非卧床脑卒中患者坐姿最大体重转移与躯干控制和平衡有关：一项横断面研究。
Maximum weight-shifts in sitting in non-ambulatory people with stroke are related to trunk control and balance: a cross-sectional study.
机构信息
Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Tervuursevest 101, 3001 Leuven Heverlee Belgium; Rehazentrum Valens - Kliniken Valens, Valens, Switzerland, Taminaplatz 1, 7317 Valens, Switzerland.
Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Tervuursevest 101, 3001 Leuven Heverlee Belgium; UZ Leuven - University Hospitals Leuven, Department of Physical Medicine and Rehabilitation, UZ Leuven campus Pellenberg, Weligerveld 1, 3212 Pellenberg, Belgium.
出版信息
Gait Posture. 2021 Jan;83:121-126. doi: 10.1016/j.gaitpost.2020.10.007. Epub 2020 Oct 15.
BACKGROUND
Impaired sitting balance is common in persons with stroke, affecting postural control in different directions. However, studies seldomly investigate sitting balance in severely affected non-ambulatory persons with stroke and precise assessment including the diagonal directions are scarce.
RESEARCH QUESTION
Are measurements of maximal voluntary weight-shifts decreased in severely affected persons with stroke in comparison to healthy controls, and is there a relationship with clinical measurements of trunk control, sitting and standing balance?
METHODS
14 Persons with stroke were recruited in the rehabilitation phase along with 32 healthy controls. A clinical pressure platform (RM Ingénierie, France) evaluated the weight-distribution during static sitting and measurements of maximal voluntary weight-shifts, by centre of pressure displacements in six directions. Clinical measurements included Trunk Control Test, Trunk Impairment Scale and Berg Balance Scale.
RESULTS
The persons with stroke had a mean (SD) age of 69 (17) years, including 5 females and 9 males and were on average 57 (40) days post stroke. No patient was able to walk without manual support and median (IQR) Berg Balance Scale score was 17 (6-33) out of 56 points. Measurements showed that the centre of pressure distance was significantly smaller in all directions in persons with stroke compared to healthy controls (p < 0.05). The clinical measurements demonstrated moderate to very high correlations with centre of pressure distance in the diagonal forward, diagonal backward and lateral directions (r = 0.54 - 0.89).
SIGNIFICANCE
This study reveals that measurements of maximal voluntary weight-shifts are feasible and show clinically relevant deficits in severely affected non-ambulatory persons with stroke. Especially the lateral and diagonal directions can be of interest to investigate further as they are most strongly correlated with clinical measurements of balance. Reaching exercises in these directions could be considered a core element of rehabilitation for this group of patients.
背景
坐立平衡障碍在脑卒中患者中较为常见，影响不同方向的姿势控制。然而，研究很少调查脑卒中严重失能非步行患者的坐立平衡，并且缺乏包括对角线方向在内的精确评估。
研究问题
与健康对照组相比，严重脑卒中患者的最大自主重量转移测量值是否降低，并且与躯干控制、坐立和站立平衡的临床测量值是否存在关系？
方法
在康复阶段招募了 14 名脑卒中患者和 32 名健康对照者。临床压力平台（法国 RM Ingénierie）评估了静态坐立时的体重分布以及通过中心压力位移在六个方向上的最大自主重量转移测量值。临床测量包括躯干控制测试、躯干损伤量表和伯格平衡量表。
结果
脑卒中患者的平均（标准差）年龄为 69（17）岁，包括 5 名女性和 9 名男性，平均发病后 57（40）天。没有患者能够在没有手动支持的情况下行走，中位数（IQR）伯格平衡量表评分为 56 分中的 17（6-33）分。测量结果表明，与健康对照组相比，脑卒中患者在所有方向上的中心压力距离均显著较小（p<0.05）。临床测量结果表明，在对角线向前、对角线向后和横向方向上，中心压力距离与临床测量的平衡具有中等至高度相关性（r=0.54-0.89）。
意义
本研究表明，最大自主重量转移测量是可行的，并显示出严重失能非步行脑卒中患者具有临床相关的缺陷。特别是横向和对角线方向可能更值得进一步研究，因为它们与平衡的临床测量相关性最强。对于这组患者，在这些方向上进行伸展运动可以被认为是康复的核心内容。
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