感觉整合模式对偏瘫患者维持平衡的作用

Effects of sensory integration mode on balance ability of patients with hemiplegia

目的:为探讨感觉整合模式变化对平衡功能的影响,本研究测量了偏瘫患者治疗前后稳定性及平衡觉三要素的参与比例。方法:符合站立条件的偏瘫患者(54.22±8.63岁)40例,利用Pro-Kine Line 254P动静态平衡仪在训练前后分别记录平板睁眼(T1)、平板闭眼(T2)、海绵睁眼(T3)、海绵闭眼(T4)四种状态下的相关指标,分析视觉、本体觉及前庭觉的变化及对平衡的影响。结果:T1状态时,移动轨迹长(Len=202.88±52.32mm)和平均移动速度(Sv=6.76±1.75mm/s)较训练前更稳定有差异(P<0.05),其他指标无差异;T2时,移动轨迹长(Len=10.45±5.66mm)较训练前更稳定有差异(P<0.05),其他指标无差异;T3时,移动轨迹长(Len=430.62±159.38mm)、运动椭圆面积(Area=430.59±318.45mm2)、平均移动速度(Sv=14.35±5.31mm/s)较训练前更稳定有差异(P<0.05);T4时,站立时间(time=28.07±5.08s)较训练前更长有差异(P<0.05),其他指标无差异。训练前视觉、本体觉、前庭觉的参与比例为31.59%、31.39%、61.05%;训练后视觉、本体觉、前庭觉的参与比例为26.11%、34.59%、58.84%。结论:不同阶段的视觉反馈训练可以有效地提高偏瘫患者的平衡能力;训练前视觉代偿对人体维持平衡有重要作用;训练后视觉参与比例下降,本体觉参与比例上升,提示康复训练可以改变平衡感觉整合模式,改善平衡功能,因此可将本体觉与视觉参与比例变化作为监测指标,以指导偏瘫患者康复训练。

Objective： In order to explore the effect of sensory integration on balance function for hemiplegic patients, we valued the stability and the participation ratio for three elements in equilibrium sense before and after rehabilita- tion training. Method： Forty patients with hemiplegia （54.22y±8.63y） who met the inclusion criteria were enrolled in this study. To analyze the balance function under the change of the vision, the proprioceptive sense or the vestibu- lar sensation, we recorded some related indicators at the condition of Tl（standing on the plat with eyes open）, T2（standing on the plat with eyes closed）,T3（standing on the sponge with eyes open）or T4（standing on the sponge with eyes closed）using static balance test and training equipment （Pro-Kine Line 254p） before and after rehabilitation training . Result： At condition T1, the length of moving track （Len=202.88±52.32mm） and average moving speed （Sv= 6.76±1.75mm/s） have statistical significance as compared with those before training, while no statistical signifi- cance for other indicators. As for T2, the length of moving track （Len=10.45±5.66mm） has significant differ- ence in comparison with that before training （P〈 0.05）. At condition T3, the length of moving track （Len=430.62±59.38mm）, motion ellipse area （Area=430.59±318.45mm^2） and Sv （14.35±5.31mm/s） have significant dif- ference as compared with those before training （P〈 0.05）. At condition T4, the standing time （time=28.07± 5.08s） has significant difference as compared with those before training （P 〈 0.05）. Before training, the participa- tion proportion of vision, proprioceptive sense and vestibular sensation are 31,59%, 31.39%,61.05% ,respective- ly. Meanwhile, after training,participation proportion are 26.11%, 34.59%, 58.84%, respectively Conclusion： Visual feedback at different stage is able to improve the ability of balance effectively. Before training, the visual compensation plays an important role in the balance function. After rehabilitation, there is the increased participation ratio of proprioceptive sense with the decreased participation ratio of visual function, suggesting that rehabilitation training can modify sensory integration mode. We come to the conclusion that the participation ratio of visual function and proprioceptive sense could be the index to monitor the rehabilitation training for hemiplegic patients.