Zhao WeiJing, You Hong, Jiang Shangrong, Zhang Hongxia, Yang Yanling, Zhang Min
Sino-French Department of Neurological Rehabilitation, Gansu Provincial Hospital, Lanzhou.
Department of Neurological, Dunhuang Hospital, Dunhuang, Gansu, China.
Medicine (Baltimore). 2019 Feb;98(7):e14503. doi: 10.1097/MD.0000000000014503.
Due to the indistinct nature of symptoms for Cerebral Small Vessel Disease (CSVD), diagnosis is often missed. With significant deterioration of movement disorder, risk of falls increases dramatically.Comparison study was conducted to explore the association between balance function and gait instability, and the treatment effectiveness of visual feedback balance training on the gait disorder in CSVD patients.Fifty-six patients with CSVD were studied. They were randomly divided into observation and control groups, and were given conventional gait rehabilitation training, including single-leg weight, shift of the center of gravity, step and hip extension training, stepping up and down on stairs with the affected leg, standing up with hip extension and support of the leg, lateral walking, and in situ walking. Training was performed twice a day for 20 minutes each for 4 consecutive weeks. In addition, the observation group received balance training using Pro-Kin visual feedback balance training system. Both groups were evaluated prior and post-treatment using the Tinetti Scale and the Pro-Kin Visual Feedback Balance Training System. For the Tinetti Scale, lower score indicates more serious gait balance dysfunction. For the Pro-Kin, greater length means poorer balance function. Larger area means poorer balance function. Smaller value of the 2 parameters indicates better balance function.After training, the trajectory lengths and areas of orbital motions were significantly decreased (P < .05). However greater decrease was seen in the observation group (P < .01). The trajectory length and area for both groups were less when the eyes open than closed (P < .01). The Tinetti scores for balance and gait functions of both groups improved significantly (P < .05). However, the observation group showed even greater results than the control group (P < .01). Results from Person test showed there was a significant correlation between balance and gait functions.Combination of visual feedback balance training with conventional rehabilitation treatment could gain a greater result than conventional rehabilitation alone. It indicates that balance training may serve as an additional method for gait stability training for CSVD patients.
由于脑小血管病(CSVD)症状不明显,诊断常常被漏诊。随着运动障碍的显著恶化,跌倒风险急剧增加。进行了一项对比研究,以探讨平衡功能与步态不稳之间的关联,以及视觉反馈平衡训练对CSVD患者步态障碍的治疗效果。
对56例CSVD患者进行了研究。他们被随机分为观察组和对照组,并接受常规步态康复训练,包括单腿负重、重心转移、步幅和髋关节伸展训练、患侧腿上下楼梯、髋关节伸展并借助腿部支撑站立、侧行以及原地行走。每天训练两次,每次20分钟,连续进行4周。此外,观察组使用Pro-Kin视觉反馈平衡训练系统进行平衡训练。两组在治疗前后均使用Tinetti量表和Pro-Kin视觉反馈平衡训练系统进行评估。对于Tinetti量表,分数越低表明步态平衡功能障碍越严重。对于Pro-Kin系统,轨迹长度越长意味着平衡功能越差。面积越大意味着平衡功能越差。这两个参数的值越小表明平衡功能越好。
训练后,眼眶运动的轨迹长度和面积显著减小(P<0.05)。然而,观察组的减小幅度更大(P<0.01)。两组睁眼时的轨迹长度和面积均小于闭眼时(P<0.01)。两组的平衡和步态功能的Tinetti评分均显著提高(P<0.05)。然而,观察组的结果比对照组更显著(P<0.01)。Person检验结果表明平衡和步态功能之间存在显著相关性。
视觉反馈平衡训练与传统康复治疗相结合比单纯传统康复治疗能取得更好的效果。这表明平衡训练可作为CSVD患者步态稳定性训练的一种补充方法。