Zhongguo cuzhong zazhi (Aug 2023)
卒中患者足底压力特点及其与躯干、平衡和运动功能的相关性研究 Study on the Characteristics of Plantar Pressure in Stroke Patients and its Correlation with Trunk, Balance and Motor Function
Abstract
目的 探讨卒中患者足底压力特点及其与躯干、平衡和运动功能的相关性。 方法 前瞻性纳入2021年6月—2022年11月首都医科大学附属北京天坛医院康复医学科收治的卒中患者。入院时采用躯干损伤量表（trunk impairment scale，TIS）、Berg平衡量表（Berg balance scale，BBS）、Fugl-Meyer运动量表下肢部分（Fugl-Meyer assessment lower extremity，FMA-LE）分别评定患者的躯干功能、平衡功能和运动功能。对双侧下肢进行睁眼和闭眼状态下的足底压力评估，比较患者健侧和患侧下肢睁眼和闭眼状态下的足底压力特点[负重、包络椭圆面积、压力中心（center of pressure，COP）路径长度和COP运动平均速度]，并对TIS、BBS和FMA-LE与双侧下肢睁眼状态下的足底压力指标进行相关性分析。 结果 共纳入45例患者，男性35例（77.8%）。健侧与患侧足底压力特征比较显示，健侧下肢的整体负重在睁眼（58.6%±11.1% vs. 41.4%±11.1%，P＜0.001）和闭眼（59.0%±11.8% vs. 40.9%±11.8%，P＜0.001）状态下均高于患侧下肢整体负重。睁、闭眼状态下足底压力特征比较显示，闭眼状态时的包络椭圆面积[（408.1±172.1）mm2 vs.（241.9±143.1）mm2，P＜0.001]大于睁眼状态、COP路径长度[（227.8±110.4）mm vs.（130.7±62.4）mm，P＜0.001]长于睁眼状态，且COP运动平均速度[（23.5±11.3）mm/s vs.（13.7±6.4）mm/s，P＜0.001）]高于睁眼状态；睁眼状态下，健侧前足负重（41.7%±12.8% vs. 38.2%±12.0%，P＝0.015）、患侧前足负重（39.0%±12.5% vs. 36.5%±12.1%， P＝0.020）高于闭眼状态，健侧后足负重（58.3%±12.8% vs. 61.7%±12.1%，P＝0.015）、患侧后足负重（60.7%±12.8% vs. 63.4%±12.1%，P＝0.018）低于闭眼状态，上述差异均有统计学意义。相关性分析显示，TIS、BBS和FMA-LE与睁眼状态下的包络椭圆面积（r＝－0.472，P＝0.001；r＝－0.537，P＜0.001；r＝－0.485，P＝0.001）、COP路径长度（r＝－0.427，P＝0.003；r＝－0.561，P＜0.001；r＝－0.424， P＝0.004）、COP运动平均速度（r＝－0.436，P＝0.003；r＝－0.563，P＜0.001；r＝－0.425，P＝0.004）及健侧下肢整体负重（r＝－0.326，P＝0.029；r＝－0.446，P＝0.002；r＝－0.551，P＜0.001）呈负相关，而与患侧下肢整体负重（r＝0.326，P＝0.029；r＝0.446，P＝0.002；r＝0.551，P＜0.001）呈正相关。 结论 卒中患者下肢负重偏向健侧；在去除视觉的情况下，患者静态站立的平衡功能下降；TIS、BBS和FMA-LE与安静站立时身体摇摆的程度及健侧下肢整体负重呈负相关，而与患侧下肢整体负重呈正相关。 Abstract: Objective To explore the characteristics of plantar pressure in stroke patients and its correlation with trunk, balance, and motor function. Methods The study prospectively included stroke patients admitted to the Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University from June 2021 to November 2022. Upon admission, trunk function was assessed by the trunk impairment scale (TIS), balance function was assessed by the Berg balance scale (BBS), and lower extremity motor function was assessed by the Fugl-Meyer assessment lower extremity (FMA-LE) . Plantar pressure assessment was performed on both lower limbs in the eyes open and eyes closed states, and the plantar pressure characteristics of the unaffected and affected limbs were compared [weight-bearing, enveloping ellipse area, center of pressure (COP) path length, and COP mean velocity]. Correlation analysis was performed to assess the relationship between TIS, BBS, FMA-LE, and plantar pressure indices in the eyes open state of both lower limbs. Results A total of 45 stroke patients were included, with 35 males (77.8%). When comparing the plantar pressure characteristics between the unaffected and affected sides, the overall weight-bearing of the unaffected lower limb was higher than that of the affected lower limb in both open-eyed (58.6%±11.1% vs. 41.4%±11.1%, P<0.001) and closed-eyed (59.0%±11.8% vs. 40.9%±11.8%, P<0.001) states. The comparison of plantar pressure characteristics between open-eyed and closed-eyed states showed that the envelope ellipse area [(408.1±172.1) mm2 vs. (241.9±143.1) mm2, P<0.001] was larger than that in open-eyed state, the COP path length [(227.8±110.4) mm vs. (130.7±62.4) mm, P<0.001] was longer than that in open-eyed state, and the COP average velocity [(23.5±11.3) mm/s vs. (13.7±6.4) mm/s, P<0.001] was higher than that in open-eyed state. In the open-eyed state, the weight-bearing of the forefoot of the unaffected side (41.7%±12.8% vs. 38.2%±12.0%, P=0.015) and affected side (39.0%±12.5% vs. 36.5%±12.1%, P=0.020) was higher than that in the closed-eyed state, while the weight-bearing of the hindfoot of the unaffected side (58.3%±12.8% vs. 61.7%±12.1%, P=0.015) and affected side (60.7%±12.8% vs. 63.4%±12.1%, P=0.018) was lower than that in the closed-eyed state. These differences were all statistically significant. Correlation analysis showed that TIS, BBS, and FMA-LE were negatively correlated with the envelope ellipse area in open eyes state (r=-0.472, P=0.001; r=-0.537, P<0.001; r=-0.485, P=0.001), COP path length (r=-0.427, P=0.003; r=-0.561, P<0.001; r=-0.424, P=0.004), COP average velocity (r=-0.436, P=0.003; r=-0.563, P<0.001; r=-0.425, P=0.004), and overall weight-bearing of the unaffected lower limb (r=-0.326, P=0.029; r=-0.446, P=0.002; r=-0.551, P<0.001), but positively correlated with the overall weight-bearing of the affected lower limb (r=0.326, P=0.029; r=0.446, P=0.002; r=0.551, P<0.001). Conclusions Stroke patients showed a weight-bearing asymmetry towards the unaffected side. In the absence of visual input, their static standing balance was compromised. TIS, BBS, and FMA-LE were negatively correlated with the extent of body sway and overall weight-bearing on the unaffected side during quiet standing, while positively correlated with overall weight-bearing on the affected side.
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