脑血管意外患者在不同认知负荷下步态的改变及平衡策略研究  

The rule of changes of gait parameters and cognition performance in different dual-tasks and walking balance strategy in CVA patients

作　　者：黎俊宇 彭康龙 艾青 李咏雪 张涛[1] 陈少贞[1] LI Junyu;PENG Kanglong;AI Qing(School of Basic Pharm acology,Sun Yat-sen University,Guangzhou,510080;不详)

机构地区：[1]中山大学附属第一医院康复医学科科,广州510080 [2]深圳市儿童医院康复科 [3]云南省第一人民医院康复科 [4]中山大学基础学院药理学系

出　　处：《中国康复医学杂志》2019年第12期1431-1437,共7页Chinese Journal of Rehabilitation Medicine

摘　　要：目的:研究老年脑血管意外(cerebrovascular accident,CVA)患者和健康老人在两种不同的"步行+认知"双重任务中,步行和认知任务之间的互相影响及双重任务消耗值,探讨两种人群注意力分配的优先规律及步态调整策略。方法:老年CVA患者和健康老人各30例,分别完成平地步行、连续减3、辨音应答和"步行+连续减3"(双重任务A)、"步行+辨音应答"(双重任务B),比较两者在双重任务中步态和认知任务的双重任务消耗值。结果:①在两种不同的双重任务下,CVA组仅步速和跨步长变小(P<0.01),步频未见明显改变(P>0.01),健康组步速、跨步长和步频均变小(P<0.01)。CVA组步速的双重任务消耗值(dual-task cost,DTC)与健康组相近(P>0.05),跨步长DTC则比健康组大(P<0.01)。两组受试在双重任务A中步行的DTC比在双重任务B中的大。②在双重任务下,不管认知负荷如何,两组受试均表现出认知表现准确率下降(P<0.01),组间没有显著性差异(P>0.05)。③在两种双重任务中,两组受试步速DTC较认知任务DTC大(P<0.01)。结论:①CVA患者步态控制比正常老年人更依赖于注意力的参与。认知任务对步行产生注意力抽离现象,认知任务负荷较重这种现象也较明显,而且在CVA患者中表现更为突出。②两组人群在双重任务中所采用的平衡策略不同,CVA组更倾向于通过减小跨步长来减慢速度,而健康组则倾向于通过减慢步频来减慢速度。③在双重任务中,健康老人和CVA老年患者均把注意力优先分配到认知任务上。Objective:To explore the interaction effect,and the dual-task costs(DTC)between cognitive tasks and walking by comparing the CVA patients and the healthy elderly people,to understand the strategy of attention orientation and gait adjustment in CVA patients.Method:Thirty patients with CVA as experimental group and 30 healthy people as the control group were recruited.The participants of these two groups were age matched.These two groups received single-walking task,cognitive tasks and"cognition-walking"dual-tasks,during which the speed,mean stride length and cadence of gait,and correct response rate(CRR)of the cognitive tasks were recorded.Cognitive tasks included serial 3 subtractions(cognitive task A)and auditory stroop test(cognitive task B).In the single-walking task,the CVA patients and control participants were required to walk for 10 m and 30 m on even ground,respectively.Result:(1)CVA group showed statistically slower gait speed and shorter stride length in the dual-tasks than in the single-walking task condition(P<0.01),but no significant difference for the cadence(P>0.01).However,the healthy group had significantly reduced gait speed,stride length and cadence in dual-tasks compared with in single-walking task(P<0.01).Two groups showed no significant difference in the DTCs of speed(P>0.05),whereas the DTCs of stride length in CVA group were larger than that in the control group(P<0.01).DTCs of gait speed,stride length and cadence in dual-task A were greater than those in dual-task B for both groups(P<0.01).(2)Regardless of the cognitive loads,both groups displayed reduced CCR(P<0.01)with no significant difference between two groups(P>0.05).(3)In both dual-tasks,DTCs of gait speed were larger than DTCs of cognitive tasks in both groups(P<0.01).Conclusion:(1)Gait control in CVA patients is more dependent on attention than in healthy elderly people.CVA patients could divide more attention from walking task to cognitive tasks,especially in high-load cognitive task,than the control group.(2)The balance strateg

关 键 词：双重任务 脑血管意外 步态 平衡策略 认知 

分 类 号：R318.01[医药卫生—生物医学工程] R493[医药卫生—基础医学]