《中国康复理论与实践》

《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (1): 68-73.doi: 10.3969/j.issn.1006-9771.2024.01.009

• 应用研究 • 上一篇    下一篇

主观垂直感知障碍对脑卒中患者功能影响的回顾性研究

王昊懿1,2, 史亚伟3, 鲁俊1,4(), 许光旭1,4()   

  1. 1.南京医科大学康复医学院，江苏南京市 210029
    2.张家港市中医医院康复科，江苏苏州市 215600
    3.南京医科大学附属口腔医院，江苏南京市 210029
    4.南京医科大学第一附属医院康复医学中心，江苏南京市 210029
  • 收稿日期:2023-12-17 出版日期:2024-01-25 发布日期:2024-02-04
  • 通讯作者: 鲁俊(1989-)，男，汉族，江苏南京市人，主管治疗师，主要研究方向：运动康复。E-mail：lujunrehab@foxmail.com；许光旭(1966-)，男，汉族，江苏徐州市人，主任医师、教授，主要研究方向：运动创伤的诊断与临床康复治疗、中枢神经损伤运动控制分析与康复干预等。E-mail：xuguangxu@njmu.edu.cn
  • 作者简介:王昊懿(1985-)，男，汉族，江苏苏州市人，硕士研究生，副主任医师，主要研究方向：中枢神经损伤康复。
  • 基金资助:
    江苏省研究生科研与实践创新计划项目(KYCX23_1934)

Impact of subjective vertical perception impairment on function in stroke patients: a retrospective study

WANG Haoyi1,2, SHI Yawei3, LU Jun1,4(), XU Guangxu1,4()   

  1. 1. Department of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu 210029, China
    2. Rehabilitation Department, the Traditional Chinese Medical Hospital of Zhangjiagang City, Suzhou, Jiangsu 215600, China
    3. Affiliated Dental Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
    4. Rehabilitation Medicine Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
  • Received:2023-12-17 Published:2024-01-25 Online:2024-02-04
  • Contact: LU Jun, E-mail: lujunrehab@foxmail.com; XU Guangxu, E-mail: xuguangxu@njmu.edu.cn
  • Supported by:
    Jiangsu Postgraduate Research & Practice Innovation Program(KYCX23_1934)

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摘要：

目的 探讨脑卒中主观垂直感知障碍对视空间认知、平衡、步行功能及日常生活活动能力的影响，以及视空间认知和侧倾行为的中介作用。

方法 2023年2月至12月，选取南京医科大学第一附属医院康复医学中心收治的脑卒中患者96例，分为垂直感知障碍组(n = 53)与非垂直感知障碍组(n = 43)。采用美国国立卫生研究院卒中量表(NIHSS)、侧推评估量表(SCP)、Burke侧倾量表(BLS)、线等分试验(LBT)、线段划消试验(LCT)、星消试验(SCT)、主观视觉垂直感知(SVV)、Berg平衡量表(BBS)、Holden步行功能分级(FAC)和Barthel指数(BI)进行评定。

结果 垂直感知障碍组SVV方向性和稳定性，NIHSS、SCT、SCP、BLS、BBS、FAC和BI评分差于非垂直感知障碍组(|t| > 2.414, Z = -3.481, P < 0.05)。两组SVV，SCT、BLS和BBS评分两两相关(|r| ≥ 0.273, P < 0.05)。控制年龄和性别后，SVV方向性对BBS评分无直接作用(β = -0.011, P = 0.920)，但可通过BLS的部分中介效应(效应量 = -0.173, 95%CI -0.278 ~ -0.076)，以及SCT和BLS的链式中介效应(效应量 = -0.073, 95%CI -0.137 ~ -0.027)两条路径对BBS评分产生影响。

结论 主观视觉垂直感知障碍影响脑卒中患者的视空间认知、平衡、步行功能和日常生活活动能力，主要通过视空间认知和侧倾行为的中介效应影响脑卒中患者的平衡功能。

关键词: 脑卒中, 主观垂直感知障碍, 平衡, 视空间认知, 日常生活活动能力, 中介效应

Abstract:

Objective To explore the impact of subjective vertical perception impairment after stroke on visuospatial cognition, balance, walking and activities of daily living, to investigate the mediating role of visuospatial cognition and lateropulsion.

Methods From February to December, 2023, 96 stroke patients were selected from the Rehabilitation Medicine Center of the First Affiliated Hospital of Nanjing Medical University. They were divided into vertical perception impairment group (n = 53) and non-vertical perception impairment group (n = 43). They were assessed with National Institutes of Health Stroke Scale (NIHSS), the Scale for Contraversive Pushing (SCP), Burke Lateropulsion Scale (BLS), Line Bisection Test (LBT), Line Cancellation Test (LCT), Star Cancellation Test (SCT), Subjective Visual Vertical (SVV), Berg Balance Scale (BBS), Holden Functional Ambulation Categories (FAC) and Barthel Index (BI).

Results Scores of SVV orientation, SVV uncertainty, NIHSS, SCT, SCP, BLS, BBS, FAC and BI were worse in the vertical perception impairment group than in the non-vertical perception impairment group (|t| > 2.414, Z = -3.481, P< 0.05). Scores of SVV were correlated with SCT, BLS and BBS (|r| ≥ 0.273, P< 0.05). After controlling for age and gender, SVV orientation score did not directly impact BBS score (β= -0.011, P =0.920). However, it exerted a partial mediating effect through BLS (effect = -0.173, 95%CI -0.278 to -0.076) and a chain-mediated effect through SCT and BLS (effect = -0.073, 95%CI -0.137 to -0.027), impacting BBS score.

Conclusion Subjective vertical perception impairment results in poorer visuospatial cognition, balance, walking and activities of daily living in stroke patients. This influence on balance function is mediated through the mediating effects of visuospatial cognition and lateropulsion.

Key words: stroke, subjective vertical perception impairment, balance, visuospatial cognition, activities of daily living, mediating effects

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