Hamzat T K, Kobiri A
Department of Physiotherapy, College of Medicine, University of Ibadan, Ibadan, Nigeria.
Eur J Phys Rehabil Med. 2008 Jun;44(2):121-6.
Walking devices such as canes and frames are often prescribed to post-stroke individuals to enhance their balance and walking, and thus facilitate community reintegration and social participation. The aim of this study was to observe social participation and balance in post-stroke hemiparetic patients and compare the performance of those walking with a cane (AD group) and without a cane (WAD group). The relationships between cane usage and activity participation and balance were also studied.
In this ex post facto research study, balance and social participation were evaluated using the Berg Balance Scale (BBS) and the Craig Handicap Assessment and Reporting Technique (CHART) in 50 individuals with hemiparesis secondary to first incidence hemispheric stroke. The study included 25 AD subjects (mean age 59.88+/-12.04 years) and 25 WAD subjects (mean age 55.84+/-11.30 years) who were consecutively recruited from the physiotherapy units of Korle Bu Teaching Hospital (KBTH) and the 37 Military Hospital in Accra (Ghana). Before recruitment into the study, both groups of subjects were matched for age, height, weight, BBS and CHART scores at the point of discharge from the inpatient units of the two hospitals, the duration of stroke, and the duration of physiotherapy post-stroke.
Mann-Whitney U statistics showed that the AD group had comparatively higher mean participation scores (U=22.37; P=0.00) and lower mean balance performance (BBS score U=30.68; P=0.00) than their WAD counterparts. Spearman's correlation coefficient also revealed a significant negative correlation between the BBS and CHART scores in both groups (AD rho=-0.063; P=0.00 and WAD rho=-0.037; P=0.05).
These findings indicate that post-stroke individuals who used a cane to aid in walking had poorer balance and less social participation than their age-matched counterparts who walked unaided. As balance improved (higher BBS score), participation also improved (lower CHART score) in both groups. In spite of the small sample size, the outcome of this study suggests that prescription of a cane for a post-stroke individual should be carefully considered by the physiotherapist, especially if the focus of rehabilitation includes restoration of balance functions and social participation.
拐杖和助行架等行走辅助器具常被开给中风后患者，以增强他们的平衡能力和行走能力，从而促进其重返社区和社会参与。本研究的目的是观察中风后偏瘫患者的社会参与和平衡情况，并比较使用拐杖行走的患者（AD组）和不使用拐杖行走的患者（WAD组）的表现。还研究了拐杖使用与活动参与和平衡之间的关系。
在这项事后研究中，使用伯格平衡量表（BBS）和克雷格障碍评估与报告技术（CHART）对50例首次发生半球性中风继发偏瘫的患者进行平衡和社会参与评估。该研究纳入了25名AD受试者（平均年龄59.88±12.04岁）和25名WAD受试者（平均年龄55.84±11.30岁），他们是从阿克拉（加纳）的科勒布教学医院（KBTH）和37军医院的物理治疗科连续招募的。在纳入研究之前，两组受试者在两家医院住院部出院时的年龄、身高、体重、BBS和CHART评分、中风持续时间以及中风后物理治疗持续时间方面进行了匹配。
曼-惠特尼U统计显示，AD组的平均参与得分相对较高（U=22.37；P=0.00），而平均平衡表现较低（BBS评分U=30.68；P=0.00），优于其对应的WAD组。斯皮尔曼相关系数还显示，两组的BBS和CHART评分之间存在显著负相关（AD组rho=-0.063；P=0.00，WAD组rho=-0.037；P=0.05）。
这些发现表明，与年龄匹配的无辅助行走的中风后患者相比，使用拐杖辅助行走的中风后患者平衡能力较差，社会参与度较低。随着平衡能力的改善（BBS评分较高），两组的参与度也有所提高（CHART评分较低）。尽管样本量较小，但本研究结果表明，物理治疗师应仔细考虑为中风后患者开具拐杖，特别是如果康复重点包括平衡功能恢复和社会参与。
