脑卒中偏瘫患者本体感觉训练对视觉代偿依赖的影响  

Influence of proprioceptive training of hemiplegic stroke patients on their visually- dependent compensatory strategy

作　　者：许志强[1] 武俊英[1] 吴亚文[1] 荣蓉[1] 原奎 

机构地区：[1]山西医科大学第一医院康复科,太原030001

出　　处：《中华物理医学与康复杂志》2013年第10期768-772,共5页Chinese Journal of Physical Medicine and Rehabilitation

摘　　要：目的探讨脑卒中偏瘫患者本体感觉训练对视觉代偿依赖的影响及其在立位平衡功能中的作用。方法对20例无前庭功能病变且具有10m步行能力的脑卒中偏瘫患者进行4周康复训练，并于入院时和训练4周对所有患者进行静态站立平衡测试。对重心左右偏移体重百分比（左右偏移）、重心前后偏移时间百分比（前后偏移）、重心分布（A％时间）进行训练前、后对比和睁、闭眼对比，采用t检验和多元线性回归分析进行统计学分析比较。结果视觉对前后偏移没有影响，同时训练前后经统计学分析比较，差异亦无统计学意义（P〉0．05）；视觉对左右偏移有影响（P〈0．05），同时睁眼状态的左右偏移在训练前后的差异有统计学意义（P〈0．05），在闭眼状态差异无统计学意义（P〉0．05）；视觉在训练前对重心分布的差异无统计学意义（P〉0．05），在训练后随着本体感觉功能改善，视觉对重心分布有影响（P〈0．05），且在睁、闭眼状态训练后与训练前比较，差异均有统计学意义（P〈0．05）。结论视觉代偿对具有步行能力但未经过训练的偏瘫患者的左右偏移有影响，但不能改善患者的重心摆动幅度，不利于患者步行；本体感觉训练可以改善立位平衡对视觉代偿的依赖，提高患者平衡功能。Objective To investigate the influence of proprioceptive training of hemiplegic stroke patients on their visually compensatory dependence. Methods Twenty stroke patients without vestibular abnormalities were recruited. They were able to walk for 10 meters. All the patients underwent 4 weeks of rehabilitation training including proprioceptive training, treadmill exercises and isometric muscle strengthening. Static standing balance test was performed before and after 4 weeks of treatment. The parameters such as the anteroposterior and mediolat- eral sway of the center of gravity, center of gravity distribution were analyzed before and after the treatment, taking into consideration of visual feedback （ eyes open or closed） by using t-test and multiple linear regression analysis. Results Visual feedback had significant no influence on the anteroposterior sway of center of gravity before and af- ter training （ P 〉 0.05 ） ; Visual feedback had significant influence on mediolateral sway of center of gravity. Reha- bilitation training significantly improved the mediolateral sway in opened-eye standing （P 〈 0.05 ） but not closed- eye standing （ P 〉 0.05 ）. Visual feedback played significant role in center of gravity distribution after training （ P 〈 0.05）. Conclusions Visual compensation is of significant influence on the mediolateral sway. Propriocep- tive training can help decrease the patient＇s dependence on visual feedback and enhance the patient＇s balance ability.

关 键 词：本体感觉 脑卒中 立位平衡 视觉依赖 

分 类 号：R743.3[医药卫生—神经病学与精神病学]