目的:观察步行训练的时机选择对脑卒中偏瘫病人平衡及步行能力的影响.方法:选择脑卒中偏瘫病人68例,随机分为观察组34例和对照组34例,观察组在早期肌张力不低下的条件下开始进行科学的步行训练,对照组在具备一定的条件(站立平衡等级超过3级、患肢能够支持3/4以上体质量、患肢具有主动屈/伸膝、屈/伸髋、踝关节背屈功能)后进行步行训练.2组在训练前、训练2个月后分别采用Berg平衡量表(BBS)、简式Fugl-Meyer 运动功能量表(FMA)、Bathel指数(MBI)、Holden步行功能分级(FAC)评定病人平衡功能、下肢运动功能、日常生活活动能力以及步行能力.此外,通过10 m最大步行速度测定法获得病人的步行速度、步长和步频等步态参数来评价步行质量.结果:训练2个月后,观察组和对照组BBS、FMA、MBI以及FAC评分均显著优于治疗前(P<0.01),且训练后观察组的各项评分均高于对照组(P<0.01);观察组步行质量优于对照组(P<0.05~P<0.01).结论:步行训练时机的选择,对于肌张力恢复正常的偏瘫病人来说有重要意义,尽早开始科学的步行训练能够有效提高脑卒中偏瘫病人的平衡及步行能力,进而提高病人的步行质量.%Objective:To observe the effects of the timing of ambulation training on balance function and walking ability of hemiplegia patients with stroke.Methods:Sixty-eight hemiplegia patients with stroke were randomly divided into the observation group(n=34) and control group(n=34).The observation group were treated with scientific walking training under the condition of the high muscle tension at the early stage,and the control group were treated with scientific walking training under certain conditions,which included the standing balance more than grade 3,injured limb supporting over 3/4 of self-body weight,normal flex and adduct function of the knee joint and hip joint,and normal dorsiflexion function of ankle joint.The balance function,lower limb motor function,activities of daily living and walking ability in two groups were evaluated using the Berg balance scale(BBS),simple type Fugl-Meyer motor function scale(FMA),Bathel index(MBI) and Holden walking function rating(FAC) before training and after two months of training, respectively.The walking speed,stride length and stride frequency were measured using the max walking speed of 10m.Results:After 2 months of training,the scores of the BBS,FMA,MBI and FAC in two groups were significantly better than before treatment(P<0.01), the scores of the BBS,FMA,MBI and FAC in observation group were significantly higher those in control group(P<0.01),and the walking quality in observation group was better that in control group(P<0.05 to P<0.01).Conclusions:The timing of scientific walking training has important significance in the recovery of muscle tension in hemiplegia patients. The starting scientific walking training as early as possible can effectively improve the balance function,walking ability and living quality of patients.
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