【摘要】 目的:探讨应用可提高人体平衡能力的平衡测试训练系统MTD训练仪测试国人平衡功能的效度和敏感性。方法:①深圳第二人民医院康复医学科2003-07/2004-02收治的脑血管意外康复期患者20例,为偏瘫组,男11例,女9例;年龄27～74岁,平均(48±13)岁;身高(168.85±9.10)cm,体质量(67.15±8.97)kg。患者均首次发病,单侧病灶,病情稳定,无认知、视觉、理解功能障碍,能够在有或无辅助装置下维持静态站立位至少持续1min。对照组20例为健康体检志愿者,男10例,女10例;年龄25～75岁,平均(49±15)岁;身高(167.25±8.32)cm,体质量(62.53±9.00)kg。②MTD平衡测试仪为10610-100(德国制造),测试台上有左右两块平衡测试踏板,当患者在左右踏板上活动时,左右踏板可将承重压力资料传到系统,患者可通过监视屏的即时显示“看到和“听到双下肢承重压力的改变,进行自我观察和配合训练。测试者双足位于平衡仪测试台相应位置,分别在30s内完成静态站立、蹲位起立、重心左右转移情况下的测试。③受试者通过重心的调节完成电脑屏幕上的接球试验,系统根据接球数自动生成得分,接球越多得分越高。由同一测试者对受试者进行Berg平衡量表评定得分和Fugl-Meyer平衡得分项目的测试,进行标准对照和差异比较。Berg平衡量表评定测试时选择14个动作对被测试者进行评定,每个动作又依据被测试者的完成质量分为0～4分5个级别予以记分,最高分56分,最低分0分,评分越低,表示平衡功能障碍越差。Fugl-Meyer平衡评定7项动作,每个动作均按3个等级记分,最高14分,最低0分,评分少于14分,说明平衡能力有障碍,评分越少,功能障碍程度越严重。将3种状态下下肢承重差和接球得分与量表得分做相关分析,检验该平衡测试系统的效度;将偏瘫组和对照组的测试结果进行独立样本的t检验,判定该平衡测试系统的敏感性。结果:按意向处理分析,2组40例患者均进入结果分析。①MTD训练仪平衡测试功能的敏感性分析结果:在静态站立、蹲位起立、重心转移3种状态下,偏瘫组的单位体质量双下肢承重差为1.92±0.46,2.38±0.58,2.47±0.73,对照组为0.24±0.09,0.43±0.12,0.37±0.14,与对照组比较显著降低(t=-0.50,-0.43,-0.81,P<0.01)。偏瘫组接球试验得分为(34.25±19.25)分,对照组为(150.10±31.46)分,与对照组比较显著增高(t=12.32,P<0.01)。②MTD训练仪平衡测试功能的效度分析结果:用Spearman相关分析法将3种状态单位体质量下的双下肢最大承重差和接球得分与Berg平衡量表评定得分和Fugl-Meyer平衡评定得分做相关分析,得出静态站立、蹲位起立、重心转移时单位体质量下的双下肢最大承重差与Berg平衡量表评定得分(r=-0.803,-0.709,-0.755)和Fugl-Meyer平衡评定得分(r=-0.787,-0.720,-0.794)呈中度至高度负相关。接球得分与Berg平衡量表评定得分和Fugl-Meyer平衡评定得分呈高度正相关(r=0.851,0.846)。结论:MTD平衡测试训练系统以双下肢在不同状态下承重差和接球试验t检验来反映人的平衡能力具有较高的敏感性。双下肢在不同状态下承重差可用随时间变化的线条图表现,具有快速、直观、形象、即时的特点,而且可将不同时期的图像在一张图中反映,有利于判断平衡功能的动态变化情况。以此为依据,根据患者的平衡能力改善进程对平衡训练计划做相应的调整,以提高训练效果。接球试验得分可以作为指标反映训练过程中平衡能力的改变。双下肢不同状态下承重差和接球得分做相关分析表明静态站立、蹲位起立、重心转移状态下成高度负相关,接球得分呈高度正相关,与Berg平衡量表评定得分和Fugl-Meyer平衡评定得分进行的相关分析呈高度正相关,MTD平衡测试训练系统具有较高的效度。更多还原

【Abstract】 AIM:To probe into the validity and sensitivity of MTDbalance system in the assessment of balance function,which can improve the balance ability.METHODS:①Twenty stroke patients who was hospitalized in Shenzhen Second Hospital from July 2003 to Febuary 2004 composed hemiplegia group.The patients included 11 males,9 females aged from 27 to74 years with mean age of (48±13) years,mean body height of (168.85±9.10) cm and mean body mass of (67.15±8.97) kg.The patients had the first onset with unilateral focus and patients’condition was stable.None of them had obstacle in cognizance,vision and comprehension.The patients were able to sustain the standing posture stablely for at least 1 minute with or without assistant equipment.Twenty healthy subjects composed control group including 10 males, 10 females aged from 25 to75 years with mean age of (49±15) years, mean body height of (167.25±8.32) cm and mean body mass of (62.53±9.00)kg.