脑卒中患者步行中自发性转身方向与平衡和跌倒风险间的关系

doi:10.3969/j.issn.1006-9771.2023.05.003

Abstract

Abstract:

Objective To investigate the relationship among spontaneous turning direction, balance ability and fall risk in patients with stroke during walking.

Methods From December, 2021 to November, 2022, 94 patients with stroke were recruited from Beijing Bo'ai Hospital. They were assessed with simple Timed 'Up and Go' Test (TUGT, TUGT1), TUGT with a cup in hand (TUGT2), and TUGT with calculation task (TUGT3). The spontaneous turning directions at the turn point were recorded, and the patients were divided into no-same group (n = 34) and same group, and the same group was further divided into affected group (n = 33) and unaffected group (n = 27), according to the spontaneous turning direction. After a spontaneous turning of each TUGT, the patients were asked to finish another TUGT turning to the opposite direction. And then, they were assessed with single leg standing test, Functional Reach Test (FRT), 360° turning test and the Morse Fall Scale (MFS).

Results There were the most patients with left hemiplegia in the affected group (χ² = 7.995, P < 0.05). The time of TUGT1, TUGT2 and TUGT3 was the most in the affected group and the least in the unaffected group (F > 4.009, P < 0.05), and it was more in the affected group than in the unaffected group as post-hoc test (P < 0.05). The one leg standing time (H= 9.403, P= 0.009) and FRT distance (F = 4.300, P = 0.016) were the least in the affected group and the most in the unaffected group, and it was less in the affected group than in the unaffected group as post-hoc test (P < 0.05). The turning time (F= 4.134, P = 0.019) and turning steps (F= 5.611, P = 0.003) were the most in the affected group and the least in the unaffected group, and it was more in the affected group than in the unaffected group as post-hoc test (P < 0.05). The score of MFS was the most in the affected group and the least in the unaffected group (H = 8.192, P = 0.017), and it was more in the affected group than in the unaffected group as post-hoc test (P < 0.05).

Conclusion The stroke patients spontaneously turning to the affected side during walking usually are poorer in balance function, and in a risk of fall.

Key words: stroke, turning, cognition, balance, fall

CLC Number:

R743.3

ZHU Xiaomin, LIU Huilin, LIU Yuanmin, YAN Zhiyu, DU Xuejing, WANG Ya'nan, ZHANG Tong. Relationship among spontaneous turning direction, balance and fall risk in stroke patients during walking[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(5): 510-515.

