减重平板训练对早期脑卒中患者下肢运动力矩峰值的影响  

The effects of body-weight-supported treadmill training on peak moment of lower limb in early stage of stroke

作　　者：毛玉珞[1] 李乐[1] 肖湘[1] 丁明晖[1] 赵江莉[1] 黄东锋[1] 

机构地区：[1]中山大学附属第一医院康复医学科运动重建实验室,广州510080

出　　处：《中华物理医学与康复杂志》2013年第1期21-24,共4页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：国家自然科学基金资助项目（30973165）

摘　　要：目的观察减重平板步行训练对早期脑卒中偏瘫患者下肢动力学的影响。方法选取首次发病且病程〈3个月内的脑卒中偏瘫患者27例，采用随机数字表法将其分为治疗组（15例）及对照组（12例）。2组患者均给予神经内科常规处理，对照组在上述基础上辅以地面步行训练，治疗组则将地面步行训练改为减重平板训练，平板运动速度从起始阶段0．22m／s逐渐增加至0．60～0．80m／s，减重量不超过体重的30％水平，减重平板训练时间从起始阶段的5rain逐渐增加至20～40min。于治疗前、治疗3周后采用AMT测力板及ViconNexus三维摄像系统对人选患者进行动态力学检测（检测指标包括患侧下肢力矩峰值、地面反作用力等），同时选用简化Fugl—Meyer量表评定2组患者下肢运动功能变化情况。结果治疗后治疗组FMA评分[（27．18±2．64）分]及对照组FMA评分[（25．64±4．67）分]均较治疗前明显改善（均P〈0．05）；治疗组经治疗后其地面反作用力[（10．764-1．11）％]较治疗前[（10．08±1．84）％]明显改善（P〈0．05），对照组则无显著变化（P〉0．05）。治疗后治疗组及对照组髋关节伸展力矩峰值[（0．44±0．40）Nm／kgVS（0．69±0．67）Nm／kg]、膝关节屈曲力矩峰值[（0．38±0．65）Nm／kgVS（0．53±0．55）Nm／kg]、踝关节背伸[（1．06±1．45）Nm／kgVS（0．61±0．46）Nm／kg]及跖屈力矩峰值[（0．39±0．60）Nm／kgVS（0．664-0．81）Nm／kg]组间差异均具有统计学意义（均P〈0．05）；此时治疗组、对照组远端和近端联合力矩峰值（包括屈曲和伸展）组间差异亦具有统计学意义（均P〈0．05）。结论减重平板步行训练能促进早期脑卒中患者下肢运动功能恢复，提高偏瘫侧下肢地面反作用力，增强患侧肢体负重能力及地面推进力，同时还能改善脑卒中偏瘫患者下肢异常运动模式。Objective To explore the outcome of body-weight-supported treadmill training on the kinetic da- ta of lower limb in early stage of stroke. Methods Twenty-seven hemiplegic stroke patients at early stage were re- cruited and randomized to an experimental group（ n = 15） and a control group （n = 12）. Both groups were adminis- tered with routine neurological interventions. In addition, the control group was treated with conventional physiothera- py and over-ground walking training, while the experimental group was treated with body-weight-supported treadmill training. The speed of the treadmill walking was started at 0.22 m/s and increased to 0.60 - 0.80 m/s gradually. The percentage of the body-weight being supported was not more than 30% , the training time was 5 min per session at the beginning and was increased gradually to 20 - 40 min. Kinetic parameters were measured by using two force plates （AMT） and six cameras capture system （Vicon Nexus） , and motor function was evaluated using Fugl-Meyer Assess- ment （FMA） at baseline and after three-week＇s therapy. Peak moment of lower limb joints, ground reaction force and motor function were analyzed. Results FMA scores were significantly improved （P 〈 O. 05 ） in both groups after treat- ment, but there was no significant differences （P 〈 0.05） between the two group. Ground reaction force was signifi- cantly increased （ P 〈 0.05 ） after treatment in the experiment group, but not in control group （ P 〉 0.05 ）. It showed that the hip extension moment at the affected side was significantly lower （P 〈 0.05） in experiment group than in the control group, the ankle joint flexion and extension moment peak were improved to a significantly larger extend in the experimental group （P 〈 0.05） than in the control group. In addition, the peak flexion and extension moment of the hip-knee joint and peak flexion and extension moment of the knee-ankle joint were also significantly different from those of the control group （P 〈

关 键 词：脑卒中 减重平板步行 力矩 运动功能 

分 类 号：R744.4[医药卫生—神经病学与精神病学]