| 黎俊宇,彭康龙,艾 青,李咏雪,张 涛,陈少贞.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[J].中国康复医学杂志,2019,(12):1431~1437 |
| 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 点此下载全文 |
| 黎俊宇 彭康龙 艾 青 李咏雪 张 涛 陈少贞 |
| 中山大学附属第一医院康复医学科，广州，510080 |
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| DOI： |
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| 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。 |
| 关键词：双重任务 脑血管意外 步态 平衡策略 认知 |
| The rule of changes of gait parameters and cognition performance in different dual-tasks and walking balance strategy in CVA patients Download Fulltext |
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| School of Basic Pharmacology， Sun Yat-sen University，Guangzhou，510080 |
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| Abstract: |
| Abstract
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 10m and 30m on even ground，respectively.
Result: ①CVA 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). ②Regardless of the cognitive loads， both groups displayed reduced CCR(P<0.01) with no significant difference between two groups(P>0.05). ③In both dual-tasks， DTCs of gait speed were larger than DTCs of cognitive tasks in both groups(P<0.01).
Conclusion: ①Gait 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. ②The balance strategies in the dual-task condition for two groups are different. CVA groups tend to slow down the walking speed by reducing the strip length， whereas the control group by reducing the cadence. ③in the dual-task condition，both groups prioritize attention on the cognitive tasks. |
| Keywords:cerebrovascular accident dual-task cognition balance strategy gait |
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