Figures/Tables 5

References 45

[1]	TSUR A, SEGAL Z. Falls in stroke patients: risk factors and risk management[J]. Isr Med Assoc J, 2010, 12(4): 216-219. pmid: 20803880
[2]	MORONE G, MARTINO CINNERA A, PAOLUCCI T, et al. Clinical features of fallers among inpatient subacute stroke: an observational cohort study[J]. Neurol Sci, 2020, 41(9): 2599-2604. doi: 10.1007/s10072-020-04352-2 pmid: 32253635
[3]	LUO Y Q, DENG X Q, WU C K, et al. Clinical characteristics and risk factors for falls within two years after stroke in elderly patients[J]. Chin J Geriatr, 2018, 37(9): 978-983.
[4]	KOH J S G, HILL A M, HILL K D, et al. Evaluating a novel multifactorial falls prevention activity programme for community-dwelling older people after stroke: a mixed-method feasibility study[J]. Clin Interv Aging, 2020, 15: 1099-1112. doi: 10.2147/CIA.S251516 pmid: 32764897
[5]	仵三娟, 杨辉, 曹慧丽, 等. 脑卒中病人跌倒危险因素及预防策略的研究进展[J]. 护理研究, 2020, 34(13): 2351-2355.
	WU S J, YANG H, CAO H L, et al. Research progress on fall risk factors and prevention strategies in stroke patients[J]. Chin Nurs Res, 2020, 34(13): 2351-2355.
[6]	YANG F, LEES J, SIMPKINS C, et al. Interventions for preventing falls in people post-stroke: a meta-analysis of randomized controlled trials[J]. Gait Posture, 2021, 84: 377-388. doi: 10.1016/j.gaitpost.2020.12.034 pmid: 33476831
[7]	XU T, CLEMSON L, O'LOUGHLIN K, et al. Risk factors for falls in community stroke survivors: a systematic review and meta-analysis[J]. Arch Phys Med Rehabil, 2018, 99(3): 563-573.e5. doi: 10.1016/j.apmr.2017.06.032
[8]	LEACH J M, MELLONE S, PALUMBO P, et al. Natural turn measures predict recurrent falls in community-dwelling older adults: a longitudinal cohort study[J]. Sci Rep, 2018, 8(1): 4316. doi: 10.1038/s41598-018-22492-6 pmid: 29531284
[9]	BONNYAUD C, PRADON D, BENSMAIL D, et al. Dynamic stability and risk of tripping during the Timed Up and Go Test in hemiparetic and healthy subjects[J]. PLoS One, 2015, 10(10): e0140317. doi: 10.1371/journal.pone.0140317
[10]	GOTO Y, OTAKA Y, SUZUKI K, et al. Incidence and circumstances of falls among community-dwelling ambulatory stroke survivors: a prospective study[J]. Geriatr Gerontol Int, 2019, 19(3): 240-244. doi: 10.1111/ggi.13594 pmid: 30623545
[11]	罗玉球, 邓晓清, 吴彩葵, 等. 老年脑卒中后2年跌倒的临床特点及危险因素分析[J]. 中华老年医学杂志, 2018, 37(9): 978-983.
	LUO Y Q, DENG X Q, WU C K, et al. Clinical characteristics and risk factors for falls within two years after stroke in elderly patients[J]. Chin J Geriatr, 2018, 37(9): 978-983.
[12]	BARROIS R P, RICARD D, OUDRE L, et al. Observational study of 180° turning strategies using inertial measurement units and fall risk in poststroke hemiparetic patients[J]. Front Neurol, 2017, 8: 194. doi: 10.3389/fneur.2017.00194
[13]	CHEN I H, LIANG P J, CHIU V J, et al. Trunk muscle activation patterns during standing turns in patients with stroke: an electromyographic analysis[J]. Front Neurol, 2021, 12: 769975. doi: 10.3389/fneur.2021.769975
[14]	CHAN P P, SI TOU J I, TSE M M, et al. Reliability and validity of the Timed Up and Go Test with a motor task in people with chronic stroke[J]. Arch Phys Med Rehabil, 2017, 98(11): 2213-2220. doi: 10.1016/j.apmr.2017.03.008
[15]	闫睿, 周健, 刘博, 等. 计时起立行走测试在老年跌倒风险筛查中的应用研究进展[J]. 中华老年医学杂志, 2022, 41(6): 743-747.
	YAN R, ZHOU J, LIU B, et al. The Timed Up and Go Test for fall risk prediction in older adults: the latest advances[J]. Chin J Geriatr, 2022, 41(6): 743-747.
[16]	郭静霞, 陈亮, 余启超, 等. 运动对预防老年人跌倒效果的网状Meta分析[J]. 中国康复理论与实践, 2021, 27(5): 563-573. doi: 10.3969/j.issn.1006-9771.2021.05.009
	GUO J X, CHEN L, YU Q C, et al. Efficacy of exercise on fall in old adults: a network meta-analysis[J]. Chin J Rehabil Theory Pract, 2021, 27(5): 563-573.
[17]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑血管病一级预防指南2019[J]. 中华神经科杂志, 2019, 52(9): 684-709.
	Chinese Society of Neurology, Chinese Stroke Society. Guidelines for the Primary Prevention of Cerebrovascular Diseases in China 2019[J]. Chin J Neurol, 2019, 52(9): 684-709.
[18]	LIPARULO L, ZHANG Z, PANELLA M, et al. A novel fuzzy approach for automatic Brunnstrom stage classification using surface electromyography[J]. Med Biol Eng Comput, 2017, 55(8): 1367-1378. doi: 10.1007/s11517-016-1597-3 pmid: 27909939
[19]	WATANABE H, TASHIRO K. Brunnstrom stages and Wallerian degenerations: a study using MRI[J]. Tohoku J Exp Med, 1992, 166(4): 471-473. pmid: 1502693
[20]	郭铁成, 卫小梅, 陈小红. 改良Ashworth量表用于痉挛评定的信度研究[J]. 中国康复医学杂志, 2008, 23(10): 906-909.
	GUO T C, WEI X M, CHEN X H. Reliability of clinical measurements obtained with modified Ashworth Scale in Chinese patients with spasticity[J]. Chin J Rehabil Med, 2008, 23(10): 906-909.
[21]	BURTON L, TYSON S F. Screening for cognitive impairment after stroke: a systematic review of psychometric properties and clinical utility[J]. J Rehabil Med, 2015, 47(3): 193-203. doi: 10.2340/16501977-1930 pmid: 25590458
[22]	LOUIE D R, ENG J J. Berg Balance Scale score at admission can predict walking suitable for community ambulation at discharge from inpatient stroke rehabilitation[J]. J Rehabil Med, 2018, 50(1): 37-44. doi: 10.2340/16501977-2280 pmid: 29068037
