基于现实环境的功能性步态训练对社区卒中后康复期老人步态特征及害怕跌倒的影响

doi:10.16460/j.issn1008-9969.2018.19.001

摘要/Abstract

摘要： 目的探讨在现实环境下运用功能性步态训练来分析社区卒中后康复期老人步态特征的改变,以及对其害怕跌倒的影响。方法选取在南京市某三级甲等医院康复出院的卒中患者进行追踪,采用随机数字表法分为干预组30例和对照组29例,对照组给予常规出院康复训练,而干预组在此基础上增加现实环境中的步态训练,分别在出院前,出院后8周采用便携式步态分析仪采集患者常速行走10 m的步态参数,同时采用单条目问题法和修订版跌倒效能量表分析老人跌倒恐惧的状况。结果干预前,2组老人各项步态参数、跌倒效能得分比较无统计学意义（P>0.05）,经过干预8周后2组患者在患侧站立相、患侧摆动相、摆动强度、落脚强度、落脚时脚角度、步频、跨步时间变异性差异有统计学意义（P<0.05）,跌倒效能干预组差异有统计学意义（P<0.05）。干预前对照组害怕跌倒的老人为14例（48.28%）,干预组为13例（43.33%）;8周后对照组害怕跌倒老人为11例（37.93%）,干预组为5例（16.67%）,差异有统计学意义（P<0.05）。结论基于现实环境的功能性步态训练对社区卒中后康复期老人步态特征及害怕跌倒有积极的改善效果。

关键词: 社区护理, 卒中, 康复期, 步态特征, 害怕跌倒

Abstract: Objective To explore the change of gait and fear of fall in community-dwelling elderly convalescent stroke patients after reality-based functional gait training. Methods Fifty-nine stroke patients discharged from one tertiary grade A hospital in Nanjing were randomly divided into intervention group (n=30)and control group (n=29). The control group performed conventional rehabilitation training after the discharge but the intervention group received additional reality-based functional gait training. Gait parameters of 10 meter walkway with normal speed were collected by using a portable gait analyzer just before and 8 weeks after the discharge. Single entry problem method and Modified Fall Efficacy Scale were employed to analyze patients’ fear of fall. Results Gait parameters and fall efficacy of the two groups before the discharge indicated no statistical significance (P>0.05). Stand phase and swing phase of the affected side, swing strength, foot fall, pre-swing angle, stride frequency and stride time variability in the intervention group after 8-week training suggested statistical significance (P<0.05) and fall efficacy in the intervention group showed statistical significance (P<0.05). Before the intervention, there were 14 cases (48.28%) of patients fearing of fall in the control group and 13 (43.33%) in the intervention group but the number decreased to 11 (37.93%) in the control group and 5 (16.67%) in the intervention group and it was statistically different (P<0.05). Conclusion Reality-based functional gait training is effective for improving gait characteristics and fear of fall in community-dwelling elderly convalescent stroke patients.

Key words: community nursing, stroke, convalescence, gait characteristics, fear of falling

中图分类号:

R473.2

孟凡嫣, 陈璇, 王艳, 吴颖. 基于现实环境的功能性步态训练对社区卒中后康复期老人步态特征及害怕跌倒的影响[J]. 护理学报, 2018, 25(19): 1-4.

MENG Fan-yan, CHEN Xuan, WANG Yan, WU Ying. Effect of Reality-based Functional Gait Training on Gait Characteristics and Fear of Fall in Community-dwelling Elderly Convalescent Stroke Patients[J]. Journal of Nursing, 2018, 25(19): 1-4.

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