脑卒中患者姿势控制的感觉系统特征

Sensory System Characteristics of Posture Control in Patients with Stroke

目的研究脑卒中患者姿势控制的感觉系统特征,分析各感受器对脑卒中患者姿势控制能力的贡献率和利用率。方法老年脑卒中患者30例(患者组)和健康老年人30例(对照组)采用计算机动态姿势描记系统进行感觉统合测试(sensory organization test,SOT),记录6种条件下的平衡得分、平衡综合分,计算分析视觉、本体感觉、前庭觉在不同站立条件下的贡献率与整体利用率。结果患者组在闭眼/支撑面稳定(Z=-3.248,P=0.001)、视觉干扰/支撑面稳定(Z=-2.829,P=0.005)、闭眼/支撑面不稳(Z=-4.283,P=0)、视觉干扰/支撑面不稳(Z=-4.074,P=0)条件下的平衡分显著低于对照组,平衡综合分显著低于对照组(Z=-4.133,P=0)。睁眼/支撑面稳定和闭眼/支撑面稳定测试中,患者组本体感觉占比分别为16.351%、34.942%,对照组本体感觉占比分别为14.307%、18.390%,患者组本体感觉占比始终大于对照组,说明本体感觉对患者组作用大于对照组。同理,视觉对患者组作用大于对照组。不同站立条件下前庭觉的贡献率最低为64.648%,说明维持人体平衡主要因素是前庭觉。患者组本体感觉、视觉、前庭觉的利用率分别为95.092%、72.382%、32.879%,其中本体感觉(Z=-1.984,P=0.047)、前庭觉(Z=-4.283,P=0)利用率显著低于对照组。结论脑卒中患者感觉系统的贡献率与利用率下降是脑卒中患者姿势控制障碍的重要因素之一,其中姿势控制贡献率前庭觉最大,其次为本体感觉、视觉。而其姿势控制利用率最大的为本体感觉,其次为视觉、前庭觉。影响脑卒中患者姿势控制能力下降的原因之一为脑卒中患者本体感觉、视觉的感觉信息输入效率下降,以及其本体感觉、前庭觉参与运动输出的部分降低。建议脑卒中患者注重本体感觉、前庭觉的训练以提高其姿势控制能力。

Objective To study the sensory system characteristics of posture control in stroke patients,and to analyze the contribution rate and utilization rate of each receptor to postural control ability of stroke patients.Methods Sensory organization tests(SOT)were conducted on 30 elderly stroke patients(patient group)and 30 healthy elderly patients(control group)with computer dynamic posture tracing system.The balance scores and balance comprehensive score were recorded under 6 conditions,and the contribution rate and overall utilization rate of vision,proprioception,and vestibular sense under different standing conditions were calculated and analyzed.Results The balance score of patient group was significantly lower than that of control group under the conditions of closed eyes/stable support surface(Z=-3.248,P=0.001),visual disturbance/stable support surface(Z=-2.829,P=0.005),closed eyes/unstable support surface(Z=-4.283,P=0),and visual disturbance/unstable support surface(Z=-4.074,P=0).The balance comprehensive score was significantly lower than that of the control group(Z=-4.133,P=0).In eyes-open/stable-support and eyes-closed/stablesupport tests,the proportion of proprioception in patient group was 16.351% and 34.942%,and 14.307% and 18.390% in control group.The proportion of proprioception in patient group was always greater than that in control group,indicating that proprioception had a greater effect in patient group than that in control group.Similarly,the effect of vision on patient group was greater than that on control group.The lowest contribution rate of vestibular sense under different standing conditions was 64.648%,indicating that the main factor to maintain balance of human body is vestibular sense.The utilization rates of proprioception,vision and vestibular sense in patient group were 95.092%,72.382%,and 32.879%,respectively.The utilization rate of proprioception(Z=-1.984,P=0.047)and vestibular sense(Z=-4.283,P=0)was significantly lower than that of the control group.Conclusions The decline in contribution and utilization of sensory system in stroke patients is one of the important factors for stroke patients with postural control disorders.Posture control contributes the most to vestibular sense,followed by proprioception and vision.The largest utilization rate of posture control is proprioception,followed by vision and vestibular sense.One of the reasons that affect the decline in posture control ability of stroke patients is the decline in the efficiency of proprioception and visual sensory information input of stroke patients,as well as the partial decrease in proprioception and vestibular sense participating in motor output.It is suggested that stroke patients should pay attention to the training of proprioception and vestibular sense to improve their posture control ability.