上肢位及椅子高度对脑卒中偏瘫患者坐-站转移时下肢负重及稳定性的影响

摘要

Objective:To explore the effects of arm position and seat height on sit‐to‐stand (STS) lower limb load‐ing and stability in hemiplegic stroke patients .Methods:Thirty hemiplegic patients with stroke were recruited who were required to complete the STS with different arm positions (grasped arms ,GA ;and crossed arms ,CA) and seat height (high chair ,and standard chair) .The duration ,mean lower limb loading ,index of asymmetry of limb load (IOA) and sway of the center of gravity (COG) in mediolateral directions (COGX) were measured during STS in 4 cases by gait and balance function training and assessment system (model AL‐080) .The differences between them were compared .Results:At GA ,except for time required for STS ,the differences were statistically significant (P<0 .05) in the average loading of the non‐paretic foot and the paretic foot ,IOA and COGX as compared with those at CA .However ,there was no significant difference in the average loading of the non‐paretic foot and the pa‐retic foot ,and IOA between the two seat heights at any arm position ,and the significant difference was found in time required for STS and COGX (P<0 .05) .There was no significant difference in all indicators between left and right hemiplegia .Conclusion:Changing the upper limb position affects lower limb loading and postural stability dur‐ing STS in hemiplegic stroke patients .However ,seat height influences postural stability during STS in hemiplegic stroke patients .%目的：探讨上肢位及椅子高度对脑卒中偏瘫患者坐‐站转移下肢负重及稳定性的影响。方法：脑卒中偏瘫患者30例，分别在双手叉握（GA）及双手交叉胸前（CA）两种上肢位及两种不同高度的椅子（高椅及标准椅）上完成坐‐站转移测试，采用A L‐080型步态与平衡功能训练评估系统对受试者完成坐‐站转移的时间、双下肢负重、双下肢负重不对称性（IOA）及人体重心点（COG）在冠状面上的摆动幅度（COGX）进行测量，探讨其不同差异。结果：姿势GA时，除坐‐站转移所需的时间外，健足平均负重、患足平均负重、IOA及 COGX与姿势CA相比较，差异均有统计学意义（P＜0．05）。在高椅子上完成坐‐站转移时，与标准椅子相比较，健足平均负重、患足平均负重及IOA无明显差异，而坐‐站转移所需时间以及COGX均差异有统计学意义（ P＜0．05）。左侧脑卒中偏瘫与右侧偏瘫相比较，坐‐站转移所需时间、患侧下肢负重、健侧下肢负重、IOA及COGX均无差异（P＜0．05）。结论：不同上肢位影响脑卒中偏瘫患者坐‐站转移的下肢负重及稳定性；椅子高度影响脑卒中偏瘫患者坐‐站转移的稳定性。