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王芗斌,侯美金,陶 静,林莉莉,饶 婷,钟锦然,林正坤.太极“云手”对脑卒中偏瘫患者步态影响的相关性研究[J].中国康复医学杂志,2016,(12):1328~1333
太极“云手”对脑卒中偏瘫患者步态影响的相关性研究    点此下载全文
王芗斌  侯美金  陶 静  林莉莉  饶 婷  钟锦然  林正坤
福建中医药大学康复医学院,福州市,350003
基金项目:财政部公益性行业科研专项资助项目(201307004)
DOI:
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摘要:
      摘要 目的:观察太极“云手”对脑卒中偏瘫患者平衡及步行功能的影响,探讨时空参数与平衡功能之间的相关性。 方法:将2个社区随机分为试验组和对照组,招募患者各14例及16例,在基础治疗上分别进行为期12周太极“云手”和常规平衡康复训练,于治疗前后采用Berg量表及步态分析系统进行功能评估。 结果:①治疗前后比较,对照组仅步频患/健比增加显著(P<0.05);试验组的患侧和健侧总支撑相百分比均缩短(P<0.05和P<0.01),患侧和健侧摆动相百分比增加显著(P<0.05和P<0.01);患侧和健侧的单足支撑期百分比增加显著(P<0.05);健侧的双足支撑期百分比缩短显著(P<0.01)。②治疗后两组Berg评分均提高显著(P<0.01)。③在排除基线差异后,两组治疗后比较,各步行时空参数及Berg评分差值均无显著性差异(P>0.05)。④两组中改善的步行时空参数与Berg评分的差值之间无显著性相关。⑤治疗前患侧、健侧的步长、跨步长、步频、步速与Berg评分存在正相关(r分别为0.60, 0.67, 0.65, 0.66, 0.60, 0.60, 0.38;P<0.01);步宽与Berg评分存在中度负相关(r=-0.49;P<0.05)。总支撑期时间的患/健侧比值,单足支撑相所占百分比的患/健侧比值与Berg评分均存在中度正相关(r分别为0.43、0.66;P<0.05),而摆动相和双足支撑相所占百分比的患/健侧比值则与Berg评分存在中度(r=-0.67;P<0.01)、低度负相关(r=-0.37;P<0.05)。 结论:太极“云手”训练与常规平衡康复训练均可明显提高脑卒中偏瘫患者平衡功能,但两种干预方法无显著性差异。太极“云手”训练有助于改善步态周期的时相百分比,提高患者的步行质量和效率,但改善的步行时空参数与平衡功能的改善无明显相关。“云手”训练作为中医康复适宜技术之一,可以在社区偏瘫障碍者中推广应用。
关键词:太极  云手  步态  时空参数  平衡功能  Berg量表  脑卒中  偏瘫
The effect of Yun Shou on gait of community-based hemiplegic patients after stroke    Download Fulltext
College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, 350003
Fund Project:
Abstract:
      Abstract Objective: To observe Tai Chi Yunshou (waving hand as clouds) exercise’s effect on balance and gait of hemiplegic patients after stroke, and to explore the correlation between the changes of temporal-spatial parameters during level walking and balance function. Method: 14 and 16 patients were recruited respectively in two randomized communities as a treating (Tai Chi) group and a control (balance therapy) group. 12 weeks of Tai Chi Yunshou exercise or routine balance training was applied in two groups correspondingly. Berg Balance Scale (BBS) and gait analysis were adopted before and after the intervention for functional assessment. Result: ①Compared data before and after treatment, only the cadence ratio of affected and unaffected side improved in control group (P<0.05). In Tai Chi group, total stance time (%) in both affected and unaffected sides were significantly shortened (P<0.05 and P<0.01). Single support time (%) and total swing time (%) on both sides were extended correspondingly (P<0.05 and P<0.01). And double support time (%) on unaffected side was shortened (P<0.01). ②Scores in BBS after treatment on both groups were higher than those before treatment (P<0.01). ③By ruling out the baseline changes between the two groups, no significant difference showed on all the temporal-spatial variables and Berg score change after two interventions (P>0.05). ④The change of the results before and after treatment in both two groups wasn’t correlated to the change of Berg score (P>0.05). ⑤Before intervention, step lengths, stride lengths, cadences and velocities on both extremities were correlated positively to BBS score (r values were 0.60, 0.67, 0.65, 0.66, 0.60, 0.60 and 0.38 respectively; P<0.01). Step width was correlated negatively to BBS score (r=-0.49; P<0.05). Ratios between affected and unaffected limb in stance phase percentage and single support time (%) were correlated positively to BBS score (r values were 0.43 and 0.66 respectively; P<0.05). And ratios between affected and unaffected limb in swing phase percentage and double support time (%) were correlated negatively to BBS score (r values were -0.67 and -0.37 respectively; P<0.01 and P<0.05). Conclusion: Both Tai Chi Yunshou exercise and routine rehabilitative therapy could improve balance function in hemiplegic cases. But no difference showed between two therapies in temporal-spatial parameters during level walking and balance improvement. Yunshou exercise improved the phase percentage in a gait cycle. It also enhanced the quality and efficiency of level walking. But no correlation showed between the changed results of temporal-spatial variables and Berg score. “Yunshou” exercise may be served as one of the appropriately traditional rehabilitation therapies to help improve balance in community-based hemiplegic patients.
Keywords:Tai Chi  Yunshou  gait analysis/temporal-spatial  balance  Berg balance scale  stroke  hemiplegia
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