司马振奋,龚剑秋,吴月峰.Lokomat训练对脑卒中后下肢痉挛患者步行能力的影响[J].中华物理医学与康复杂志,2022,44(3):209-213
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| Lokomat训练对脑卒中后下肢痉挛患者步行能力的影响 |
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| DOI：10.3760/cma.j.issn.0254-1424.2022.03.004 |
| 中文关键词: 步行能力 Lokomat训练 下肢痉挛 脑卒中 平地步行训练 |
| 英文关键词: Walking ability Lokomat training Spasm Stroke Walking training |
| 基金项目:绍兴市公益性技术应用研究计划（2015B70049），绍兴市卫生计生科技计划青年科技项目（2017QN003） |
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| 中文摘要: |
| 目的 观察Lokomat训练对脑卒中后下肢痉挛患者步行能力的影响。 方法 采用随机数字表法将80例脑卒中后下肢痉挛患者分为观察组及对照组。2组患者均给予常规康复干预（包括良姿位摆放、被动关节活动、翻身训练、斜床站立等），观察组在此基础上辅以Lokomat训练，对照组则辅以平地步行训练，每周训练3次，连续训练8周。于治疗前、治疗4周、8周后分别对2组患者步行能力、下肢痉挛程度、下肢运动功能、平衡功能以及日常生活活动（ADL）能力进行评定。 结果 治疗4周及8周时观察组恢复独立步行能力患者例数（分别为16例、29例）均明显多于对照组（P＜0.05），观察组步频、患侧步长、患侧支撑相时间及占比均明显优于对照组（P＜0.05）；治疗8周时观察组平均步速亦优于对照组（P＜0.05）。治疗4周、8周时观察组下肢肌张力恢复正常患者例数（分别为28例、33例）均明显多于对照组（P＜0.05）。治疗4周、8周时观察组下肢Fugl-Meyer评分［分别为（20.10±8.11）分和（24.07±7.98）分］、Berg平衡量表评分［分别为（28.87±13.41）分和（40.80±12.90）分］及改良Barthel指数评分［分别为（72.00±20.22）分和（82.25±15.79）分］均较治疗前及对照组明显改善（P＜0.05）。 结论 Lokomat训练能在短期内显著改善脑卒中后下肢痉挛患者步频、步长、患侧支撑等步行参数，长期训练还能进一步提高步速，缓解下肢痉挛，同时对患者下肢运动功能、平衡功能及ADL能力等亦有明显改善作用，从而提高患者整体康复疗效。 |
| 英文摘要: |
| Objective To explore the effect of Lokomat training on the walking ability of stroke survivors with lower limb spasm. Methods Eighty stroke survivors with lower limb spasm were randomly divided into an observation group and a control group, each of 40. Their routine rehabilitation treatment included normal limb positioning, passive joint movement, turnover training and inclined bed standing training. In addition, the control group underwent flat-ground walking training, while the observation group was given Lokomat training 3 times a week for 8 weeks. Both groups were evaluated after 4 and 8 weeks of treatment in terms of their walking ability, degree of lower limb spasm, lower limb motor functioning, balance and ability in the activities of daily life. Results After 4 and 8 weeks the number of patients walking independently was significantly greater in the observation group. Their average stride frequency, step length on the affected side, support phase time and proportion of weight borne on the affected side were all significantly better than the control group′s averages. At both time points significantly more patients of the observation group had normal lower limb muscle tone. The observation group′s average Fugl-Meyer score, Berg Balance Scale score and modified Barthel Index score had improved significantly compared with those before the treatment, and were significantly better than the control group′s averages at the same time point. After 8 weeks of treatment the average walking speed of the observation group was faster than that of the control group. Conclusions Lokomat training can significantly improve the walking ability of stroke survivors with lower limb spasm in the short term. Longer-term training can consolidate the effect and further improve the walking speed, motor function in the lower limbs, balance and even facility in daily life activities, as well as relieving spasm. |
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