丘脑底核深部脑刺激（STN-DBS）治疗帕金森病患者术后康复的平衡和步态改善
Balance and Gait Improvements of Postoperative Rehabilitation in Patients with Parkinson's Disease Treated with Subthalamic Nucleus Deep Brain Stimulation (STN-DBS).
作者信息
Sato Kazunori, Aita Noriaki, Hokari Yoshihide, Kitahara Eriko, Tani Mami, Izawa Nana, Hatori Kozo, Nakamura Ryota, Sasaki Fuyuko, Sekimoto Satoko, Jo Takayuki, Oyama Genko, Hatano Taku, Shimo Yasushi, Iwamuro Hirokazu, Umemura Atsushi, Hattori Nobutaka, Fujiwara Toshiyuki
机构信息
Department of Rehabilitation Medicine, Juntendo University Hospital, Tokyo, Japan.
Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
出版信息
Parkinsons Dis. 2019 Aug 4;2019:7104071. doi: 10.1155/2019/7104071. eCollection 2019.
BACKGROUND
Deep brain stimulation of the subthalamic nucleus (STN-DBS) is a surgical treatment to reduce the "off" state motor symptoms of Parkinson's disease (PD). Postural instability is one of the major impairments, which induces disabilities of activities of daily living (ADLs). The effectiveness of STN-DBS for postural instability is unclear, and the effect of rehabilitation following STN-DBS has remained uncertain.
OBJECTIVE
The purpose of this study was to examine changes in balance ability, gait function, motor performance, and ADLs following 2 weeks of postoperative rehabilitation in PD patients treated with STN-DBS.
METHODS
Sixteen patients were reviewed retrospectively from February 2016 to March 2017. All patients were tested in their "on" medication state for balance and gait performance using the Mini-Balance Evaluation Systems Test (Mini-BESTest) and the Timed "Up and Go" (TUG) test before the operation, after the operation, and during the discharge period. The UPDRS motor score (UPDRS-III) and Barthel Index (BI) were assessed before the operation and during the discharge period. Rehabilitation focused on muscle strengthening with stretching and proactive balance training. Friedman's test and the post hoc Wilcoxon's signed-rank test were used to analyze the balance assessments, and ANOVA and the post hoc Tukey's test were used to analyze gait performance. The significance level was < 0.05.
RESULTS
During the discharge period, the Mini-BESTest and TUG were significantly improved compared with the preoperative and postoperative periods ( < 0.05). There were no differences between preoperative and postoperative periods in the Mini-BESTest (=0.12) and TUG (=0.91). The BI and motor sections of the UPDRS did not differ significantly between the preoperative and postoperative periods (=0.45, =0.22).
CONCLUSION
The results of this study suggest that postoperative rehabilitation improves balance and gait ability in patients with PD treated with STN-DBS.
背景
丘脑底核深部脑刺激术（STN-DBS）是一种用于减轻帕金森病（PD）“关”期运动症状的外科治疗方法。姿势不稳是主要损害之一，会导致日常生活活动（ADL）障碍。STN-DBS对姿势不稳的有效性尚不清楚，且STN-DBS术后康复的效果仍不确定。
目的
本研究旨在探讨接受STN-DBS治疗的PD患者术后2周康复训练后平衡能力、步态功能、运动表现和ADL的变化。
方法
回顾性分析2016年2月至2017年3月期间的16例患者。所有患者在术前、术后及出院时，于服药“开”期使用简易平衡评估系统测试（Mini-BESTest）和定时起立行走测试（TUG）对平衡和步态表现进行测试。术前及出院时评估统一帕金森病评定量表运动评分（UPDRS-III）和巴氏指数（BI）。康复训练重点为肌肉强化、拉伸及主动平衡训练。采用Friedman检验及事后Wilcoxon符号秩检验分析平衡评估结果，采用方差分析及事后Tukey检验分析步态表现。显著性水平为<0.05。
结果
出院时，与术前和术后相比，Mini-BESTest和TUG显著改善（<0.05）。Mini-BESTest（=0.12）和TUG（=0.91）在术前和术后之间无差异。术前和术后UPDRS的BI和运动部分无显著差异（=0.45，=0.22）。
结论
本研究结果表明，术后康复可改善接受STN-DBS治疗的PD患者的平衡和步态能力。
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