姿势控制训练对脑卒中偏瘫患者足底压力、平衡功能和步行功能改善的影响

Effects of postural control training on plantar pressure,balance function and walking improvement in patients with cerebral stroke complicated by hemiplegia

目的观察姿势控制训练对脑卒中偏瘫患者足底压力、平衡功能及步行改善的影响。方法选取脑卒中偏瘫患者120例,随机分为研究组和对照组,每组60例。对照组接受常规康复治疗,研究组在对照组基础上进行姿势控制训练。2组均接受20次康复治疗,每周3次,每次90 min。比较2组患者治疗后足底压力,平衡功能以及治疗前后步行功能。结果治疗后,研究组患者健足前半足和后半足峰值压力显著低于对照组[前半足:(158.52±56.71)N、(218.83±73.35)N,t=5.04,P<0.05;后半足:(257.36±85.45)N、(311.47±97.33)N,t=3.24,P<0.05],患足前半足和后半足峰值压力显著低于对照组[前半足:(85.35±37.62)N、(133.49±66.23)N,t=4.90,P<0.05;后半足:(159.84±59.16)N、(186.52±74.37)N,t=2.17,P<0.05];研究组健足前半足和后半足平均压力显著低于对照组[前半足:(54.13±14.58)%、(73.57±18.25)%,t=6.45,P<0.05;后半足:(67.46±17.36)%、(88.75±20.87)%,t=6.07,P<0.05],患足前半足和后半足平均压力显著高于对照组[前半足:(49.51±16.98)%、(37.72±20.34)%,t=3.45,P<0.05;后半足:(53.37±12.38)%、(44.63±15.47)%,t=3.42,P<0.05]。研究组PASS显著高于对照组[(33.9±2.6)分、(31.2±2.7)分,t=5.58,P<0.05],压力中心偏移的椭圆轨迹长度显著低于对照组[(160.5±65.5)mm、(241.2±71.3)mm,t=6.46,P<0.05],包络椭圆面积显著低于对照组[(169.5±34.5)mm^2、(184.3±42.7)mm^2,t=2.09,P<0.05],比值显著低于对照组[(0.9±0.2)、(1.3±0.2),t=10.95,P<0.05]。2组患者治疗后TUGT均显著降低[研究组:(20.6±4.5)s、(14.7±3.4)s,对照组:(21.8±3.7)s、(18.3±4.2)s,t值分别为6.27,1.08,P<0.05],且研究组TUGT显著低于对照组(t=5.16,P<0.05)。2组患者治疗后的6 min步行测试分值均显著升高[研究组:(216.98±99.99)m、(291.76±96.70)m,对照组:(207.53±114.06)m、(241.84±90.29)m,t值分别为3.95,2.34,P<0.05];且研究组显著高于对照组(t=2.92,P<0.05)。结论姿势控制训练可显著提高脑卒中偏瘫患者的平衡及步行功能。

Objective To observe the effects of postural control training on plantar pressure,balance function and walking improvement in patients with cerebral stroke complicated by hemiplegia. Methods A total of 120 patients with cerebral stroke complicated by hemiplegia were randomly divided into observation group and control group,with 60 patients in each group. The patients in control group were treated by conventional rehabilitation therapy,however,the patients in observation group,on the basis of control group,were treated by postural control training,90 min once,three times a week,a total of 20 times treament for both groups. Then the foot sole pressure,balance function and walking function were observed and compared between two groups. Results After treatment,the peak pressure of front half foot and back half foot in unaffected side in observation group was significantly lower than that in control group[front half foot：（ 158. 52 ± 56. 71） N vs（ 218. 83 ± 73. 35） N,P 0. 05： back half foot：（ 257. 36 ± 85. 45） N vs（ 311. 47 ± 97. 33） N,P 0. 05]. The peak pressure of front half foot and back half foot in affected side in observation group was significantly lower than that in control group[front half foot：（ 85. 35 ± 37. 62） N vs（ 133. 49 ± 66. 23） N,P 0. 05; back half foot：（ 159. 84 ± 59. 16） N vs（ 186. 52 ± 74. 37） N,P 0. 05]. Moreover the average pressure of the front half foot and back half foot in unaffected side in observation group was significantly lower than that in control group[front half foot：（ 54. 13 ± 14. 58） % vs（ 73. 57 ± 18. 25） %,P 0. 05; back half foot：（ 67. 46 ± 17. 36） % vs（ 88. 75 ± 20. 87） %,P 0. 05]. However the average pressure of the front half foot and back half foot of in affected side in observation group was significantly higher than that in control group[front half foot：（ 49. 51 ± 16. 98） % vs（ 37. 72 ± 20. 34） %,P 0. 05; back half foot：（ 53. 37 ± 12. 38） % vs（ 44. 63 ± 15. 47） %,P 0. 05]. In addition the PASS scores in observation group were significantly higher than those in control group[（ 33. 9 ± 2. 6） vs（ 31. 2 ± 2. 7）,P 0. 05],but the elliptic trajectory length in observation group was significantly shorter than that in control group[（ 160. 5 ± 65. 5） mm vs（ 241. 2 ± 71. 3） mm,P 0. 05 ],and the elliptical area in observation group was significantly less than that in control group [（ 169. 5 ± 34. 5） mm^2 vs（ 184. 3 ± 42. 7） mm^2,P 0. 05]. The ratio of elliptic trajectory length/elliptical area in observation group was significantly lower than that in control group[（ 0. 9 ± 0. 2） vs（ 1. 3 ± 0. 2）,P 0. 05]. The TUGT was decreased significantly in both groups[observation group：（ 20. 6 ± 4. 5） s vs（ 14. 7 ± 3. 4） s,control group：（ 21. 8 ± 3. 7） s vs（ 18. 3 ± 4. 2） s,P 0. 05],moreover,which in observation group was significantly lower than that in control group（ P 〈0. 05）. Besides the 6-minute walk test scores were increased significantly in both groups[observation group：（ 216. 98 ± 99. 99） m vs（ 291. 76 ± 96. 70） m,control group：（ 207. 53 ± 114. 06） m vs（ 241. 84 ± 90. 29） m,P 0. 05],moreover,which in observation group were significantly higher than those in control group（ P 〈0. 05）. Conclusion The postural control training can obviously improve balance function and walking function in patients with cerebral stroke complicated by hemiplegia.