[23]	WONG C K. Interrater reliability of the Berg Balance Scale when used by clinicians of various experience levels to assess people with lower limb amputations[J]. Phys Ther, 2014, 94(3): 371-378. doi: 10.2522/ptj.20130182 pmid: 24092903
[24]	黄小芳, 严谨, 杨土保, 等. Morse跌倒量表评估在住院患者防跌倒护理中的成本效果[J]. 中南大学学报(医学版), 2021, 46(5): 529-535.
	HUANG X F, YAN J, YANG T B. Cost-effectiveness of Morse Fall Scale assessment in fall prevention care in hospitalized patients[J]. J Central South Univ (Med Sci), 2021, 46(5): 529-535.
[25]	MORSE J M, BLACK C, OBERLE K, et al. A prospective study to identify the fall-prone patient[J]. Soc Sci Med, 1989, 28(1): 81-86. pmid: 2928815
[26]	MACIASZEK J. Effects of posturographic platform biofeedback training on the static and dynamic balance of older stroke patients[J]. J Stroke Cerebrovasc Dis, 2018, 27(7): 1969-1974. doi: S1052-3057(18)30117-4 pmid: 29598908
[27]	PORTNOY S, REIF S, MENDELBOIM T, et al. Postural control of individuals with chronic stroke compared to healthy participants: Timed-Up-and-Go, Functional Reach Test and center of pressure movement[J]. Eur J Phys Rehabil Med, 2017, 53(5): 685-693.
[28]	朱晓敏, 刘元旻, 杜雪晶, 等. 功能性伸展测试临床应用进展[J]. 中国康复理论与实践, 2021, 27(5): 583-587. doi: 10.3969/j.issn.1006-9771.2021.05.011
	ZHU X M, LIU Y M, DU X J, et al. Advance in application of Functional Reach Test (review)[J]. Chin J Rehabil Theory Pract, 2021, 27(5): 583-587.
[29]	SHIU C H, NG S S, KWONG P W, et al. Timed 360° Turn Test for assessing people with chronic stroke[J]. Arch Phys Med Rehabil, 2016, 97(4): 536-544. doi: 10.1016/j.apmr.2015.11.010
[30]	ZOU T E, LIANG P J, LEE S C. Turning duration and steps predict future falls in poststroke hemiplegic individuals: a preliminary cohort study[J]. Top Stroke Rehabil, 2021, 28(1): 33-41. doi: 10.1080/10749357.2020.1760644
[31]	HEUNG T H, NG S S. Effect of seat height and turning direction on the Timed Up and Go Test scores of people after stroke[J]. J Rehabil Med, 2009, 41(9): 719-722. doi: 10.2340/16501977-0411 pmid: 19774304
[32]	LYDERS JOHANSEN K, DERBY STISTRUP R, SKIBDAL SCHJØTT C, et al. Absolute and relative reliability of the Timed 'Up & Go' Test and '30 second Chair-Stand' test in hospitalised patients with stroke[J]. PLoS One, 2016, 11(10): e0165663. doi: 10.1371/journal.pone.0165663
[33]	ZAK M, KRUPNIK S, BROLA W, et al. Functional capacity and dual-task cost in the institutionalized older adults, both affected and unaffected by mild cognitive impairment[J]. Eur Rev Aging Phys Act, 2021, 18(1): 16. doi: 10.1186/s11556-021-00270-0
[34]	AL-YAHYA E, DAWES H, SMITH L, et al. Cognitive motor interference while walking: a systematic review and meta-analysis[J]. Neurosci Biobehav Rev, 2011, 35(3): 715-728. doi: 10.1016/j.neubiorev.2010.08.008
[35]	YANG L, HE C, PANG M Y. Reliability and validity of dual-task mobility assessments in people with chronic stroke[J]. PLoS One, 2016, 11(1): e0147833. doi: 10.1371/journal.pone.0147833
[36]	LIANG P J, CHIU V J, TENG Y C, et al. Turning difficulties after stroke and its relationship with trunk function[J]. Eur J Phys Rehabil Med, 2021, 57(6): 859-865.
[37]	BARROIS R P, RICARD D, OUDRE L, et al. Observational study of 180° turning strategies using inertial measurement units and fall risk in poststroke hemiparetic patients[J]. Front Neurol, 2017, 15(8): 194.
[38]	KUAN Y C, LIN L F, WANG C Y, et al. Association between turning mobility and cognitive function in chronic poststroke[J]. Front Neurol, 2022, 13: 772377. doi: 10.3389/fneur.2022.772377
[39]	STUART S, BELLUSCIO V, QUINN J F, et al. Pre-frontal cortical activity during walking and turning is reliable and differentiates across young, older adults and people with Parkinson's disease[J]. Front Neurol, 2019, 10: 536. doi: 10.3389/fneur.2019.00536 pmid: 31191434
[40]	LAMONTAGNE A, FUNG J. Gaze and postural reorientation in the control of locomotor steering after stroke[J]. Neurorehabil Neural Repair, 2009, 23(3): 256-266. doi: 10.1177/1545968308324549
[41]	LEWALLEN L K, SRIVASTAVA S, KAUTZ S A, et al. Assessment of turning performance and muscle coordination in individuals post-stroke[J]. J Biomech, 2021, 114: 110113. doi: 10.1016/j.jbiomech.2020.110113
[42]	HOLLANDS K L, VAN VLIET P, ZIETZ D, et al. Stroke-related differences in axial body segment coordination during preplanned and reactive changes in walking direction[J]. Exp Brain Res, 2010, 202(3): 591-604. doi: 10.1007/s00221-010-2162-1 pmid: 20107979
[43]	ROUTSON R L, KAUTZ S A, NEPTUNE R R. Modular organization across changing task demands in healthy and poststroke gait[J]. Physiol Rep, 2014, 2(6): e12055. doi: 10.14814/phy2.12055
[44]	CHAN W N, TSANG W W. The performance of stroke survivors in turning-while-walking while carrying out a concurrent cognitive task compared with controls[J]. PLoS One, 2017, 12(12): e0189800. doi: 10.1371/journal.pone.0189800
[45]	方潇. 传统中国"利手性"及其礼法境遇:兼与西方传统比较[J]. 安徽史学, 2022(5): 5-15.
	FANG X. Traditional Chinese "Chirality" and its ritual and legal circumstances: a comparison with western tradition[J]. Anhui Historiography, 2022(5): 5-15.

