特点和程度,进而针对性地制定康复训练计划并定量评定治疗效果,具有良好的临床应用价值。

Objective： To analyze the characteristics of plantar pressure distribution and gait pattern in patients with Parkin- son＇s disease （PD） by static and dynamic plantar pressures assessments, and to guide targeted rehabilitation strat- egies. Method： Thirty PD patients were recruited. In addition, 30 sex and age-matched health controls were also in- cluded. The plantar pressure distribution associated with standing balance and dynamic support in 8 zones of the foot were measured. Result： During static assessments, the bilateral plantar pressures of the fifth metatarsal bone pressure （Zone 5） were significantly higher in PD group compared with that in control group （the left side pressure of Zone 5, （40.39±22.44）kPa vs. （21.58±10.37）kPa; the right side pressure of Zone 5, （30.40±13.12）kPa vs. （20.77±9.08） kPa, P〈0.05）. Compared with control group, the PD group showed the fifth metatarsal bone pressure （Zone 5） and the middle plantar pressure （Zone 6） ranked higher than the first metatarsal bone pressure （Zone 3）. For dynamic assessments, PD patients showed the pressure of Zone 5 ranked higher than that of Zone 3 on the left foot compared with control group; heel-strike duration percentage （defined by the percentage of heel-strike phase in the whole foot-strike phase） significantly decreased in PD group than that in control group [the left side （0.82±2.03）% vs. （4.80±2.94）%, P=0.008 and the right side （1.62±3.15）% vs. （6.31±6.25）%, P=0.02]. Conclusion： PD patients tend to increase instability of the center of gravity and drift area; forward shift the center of gravity, loss of foot strike phase and aggravate the festinating gait and the risk of falling. Therefore, enhancement of heel-first strike pattern could facilitate gravity control substantially and improve the festinating gait. Plantar pressure information is essential for intuitivly understanding the patient＇s gait problems and providing targeted PD patient＇s rehabilitation strategies.