太极拳姿势训练联合Bobath疗法对脑卒中偏瘫患者步态康复的影响  

Effect of Tai chi posture training combined with Bobath therapy on gait rehabilitation in ischemic stroke patients with hemiplegia

作　　者：吴家宝 孙伊婷 张勇[1] 孙三峰 谢春荣[2] 周莉[1] 葛杜娟 赵明智 滕驰 陈恺[1] 景城阳 李玉月 李莹洁 李宗衡[1] WU Jiabao;SUN Yiting;ZHANG Yong;SUN Sanfeng;XIE Chunrong;ZHOU Li;GE Dujuan;ZHAO Mingzhi;TENG Chi;CHEN Kai;JING Chengyang;LI Yuyue;LI Yingjie;LI Zongheng(Dongzhimeng Hospital of Beijing University of Chinese Medicine,Beijing 100020,China;Huairou District Hospital of Traditional Chinese Medicine,Beijing 101400,China)

机构地区：[1]北京中医药大学东直门医院,北京100020 [2]北京市怀柔区中医医院,北京101400

出　　处：《现代中西医结合杂志》2024年第3期306-315,共10页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：国家自然科学基金面上项目(81673894);北京中医药大学重点攻关项目(2020-JYB-ZDGG-112)。

摘　　要：目的探讨太极拳姿势训练联合Bobath疗法对缺血性脑卒中偏瘫患者步态康复的影响。方法将2017年4月-2022年4月就诊于北京中医药大学东直门医院和北京中医医院怀柔医院的120例缺血性脑卒中偏瘫患者随机分为试验组和对照组,对照组患者接受Bobath疗法训练,试验组患者接受太极拳姿势训练与Bobath疗法训练,2组疗程均为4周。于入组时及治疗4周后分别进行压力步道测试,分析比较2组患者全足平衡性、足底力学参数[趾骨区(T1-T5)、跖骨区(M1-M5)、中足区、足跟内侧区(HM)、足跟外侧区(HL)的冲量、触地面积、最大压力峰值、最大压强峰值]及基本时空参数[步长、步宽、步幅、步速、行走支撑时相、足轴角]、临床量表评分[量表包括美国国立卫生研究院卒中量表(NIHSS)、Fugl-Meyer评分量表(FMA)、Berg平衡量表(BBS)、Bathel指数(BI)、修订Rankin量表(mRS)、脑卒中生活质量量表(SSQOL)]、肌张力Ashworth分级、Brunnstrom分级,并分析2组差异有统计学意义的指标间的关联性。结果试验组和对照组各50例完成研究。治疗后,试验组的全足平衡曲线更平滑,T2-5趾与M1、M2最大压强峰值和T1触地面积均明显增大(P均<0.05),足轴角减小(P<0.05);对照组的全足平衡曲线出现分离现象,M3触地面积增大(P<0.05),HL触地面积和冲量减小(P均<0.05);2组步速均增快,患侧支撑相及步态周期均缩短,步长、步幅均增大,差异均有统计学意义(P均<0.05)。治疗后试验组M1最大压力峰值、步长、步幅均明显大于对照组,M3触地面积和足轴角明显小于对照组,步速明显快于对照组,患侧支撑相及步态周期均明显短于对照组,Ashworth分级、Brunnstrom患侧下肢分级、mRS评分均明显低于对照组,FMA下肢评分、Berg评分、BI评分均明显高于对照组,差异均有统计学意义(P均<0.05)。结论太极拳姿势训练联合Bobath疗法能够重新分配缺血性脑卒中偏瘫患�Objective It is to explore the effect of Tai chi posture training combined with Bobath therapy on gait rehabilitation in ischemic stroke patients with hemiplegia.Methods One hundred and twenty patients with ischemic stroke and hemiplegia treated in Dongzhimen Hospital of Beijing University of Chinese Medicine and Huairou District Hospital of Traditional Chinese Medicine from April 2017 to April 2022 were randomly divided into test group and control group.The patients in the control group were treated with Bobath therapy training,the patients in the test group were treated with Tai chi posture training and Bobath therapy training,both groups were treated for 4 weeks.The pressure trail test was performed at the time of enrollment and 4 weeks after treatment.The whole foot balance,plantar mechanical parameters[impulse,ground contact area,peak maximum force,peak maximum pressure of phalangeal area(T1-T5),metatarsal area(M1-M5),middle foot area,medial heel area(HM),lateral heel area(HL)]and basic time and space parameters[step length,stride length,stride width,stride speed,walking support phase,foot axis angle],clinical scale score[including National Institutes of Health Stroke scale(NIHSS),Fugl-Meyer rating scale(FMA),Berg balance scale(BBS),Bathel Index(BI),Modified Rankin Scale(mRS),Stroke-Specific of Life scale(SSQOL)],muscular tension[Modified Ashworth rating Scale,Brunnstrom rating Scale]of patients in the two groups were analyzed and compared,and the correlation of these indexes with statistically significant differences between the two groups was analyzed.Results The study was completed in 50 cases in the test group and 50 cases in the control group.After treatment in the test group,the whole foot balance curve was more smoother,the peak pressure of T2-5 toe and M1 and M2 and the ground contact area of T1 were significantly increased,and the foot axis angle was decreased(all P<0.05).The whole foot balance curve of the control group was separated,the ground contact area of M3 was increased,and the ground contac

关 键 词：步行能力 缺血性脑卒中 偏瘫步态 太极拳姿势训练 

分 类 号：R743.3[医药卫生—神经病学与精神病学]