急性视力下降对偏瘫患者步态的即时影响  

Immediate Impact of Acute Visual Acuity Decline on the Gait of Hemiplegic Patients

作　　者：冷洪帅 孟庆华[1,2,4] 周鲁星 张楠 邓一杰[5] LENG Hongshuai;MENG Qinghua;ZHOU Luxing;ZHANG Nan;DENG Yijie(School of Sports and Health,Tianjin Institute of Sports,Tianjin 301617,China;School of Sports Economics and Management,Tianjin Institute of Sports,Tianjin 301617,China;School of Social Sports,Tianjin Institute of Sports,Tianjin 301617,China;Tianjin Sports Injury and Rehabilitation Virtual Simulation Experimental Teaching Center,Tianjin 301617,China;School of Physical Education and Health,Zunyi Medical University,Zunyi 563000,Guizhou,China)

机构地区：[1]天津体育学院运动健康学院,天津301617 [2]天津体育学院体育经济与管理学院,天津301617 [3]天津体育学院社会体育学院,天津301617 [4]天津市运动损伤与康复虚拟仿真实验教学中心,天津301617 [5]遵义医科大学体育与健康学院,贵州遵义563000

出　　处：《医用生物力学》2025年第2期300-306,328,共8页Journal of Medical Biomechanics

基　　金：国家自然科学基金项目(11372223,11102135);天津市自然科学基金项目(17JCZDJC36000,18JCZDJC35900);国家体育总局科研项目(22KJCX077,2022pqky-01,24ZDKJCX11);天津市体育局科研项目(22BZ02,24BZ02)。

摘　　要：目的 探究偏瘫患者急性视力变化对其步态的即时影响。方法 招募30名视力正常偏瘫患者,选取不同屈光程度的平面镜(0°)、凹透镜(+150°、+450°)分别模拟正常视力、中度近视、高度近视情境进行直线行走测试,运用Qualisys三维动作捕捉系统、Kistler三维测力台对患者运动学和动力学数据进行采集,比较视觉干预前后相关指标差异性。结果 视力干预下,偏瘫患者的步长、步速、关节角度均会受到影响,尤其急性视力变化后患者患侧步长、踝关节角度存在显著差异。高度近视下,步长及步长对称性较中度近视下表现更好,但牺牲了步速。视力干预下,步长对称性、关节角度对称性有不对称趋势。压力中心(center of pressure, COP)及COP对称性方面,正常视力与高度近视间呈现极为显著差异。结论 急性视力变化会影响偏瘫患者步态,尤其在高度近视时步速降低和踝关节活动度增大,中度近视时步速增加,同时COP对称性下降,显示出急性视力变化会导致患者面临更高的跌倒风险。偏瘫患者康复过程中,通过施行合理的视力评估和相应的干预措施,有望提高患者的行走能力和生活质量。Objective To explore the immediate impact of acute vision changes in hemiplegic patients on their gait.Methods Thirty visually normal hemiplegic patients were recruited.Plane mirrors(0°),concave lenses(+150°,+450°)were selected to simulate normal vision,moderate myopia,and high myopia scenarios for straight line walking tests.The Qualisys three-dimensional(3D)motion capture system and Kistler 3D force platform were employed to collect kinematic and dynamic parameters of the patients,and the differences in related indicators before and after visual intervention were compared.Results Visual intervention affected the step length,walking speed,and joint angles of hemiplegic patients.Especially after acute vision changes,there was a significant difference in the stride length and ankle joint angles on the patient’s affected side.Under high myopia,the step length and step length symmetry were better than those under moderate myopia,but at the expense of gait speed.Visual intervention led to asymmetric trends in step the length symmetry and joint angle symmetry.There were very significant differences in center of pressure(COP)and COP symmetry between normal vision and high myopia.Conclusions Acute vision changes can affect the gait of hemiplegic patients,especially in individuals with high myopia presenting both a notable decrease in walking speed and an increased ankle range of motion,and an increase in walking speed with moderate myopia.Meanwhile,the symmetry of the COP decreases,indicating that acute vision changes lead to a higher risk of falls for patients.Reasonable vision assessment and corresponding intervention measures are expected to improve walking ability and life quality of the patients.

关 键 词：偏瘫 视力障碍 视觉干预 即时影响 跌倒 步态 

分 类 号：R318.01[医药卫生—生物医学工程]