基于Bobath理念的步行训练在恢复期脑卒中患者中的应用  

Application of gait training based on Bobath concept framework in rehabilitation of stroke patients in convalescent phase

作　　者：王文威[1] 王路[1] 李凌晋[1] 石新棉[2] 林冠梁[1] 杜志伟[1] 曾祥城[1] 潘翠环[1] 

机构地区：[1]广州医学院第二附属医院康复科,510260 [2]河北以岭医院康复科

出　　处：《中国康复医学杂志》2012年第12期1124-1128,共5页Chinese Journal of Rehabilitation Medicine

摘　　要：目的:观察基于Bobath理念的步行训练对恢复期脑卒中患者的步行功能的疗效。方法:80例具有步行功能障碍的脑卒中恢复期患者随机分为Bobath组(n=40),对照组(n=40)。Bobath组接受一套基于Bobath理念理论框架下的步态训练法。对照组接受常规的步行训练。两组患者步行训练时间均为30min/d,5d/周,持续4周,其余康复治疗如作业疗法、物理因子治疗等两组均相同。两组患者分别于治疗前、治疗后及出院后3周予以FMA下肢(FMA-LE)运动功能评定、Berg平衡量表(BBS)进行评定,同时选用足印步态分析法测量患者的步行参数变化。结果:两组患者治疗后FMA-LE和BBS的评分均较治疗前提高,步行参数(平均步长、步宽及步速)得到改善,治疗前、后各量表的评分差异具有显著性(P<0.05);与对照组相比,Bobath组患者在各量表评分提高幅度更大(P<0.05)。两组患者在出院后3周再次评定时,组内比较各量表评分均较治疗后有所提高,但Bobath组内评分比较具有显著性(P<0.05),对照组内比较无显著性(P>0.05)。结论:对于步行功能障碍的脑卒中患者,采用基于Bobath理念的步行训练法可以更好的改善其步行功能,并且疗效具有持续性。Objective： To observe the effects of gait training based on Bobath concept framework intervening on walking ca- pability of stroke patients in convalescent phase. Method： Eighty subjects participated in this randomized single-blind study. Subjects in Bobath group （n=40） prac- ticed with gait training based on Bobath concept framework, and control group （n=40） performed conventional gait training. Program of gait training for both groups were 30 min per day, 5d per week for 4 weeks. Meanwhile, the other rehabilitation therapy programs （occupational therapy, physical modalities therapy） were the same for both group. Fugl-Meyer assessment of lower extremity （FMA-LE）, Berg balance scale（BBS）, and foot-print analysis were used as outcome measure pre-training, post-training and discharging from hospital after 3 weeks by two ap- pointed raters. Result： Compared with pre-training, both groups had significant improvement on FMA-LE （P〈0.05）, BBS （P〈 0.05）, and foot-print analysis （step length, stride width, walking velocity） （P〈0.05）. Compared with control group, gait training underlying Bobath concept framework group had significantly greater improvement on FMA-LE （P〈0.05）, BBS （P〈0.05）, and foot-print analysis （P〈0.05）. In addition, after discharging from hospital 3 weeks, there were also significant improvements in eaeh seales of patients in Bobath group（P〈0.05）, and less improvement in control group（P〉0.05）. Conclusion： Gait training based on Bobath coneept may be more advantageous for improving walking ability of stroke patients in convalescent phase, and the therapy effects may last much longer.

关 键 词：Bobath理念 脑卒中 核心稳定性 中枢模式发生器 

分 类 号：R743.3[医药卫生—神经病学与精神病学]