From the Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Republic of Korea (EYL, JSN, H-KK, S-BP); Brain Convergence Research Center, Korea University, Seoul, Republic of Korea (YN, MC, YMH, S-BP); and Department of Biomedical Sciences, Korea University, Seoul, Republic of Korea (YN, MC, S-BP).
Am J Phys Med Rehabil. 2022 Mar 1;101(3):203-210. doi: 10.1097/PHM.0000000000001856.
The aim of the study was to investigate the key factors of balance function in the early subacute phase after stroke.
Ninety-four stroke patients were included. Multiple variables were evaluated, including demographic factors, clinical variables (stroke type; lesion site; Mini-Mental State Examination; motor strength of the hip, knee, and ankle joints; Fugl-Meyer Assessment of lower extremity), neurophysiological variables (amplitude ratio of somatosensory evoked potential of the tibial nerves), and laterality index of fractional anisotropy of the corticospinal tract using diffusion tensor imaging. Balance function was measured using the Berg Balance Scale.
The Berg Balance Scale score was significantly negatively correlated with age and laterality index of fractional anisotropy and positively correlated with Mini-Mental State Examination; Fugl-Meyer Assessment of lower extremity; motor strength of the affected hip, knee, and ankle joint; and somatosensory evoked potential amplitude ratio (P < 0.05). The abnormal somatosensory evoked potential group and poor integrity of the corticospinal tract group showed significantly decreased Berg Balance Scale scores. In multivariable logistic regression analysis, age, Fugl-Meyer Assessment of lower extremity score, and ankle plantar flexion strength were significantly associated with balance function (odds ratios = 0.919, 1.181, and 15.244, respectively, P < 0.05).
Higher age, severe initial motor impairment, and strength of the affected lower limb muscles, especially the ankle plantar flexor, are strongly associated with poor balance function early after stroke.
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME.
Upon completion of this article, the reader should be able to: (1) Enhance ability to evaluate motor and balance function of stroke patients by learning common assessment tools including clinical tests, neurophysiological and neuroimaging studies; (2) Explain the important factors associated with balance function impairment in early subacute stroke patients; and (3) Enhance planning rehabilitation strategies for improvement of balance function according to recovery stage after stroke.
Advanced.
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
本研究旨在探讨脑卒中后早期亚急性期平衡功能的关键因素。
纳入 94 例脑卒中患者。评估了多种变量，包括人口统计学因素、临床变量（脑卒中类型；病变部位；简易精神状态检查；髋关节、膝关节和踝关节的运动力量；下肢 Fugl-Meyer 评估）、神经生理学变量（胫神经体感诱发电位的幅度比）和皮质脊髓束的各向异性的侧偏指数使用弥散张量成像。平衡功能采用 Berg 平衡量表进行测量。
Berg 平衡量表评分与年龄和皮质脊髓束侧偏指数呈显著负相关，与简易精神状态检查呈显著正相关；下肢 Fugl-Meyer 评估；受影响的髋关节、膝关节和踝关节的运动力量；体感诱发电位幅度比（P < 0.05）。体感诱发电位异常组和皮质脊髓束完整性差组 Berg 平衡量表评分明显降低。多变量逻辑回归分析显示，年龄、下肢 Fugl-Meyer 评估评分和踝关节跖屈肌力与平衡功能显著相关（优势比分别为 0.919、1.181 和 15.244，P < 0.05）。
年龄较高、初始运动障碍严重以及下肢肌肉，特别是踝关节跖屈肌的力量，与脑卒中后早期平衡功能不良密切相关。
要求 CME 学分：完成在线自我评估活动和评估，网址为：http://www.physiatry.org/JournalCME。
CME 目标：完成本文后，读者应能够：（1）通过学习常见的评估工具，包括临床检查、神经生理学和神经影像学研究，提高评估脑卒中患者运动和平衡功能的能力；（2）解释与早期亚急性脑卒中患者平衡功能障碍相关的重要因素；（3）根据脑卒中后的恢复阶段，增强改善平衡功能的康复策略计划。
高级。
学术物理治疗师协会由继续医学教育认证委员会认可，为医生提供继续医学教育。学术物理治疗师协会指定此基于期刊的 CME 活动可获得最多 1.0 项 AMA PRA 类别 1 学分（TM）。医生只能要求与其参与活动程度相符的学分。