②MTDbalance system(10610100) were made in German.There were two balance measurement footplates which could send the pressure to the computer.By the screen and loudhailer, the patients could see and hear the lower limbsload difference so as to perform selfobservation and training.All subjects were measured by MTDbalance system in three conditions(to stand up and sit down, balance when standing,weight shift when standing) about two indexes(the lower limbsload difference and the receiving boll test score)in 30 s.③The testees completed receiving ball on the screen through regulating the barycenter.They were also assessed by the Berg’s balance test and the FuglMeyer balance test.There are 14 motions composed the Berg’s balance test.Every motion score was from 0 to 4 according to the quality of receiving ball.Total score was 56.The lowest score was 0.The lower the score,the worse the balance ability was.There are 7 motions composed the FuglMeyer balance test.Every motion was recorded according to 3 degrees.Total score was 14,and the lowest score was 0. The balance obstacle was being when the score was less than 14.The less the score,the severe the function obstacle was.Spearman rank correlation were used between the results measured by the MTDbalance systems and the scores which were assessed by the Berg’s balance test and the FuglMeyer balance test to prove the validity.The test results in the hemiplegia group and control group were performed independent sample t test so as to prove the sensitivity of balance system.RESULTS:According to intentiontotreat analysis,40 cases of the 2 group all entered the result analysis.①Sensitivity of MTDbalance systems in the measurement of function:The limbload difference between the two lower limbs at a unit body mass in three conditions was 1.92±0.46,2.38±0.58,2.47±0.73,respectively, in the hemiplegia group,and 0.24±0.09,0.43±0.12,0.37±0.14,respectively, in the control group.The limbload difference in the hemiplegia group was significantly lower than that in the control group(t=-0.50,-0.43,-0.81,P< 0.01). The score on receiving ball test in the hemiplegia was 34.25±19.25, and 150.10±31.46 in the control group. Compared with the control group, the score was significantly increased in the hemiplegia group (t=12.32,P< 0.01).②Validity of MTDbalance system in the assessment of balance function:Using Spearman correlation analysis between the scores on Berg’s balance test and FuglMeyer balance test and the limbload difference and socres on receiving ball test score in three conditions, there was a moderate to high negative correlation between the MTDbalance system assessment and the clinical balance test(r=-0.803,-0.709,-0.755,-0.787,-0.720,-0.794), and a high positive correlation between the scores on receiving ball test and the scores on Berg’s balance test and FuglMeyer balance assessment (r=0.851,0.846).CONCLUSION:MTDbalance system has a higher sensitivity in assessment of body’s balance by the limbload difference and the scores on receiving ball test.In different state, the limbsload diffence can be exhibite更多还原