运动-步行双任务训练对脑卒中患者步行功能影响的临床研究

Effect of exercise-walking dual-task training on walking function in patients with stroke

摘要:

目的：探讨运动-步行双任务训练对脑卒中患者步行功能的影响。方法：采用信封抽签法将56例脑卒中偏瘫患者随机分为对照组（n=27）和试验组（n=29），对照组给予常规步行训练，试验组进行与对照组相同时间与频次的运动-步行双任务训练。在干预前、干预4周后记录患侧股直肌、股二头肌、胫前肌、腓肠肌最大等长收缩的积分肌电值（integrated electromyography，IEMG）及屈膝、伸膝，踝背伸、跖屈时的协同收缩率（co-contraction rate，CR）；计算10 m步行测试时的单任务步速、托盘行走时的双任务步速及双任务步速成本（dual-task walking speed cost，DTC）。结果：对照组26 例，试验组27 例完成研究。干预4 周后，2组患者的IEMG、CR及步速均比干预前明显改善（P<0.01）。伸膝和踝背屈时，试验组股直肌和胫前肌的IEMG高于对照组（P<0.05），CR低于对照组（P<0.05）。试验组双任务下的步速高于对照组（P<0.001），DTC低于对照组（P<0.001）。结论：运动-步行双任务训练可改善患者的步行功能，相较于常规步行训练更有助于患者偏瘫下肢主动肌与拮抗肌之间的协同。

Abstract:

Objective：To explore the effect of exercise-walking dual-task training on walking function in patients with stroke. Methods：A total of 56 hemiplegic patients with stroke were randomized into control group（n=27） and experimental group（n=29）. The control group was given routine walking training，and the experimental group was given exercise-walking dual-task training as the same time and frequency as the control group. The integrated electromyography（IEMG） of maximal isometric contraction of rectus femoris，biceps femoris，tibialis anterior muscle and gastrocnemius muscle，and the co-contraction rate（CR） of knee flexion，knee extension，ankle dorsiflexion and ankle plantarflexion were recorded before intervention and after 4 weeks of intervention. The single-task walking speed，dual-task walking speed and dual-task walking speed cost（DTC） during 10 m walking test were calculated. Results：A total of 26 cases in the control group and 27 cases in the experimental group completed the study. After 4 weeks of intervention，the IEMG，CR and walking speed of patients in both groups were significantly improved as compared with those before intervention（P<0.01）. During knee extension and ankle dorsiflexion，the IEMG of rectus femoris and tibialis anterior muscle in the experimental group was higher than that in the control group（P<0.05），while CR was lower than that in the control group（P<0.05）. The walking speed of the experimental group under dual-task was higher than that of the control group（P<0.001），and the DTC was lower than that of the control group（P<0.001）. Conclusion：Exercise-walking dual-task training can improve the walking function of patients，and compared with routine walking training，it’s more helpful to the coordination between agonistic muscle and antagonistic muscle of hemiplegic lower limbs.