Kılınç Muhammed, Avcu Fatma, Onursal Ozge, Ayvat Ender, Savcun Demirci Cevher, Aksu Yildirim Sibel
Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation , Ankara, Turkey.
Top Stroke Rehabil. 2016 Feb;23(1):50-8. doi: 10.1179/1945511915Y.0000000011. Epub 2015 Aug 10.
The aim of this study was to investigate the effects of Bobath-based individually designed trunk exercises on trunk control, upper and lower extremity function, and walking and balance in stroke patients. The main aim of treatment was to eliminate individual trunk impairments during various patient functions.
The study was planned as an assessor-blinded, randomized controlled trial. A total of 22 patients volunteered to participate in the study. Trunk function, functional capacity, and gait were assessed with the Trunk Impairment Scale (TIS), stroke rehabilitation assessment of movement (STREAM), and a 10-m walking test, respectively. The Berg Balance Test (BBT), functional reach (FR), and timed up-and-go (TUG) tests were used to evaluate balance. After the initial assessment, the patients were divided randomly into two groups, the study group (12 patients) and the control group (10 patients). The mean age of the patients in the study group was 55.91 years (duration of stroke 58.66 months) and that of the control group was 54.00 years (duration of stroke 67.20 months). Individual training programs were determined for the patients in the study group, taking into consideration their evaluation results; and strengthening, stretching, range of motion, and mat exercises were determined for the control group according to their functional level. The participants in both groups were taken into the physiotherapy program for 12 weeks, 3 days a week for 1 hour a day.
In group analyses, both groups showed improvement in STREAM, TIS, and TUG tests. Only the study group produced significant gains in the BBT, FR, and 10 m walking tests (P < 0.05). According to the pre- and post-treatment results, no significant difference was observed in any of the evaluated parameters between the two groups (P>0.05).
Individually developed exercise programs in the Bobath concept improve trunk performance, balance, and walking ability in stroke patients more than do conventional exercises.
本研究旨在探讨基于Bobath法的个性化躯干训练对脑卒中患者躯干控制、上下肢功能以及步行与平衡能力的影响。治疗的主要目的是消除患者在各种功能活动中存在的个体躯干功能障碍。
本研究设计为评估者盲法随机对照试验。共有22名患者自愿参与本研究。分别采用躯干功能障碍量表(TIS)、运动功能脑卒中康复评估量表(STREAM)和10米步行试验对躯干功能、功能能力和步态进行评估。采用伯格平衡量表(BBT)、功能性伸展测试(FR)和计时起立行走测试(TUG)评估平衡能力。初始评估后,将患者随机分为两组,即研究组(12例患者)和对照组(10例患者)。研究组患者的平均年龄为55.91岁(脑卒中病程58.66个月),对照组患者的平均年龄为54.00岁(脑卒中病程67.20个月)。根据研究组患者的评估结果为其制定个性化训练方案;根据对照组患者的功能水平为其确定强化、拉伸、关节活动度和垫上运动训练方案。两组参与者均接受为期12周的物理治疗方案,每周3天,每天1小时。
在组间分析中,两组患者的STREAM、TIS和TUG测试结果均有改善。只有研究组在BBT、FR和10米步行测试中取得了显著进步(P < 0.05)。根据治疗前后的结果,两组之间在任何评估参数上均未观察到显著差异(P > 0.05)。
与传统训练相比,基于Bobath理念的个性化训练方案能更有效地改善脑卒中患者的躯干功能、平衡能力和步行能力。