基于可穿戴式步行引导仪的可视化步行训练对帕金森病冻结步态患者步行能力的影响

The effect of a visual walking training based on wearable walking guide devices on the walking ability of Parkinson's disease patients with freezing of gait

目的:探讨基于可穿戴式步行引导仪的可视化步行训练对帕金森病冻结步态患者步行能力的影响。方法:选取23例帕金森病冻结步态患者为试验组,同时选取20例性别、年龄等匹配的健康者为对照组。试验组给予利用可穿戴式步行引导仪的可视化步行训练,20min/次,2次/日,训练1周。利用Vicon三维步态分析系统收集试验组训练前后和对照组时空参数、非优势侧及优势侧运动学参数、非优势侧及优势侧地面反作用力参数(包括前-后侧峰值、内-外侧峰值及纵向第一峰值)。结果:(1)训练后,试验组患者步速及双侧步长均明显增加,步频、双支撑期明显减小,与训练前相比,差异均有显著性意义(P<0.05);训练后,试验组患者优势侧步长、步频及双支撑期与对照组比较,差异均无显著性意义(P>0.05)。(2)训练后,试验组患者双侧髋关节着地角度、踝背屈及跖屈最大角度及下肢关节活动范围均明显增加,膝关节着地角度减小,踝关节第一峰值出现的阶段延迟,与训练前相比,差异均有显著性意义(P<0.05);训练后,试验组患者双侧(膝关节着地角度、踝背屈最大角度、踝关节第一峰值出现阶段、下肢关节活动范围)和优势侧(髋关节着地角度、踝跖屈最大角度)与对照组比较,差异均无显著性意义(P>0.05)。(3)干预后,试验组患者双侧地面反作用力前-后侧峰值及纵向第一峰值明显提高,地面反作用力内-外侧峰值明显下降,差异均有显著性意义(P<0.05)。与对照组相比,非优势侧后侧峰值、内侧峰值及优势侧各项参数均无显著性差异(P>0.05)。结论:基于可穿戴式步行引导仪的可视化步行训练可有效提高帕金森病冻结步态患者步行平衡稳定性及步伐连贯性。

Objective:To investigate the effect of a visual walking training based on wearable cueing devices on ground reaction force of Parkinson's disease patients with freezing of gait.Method:Twenty-three PD with FOG(PD+FOG)were selected and twenty healthy controls(HC)were tested in gait laboratory.The experimental group was trained with wearable walking guide devices for 20 minutes,twice a day for one week.The Vicon 3D gait analysis system was used to collect the spatiotemporal parameters and the ground reaction force parameters of the non-dominant side and the dominant side including frontback peak,medial-lateral peak and the first vertical peak of the experimental group and the control group before and after training.Result:①After the intervention,the bilateral step length and velocity of patients in the experimental group increased significantly(P<0.05),while cadence,double stance phase decreased significantly(P<0.05).After training,there was no significant difference in the dominant step length,cadence and double stance phase between experimental group and control group(P>0.05).②After the training,bilateral parameters(landing angles of hip joints,the maximum angles of ankle dorsiflexion and plantar flexion,and the ranges of motion of lower limb joints)in the experimental group increased significantly,while the landing angles of knee joints decreased,and the stage of the first peak of ankle joints was delayed,with statistical significance(P<0.05).After the training,knee joint landing angle,maximum ankle dorsiflexion angle,the first peak stage of ankle joint,lower limb joint range of motion had no significant difference between the experimental group and the control group in both sides(P>0.05).③After the intervention,the front-back peak value and the first vertical peak of the bilateral ground reaction force in the experimental group were significantly increased(P<0.05),while the medial-lateral peak value of the ground reaction force was significantly decreased(P<0.05).Compared with the control group,there was no significant difference in the backward peak,medial peak of non-dominant side and parameters of the dominant side(P>0.05).Conclusion:The visual walking training based on wearable walking guide devices improve the stability and consistency of gait of PD+FOG.