项目	n	性别 (男/女)/n	年龄/岁	体质量/kg	身高/cm	偏瘫侧 (左/右)/n	卒中性质 (出血/梗死) /n	病程/月	MMSE 评分
患侧组	33	16/17	68.00±4.75	67.70±4.41	165.33±4.47	23/10	15/18	4(2.5, 5)	28(27, 28)
健侧组	27	14/13	67.44±3.38	69.48±4.77	166.07±4.77	10/17	13/14	4(2, 5)	28(27, 28)
转向不一致组	34	17/17	67.02±3.29	67.21±4.60	164.65±5.09	14/20	16/18	4(2, 5)	28(27, 28)
χ²/F/H值		0.067	0.524	1.991	0.670	7.995	0.045	0.037	0.528
P值		0.967	0.594	0.142	0.514	0.018	0.978	0.982	0.768

组别	n	TUGT1		TUGT2		TUGT3
组别	n	健侧	患侧	健侧	患侧	健侧	患侧
患侧组	33	26.33±5.75	26.18±6.10	26.58±5.47	26.48±5.79	30.00±5.79	30.51±6.34
健侧组	27	20.89±6.68^a	21.07±6.84^a	21.33±6.64^a	21.63±7.08^a	24.81±6.62^a	25.07±7.02^a
转向不一致组	34	23.12±7.43	22.62±7.20	23.50±7.33	23.44±7.34	26.62±7.49	26.88±7.67
F值		4.666	5.101	4.962	4.009	4.740	4.745
P值		0.012	0.008	0.009	0.021	0.011	0.011

组别	n	TUGT1		TUGT2		TUGT3
组别	n	健侧	患侧	健侧	患侧	健侧	患侧
左侧组	47	23.49±6.84	23.00±6.86	23.68±6.65	23.57±6.78	27.47±7.22	27.30±7.05
右侧组	47	23.72±7.13	23.85±7.16	24.26±7.04	24.40±7.21	27.11±6.73	27.98±7.64
t值		0.162	0.588	0.407	0.575	0.251	0.449
P值		0.871	0.558	0.685	0.567	0.802	0.654

组别	n	单腿支撑/s	FRT/cm	转向时间/s	转向步数/n	MFS
患侧组	33	5(4.5, 7.5)	14.76±4.10	8.97±1.87	10.39±1.85	25(15, 25)
健侧组	27	8(6, 9)^a	18.04±5.06^a	7.20±2.54^a	8.56±2.31^a	15(15, 25)^a
转向不一致组	34	6(5, 9)	17.53±5.14	8.04±2.70	9.09±2.45	15(15, 25)
F/H值		9.403	4.300	4.134	5.611	8.192
P值		0.009	0.016	0.019	0.003	0.017

