任务导向性训练对偏瘫患者步行的影响

【作者】 闫艳；

【导师】 杨宁；

【作者基本信息】 南京师范大学 ， 运动人体科学， 2017， 硕士

【摘要】 目的:如何提高慢性偏瘫患者步行能力是康复领域的一个重点。探讨任务导向性训练对偏瘫患者步行的影响,分析其对偏瘫患者步行功能、运动学参数、动力学参数的作用,为临床上寻求一种更有效、综合的康复干预措施提供依据。方法:选取5名符合纳入标准的男性慢性偏瘫患者为研究对象,均为左侧偏瘫。受试者接受8周的任务导向性训练,应用ICF的分类,分别设立功能结构层面和活动层面的任务及任务的难度和数量,训练中运用神经音乐疗法技术,采用一对一的方式进行康复训练。在训练的前后进行步行功能测试和三维步态分析测试,所有的测试都要进行录像。步行能力测试包括10m步行速度测试、起立-行走计时测试。使用Vicon运动捕捉系统进行三维步态分析测试,包括运动学参数、动力学参数。观察干预前后各参数的变化。结果:1.干预后,患者的10m步行速度、起立—行走计时测试降低(P<0.05);2.时空参数:干预后,患者的患侧步长、健侧步长、跨步长、健侧步频、患侧的摆动时间百分比显著增加(P<0.05),患侧支撑时间百分比显著减少(P<0.05);步速、患侧步频、步宽、健侧摆动时间百分比增加,健侧支撑时间百分比、双支撑时间百分减少,但差异无统计学意义(P>0.05);3.关节角度:(1)干预后,踝关节最大背屈、跖屈、内收角度显著增加(P<0.05),膝关节最大屈曲、内收、内旋、外旋角度显著增加(P<0.05),髋关节最大伸展角度显著增加(P<0.05);踝关节最大外翻、外展角度显著减少(P<0.05);踝关节最大内翻角度增加,膝关节最大伸展角度增加,最大外展角度所减少,髋关节最大外展、内旋角度增加,最大屈曲、内收、外旋角度减少,但差异均无统计学意义(P>0.05);(2)干预后,在足趾离地时刻,踝关节背屈角度显著减少(P<0.05),膝关节屈曲角度显著增加(P<0.05);髋关节屈曲角度减少,但差异无统计学意义(P>0.05)。4.动力学参数:(1)干预后,踝关节、膝关节和髋关节屈伸、外展力矩显著增加(P<0.05),踝关节最大内翻力矩、膝关节最大内旋力矩、髋关节最大外旋力矩显著增加(P<0.05);膝关节最大外翻、内收力矩增加,膝关节最大内收、外旋力矩增加,髋关节最大内收、内旋力矩增加,但差异无统计学意义(P>0.05);(2)干预后,垂直GRF峰值显著增加(P<0.05),向前GRF峰值减少,差异无统计学意义(P>0.05)。结论:本研究证实进行8周的任务导向性训练可以提高患者的步行能力,具体体现在以下几个方面:1.可以减少偏瘫患者10m步行速度、起立—行走计时测试;2.能够增加患者的步长、跨步长、步速、步频,增加摆动时间百分比,减少支撑时间百分比和双侧支撑时间百分比;3.使患者踝关节和膝关节的最大屈伸角度、髋关节的伸展角度增加,髋关节的最大屈曲角度减少;踝关节的最大内收角度,膝关节的内收、内旋、外旋角度增加;4.可以增加踝关节、膝关节和髋关节的最大屈伸力矩、内收外展力矩、内旋外旋力矩,增加垂直方向的地面反作用力峰值。更多还原

【Abstract】 Objective:How to improve the walking ability of patients with chronic hemiplegia is a focus in the field of rehabilitation.Exploring the effects of task-oriented training on waiking in patients with hemiplegia,analyzing its walking function,kinematic parameters and kinetics parameters,to seek a more effective and comprehensive clinical rehabilitation interventions.Methods:Selecting five male chronic hemiplegia patients that accorded with inclusion criteria as the research object,were left hemiplegia.Subjects received 8 weeks of task-oriented training,applying the classification of ICF,respectively,to set up the function and structure level tasks and activity level tasks,set the difficulty and the number of the task.Using neurologic music therapy technology,adopting the way of one to one in rehabilitation training.Before and after the training,conducting walking function test and three-dimensional gait analysis test.All tests were taken videos.Walking ability tests includes 10m walking speed testing and TUGT.Using Vicon motion capture system for three-dimensional gait analysis test,including kinematic parameters and kinetics parameters.Observing the changes of the parameters before and after the intervention.Results:1.After the intervention,the patient’s 10 m walking speed increased(P<0.05),TUGT reduced(P<0.05);2.Spatial and temporal parameters:at posttest,the patient’s affected sides step length,unaffected side length,stride length,unaffected side stride frequency,percentage of affected side’s swing time increased significantly(P<0.05),the percentage of affected side’s support time significantly reduced(P<0.05);Speed,unaffected side stride length,step width,the unaffected side’s swing time percentage increase,the unaffected side’s support time percentage,double support time percentage decreased,but there was no statistically significant difference(P>0.05);3.Joint angles(1)At posttest,ankle maximum dorsiflexion and plantarflexion and adduction angle increased significantly(P<0.05),knee maximum flexion,adduction,and internal rotation,rotation angle increased significantly(P<0.05),maximum hip extension angle increased significantly(P<0.05);Ankle valgus,abduction angle significantly reduced(P<0.05);Ankle maximum varus angle increased,knee maximum extension angle increased,hip maximum abduction angle,and internal rotation angle increased,the maximum flexion,adduction,external rotation angle decreased,but there were no statistically.(2)At posttest,the moment of toe off,ankle dorsiflexion angle significantly reduced(P<0.05),knee flexion angle increased significantly(P<0.05);Hip flexion angle decreased,but there was no statistically significant difference(P>0.05).4.Kinetics parameters(1)At posttest,the ankle,knee and hip maximum flexion,extension moment increased significantly(P<0.05),the ankle maximum varus moment,knee maximum internal rotation moment,hip maximum external rotation moment increased significantly(P<0.05);Knee maximum valgus,adduction moment increased,knee maximum adduction,external rotation moment increasd,hip maximum adduction,internal rotation moment increased,but there was no statistically significant difference(P>0.05);(2)At posttest,the peak vertical GRF increased significantly(P<0.05),forward GRF peak decreases,there was no statistically significant difference(P>0.05).Conclusion:The study confirmed that 8 weeks’ task-oriented training can improve the walking ability of patients,including the following aspects:1.It can reduce the time of the 10 m walking speed and the TUG.;2.It can increase patients’ step length,stride length,speed,stride length,swing time percentage,reduce support time percentage and double support time percentage;3.It can increase ankle and knee maximum flexion and extension angle,hip maximum extension angle,reduce maximum hip flexion angle;increase ankle maximum adduction angle,knee maximum adduction,internal rotation,external rotating angle;4.It can increase the ankle,knee and hip maximum flexion and extension,adduction and abduction,external rotating t and internal rotation moment and increase the peak ground reaction force of the vertical direction.更多还原