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基于回顾性病历审查的观察性研究(符合 STROBE 标准):比较脑卒中患者瘫痪侧的步态恢复模式。

Comparison of gait recovery patterns according to the paralyzed side in stroke patients: An observational study based on a retrospective chart review (STROBE compliant).

机构信息

Department of Internal Medicine and Neuroscience.

Hanbang Cardio-Renal Syndrome Research Center, College of Oriental Medicine, Wonkwang University, Iksan, Republic of Korea.

出版信息

Medicine (Baltimore). 2021 Apr 23;100(16):e25212. doi: 10.1097/MD.0000000000025212.

DOI:10.1097/MD.0000000000025212
PMID:33879656
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8078470/
Abstract

Gait rehabilitations have been abundantly performed for post-stroke patients, because gait is the most important factor for the return of post-stroke patients to daily life. However, conventional uniform gait rehabilitations tend to be tedious and reduce motivation. The aim of this study was to contribute to the development of personalized rehabilitation of gait by identifying differences in gait recovery pattern according to the paralyzed side of post-stroke patients.The gait analysis was performed on stroke patients who are right-handed and can walk independently. We retrospectively analyzed the results of pelvic movements and displacement of center of pressure (COP) during gait using corresponding equipments. To show the difference of gait recovery pattern according to the paralyzed side, we divided subjects into two groups, right (n = 19) and left (n = 20) hemiparesis group. The measured variables were as follows: tilt, obliquity, and rotation symmetries of pelvis; area, velocity, and lateral symmetry of COP.First, in the left hemiparesis group, obliquity (P < .01) and rotation (P < .01) symmetries of the movement of the pelvis were significantly improved in the follow-up compared to the initial gait analysis. In the right hemiparesis group, tilt (P < .001), obliquity (P < .001), and rotation (P < .05) symmetries were significantly improved in the follow-up compared to the initial gait analysis. Second, COP area and COP velocity values in the follow-up were significantly smaller than those in the initial gait analysis in the left (P < .001, P < .05) and right (P < .001, P < .01) hemiparesis groups. The positive value of lateral symmetry increased, although not a significant difference statistically, as walking ability improved in both groups. In the correlation analysis among variables obtained using Treadmill, there were significant positive linear relationships between the lateral symmetry and the COP area (P < .05), and between the COP velocity and the lateral symmetry (P < .001) of the follow-up gait analysis in the right hemiparesis group.It was confirmed that the gait recovery pattern differs according to the paralyzed side of post-stroke patients and the role of the intact side, such as moving the COP to the intact side, is important for the improvement of gait function in both groups.This study was registered with the Clinical Research Information Service (CRIS) of the Korea National Institute of Health (NIH), Republic of Korea (KCT0002984) and was approved by the Institutional Review Board (IRB) of the WKUGH (WKIRB [2018-25], November 28, 2018).

摘要

本研究旨在通过识别脑卒中患者瘫痪侧别不同的步态恢复模式,为个性化步态康复提供帮助。

本研究对象为右利手、可独立行走的脑卒中患者,对其进行步态分析。我们使用相应设备,回顾性分析了患者步态过程中骨盆运动和中心脚压(COP)位移的结果。为了显示瘫痪侧别的步态恢复模式差异,我们将研究对象分为右侧(n=19)和左侧(n=20)偏瘫组。测量变量包括:骨盆倾斜、倾斜、旋转的对称性;面积、速度、COP 的侧向对称性。

首先,在左侧偏瘫组中,与初始步态分析相比,骨盆运动的倾斜(P<.01)和旋转(P<.01)对称性在随访中显著改善。在右侧偏瘫组中,与初始步态分析相比,骨盆的倾斜(P<.001)、倾斜(P<.001)和旋转(P<.05)对称性在随访中显著改善。其次,在左侧(P<.001,P<.05)和右侧(P<.001,P<.01)偏瘫组中,与初始步态分析相比,COP 面积和 COP 速度值在随访中显著减小。在两组中,随着步行能力的提高,COP 侧向对称性的正值虽然统计学上没有显著差异,但有所增加。在使用跑步机获得的变量之间的相关性分析中,右侧偏瘫组的 COP 侧向对称性与 COP 面积之间存在显著的正线性关系(P<.05),与 COP 速度与 COP 侧向对称性之间存在显著的正线性关系(P<.001)。

研究证实,脑卒中患者的步态恢复模式因瘫痪侧别而异,健侧将 COP 移向健侧的作用对于两组步态功能的改善都很重要。

本研究在韩国国立卫生研究院(NIH)临床研究信息服务(CRIS)注册(KCT0002984),并经 WKUGH 机构审查委员会(IRB)批准(WKIRB [2018-25],2018 年 11 月 28 日)。

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