组别	n	单腿支撑/s	FRT/cm	转向时间/s	转向步数/n	MFS
左侧组	47	7(5, 9)	16.89±4.49	7.96±2.39	9.36±2.23	15(15, 25)
右侧组	47	6(5, 8)	16.51±5.40	8.29±2.56	9.42±2.44	15(15, 25)
t/Z值		-0.374	0.374	0.653	0.132	-0.877
P值		0.708	0.709	0.515	0.895	0.381

Relationship among spontaneous turning direction, balance and fall risk in stroke patients during walking

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 5

References 45

Related Articles 15

Metrics

Comments

Recommended 0

[1]	LIN Na, GAO Hanlu, LU Huiping, CHEN Yanqing, ZHENG Junfan, CHEN Shurong. Effect of virtual reality on upper limb function after stroke: a study of diffusion tensor imaging [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 61-67.
[2]	WANG Haoyi, SHI Yawei, LU Jun, XU Guangxu. Impact of subjective vertical perception impairment on function in stroke patients: a retrospective study [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 68-73.
[3]	CHEN Junwen, CHEN Qian, CHEN Cheng, LI Shuyue, LIU Lingling, WU Cunshu, GONG Xiang, LU Jun, XU Guangxu. Effect of modified Baduanjin exercise on cardiopulmonary function, motor function and activities of daily living for stroke patients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 74-80.
[4]	HU Yonglin, MA Ying, DOU Chao, LU Anmin, JIANG Xiaoge, SONG Xinjian, XIAO Yuhua. Effect of neural mobilization based on shoulder control training on shoulder pain and upper limb function in stroke patients with hemiplegia [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 81-86.
[5]	WANG He, HAN Liang, KAN Mengfan, YU Shaohong. Efficacy of electrical stimulation on shoulder-hand syndrome after stroke: a systematic review and meta-analysis [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(9): 1048-1056.
[6]	YANG Ya'nan, MU Liping, XING Fengmei, XUE Xinhong, WANG Xiaoguang, TAO Yangyu, SUN Zhumei, ZHANG Xiaoli. Effect of intervention based on theory of planned behavior on muscle attenuation and balance of the elderly with sarcopenia [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 869-874.
[7]	SUN Tengfang, REN Mengting, YANG Lin, WANG Yaoting, WANG Hongyu, YAN Xingzhou. Effect of hyperbaric oxygen therapy combined with repetitive peripheral magnetic stimulation on ankle motor function and balance of stroke patients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 875-881.
[8]	MA Shengnan, KE Jingyue, DONG Hongming, LI Jianping, ZHANG Honghao, LIU Chao, SHEN Shuang, LI Guqiang. Effect of core stability training on dynamic balance and surface electromyography after anterior cruciate ligament reconstruction [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 882-889.
[9]	WANG Ya'nan, LIU Xihua. Correlation and predictive effect of subjective and objective balance function measurements in stroke patients with hemiplegia [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 890-895.
[10]	JIANG Changhao, HUANG Chen, GAO Xiaoyan, DAI Yuanfu, ZHAO Guoming. Effect of neurofeedback training on cognitive function in the elderly: a systematic review [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 903-909.
[11]	WANG Haiyun, WANG Yin, ZHOU Xinjie, HE Aiqun. Effect of transcranial direct current stimulation combined with acupuncture on central and upper limb function in stroke patients based on central-peripheral-central theory [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 919-925.
[12]	CHEN Yiting, WANG Qian, CUI Shenhong, LI Yingcai, ZHANG Siyu, WEI Yanxu, REN Hui, LENG Jun, CHEN Bin. Effect of bilateral sequential repetitive transcranial magnetic stimulation on motor function of upper limbs in stroke patients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 926-932.
[13]	LI Zhenya, SUN Jie, GUO Pengfei, WANG Guangming. Correlation between changes of swallowing function in oral and pharyngeal phases, and aspiration in stroke patients based on videofluroscopic swallowing study [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 933-939.
[14]	HUA Ling, ZHANG Yi'nan, ZHENG Yu, SUN Qiaoyi, FANG Hui, SONG Da. Effect of hand controlled rhythm music therapy on unilateral spatial neglect after stroke [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(7): 833-838.
[15]	JIANG Xiaocui, LIU Zhen, SU Qinglun, ZHAO Qin, XIA Xiaomei, LU Fei. Effect of intermittent theta burst transcranial magnetic stimulation on non-fluent aphasia after stroke [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(7): 839-843.