【作者】 陆蓉蓉；

【导师】 吴毅； 胡永善； 李放； 白玉龙；

【作者基本信息】 复旦大学 ， 康复医学， 2010， 硕士

【摘要】 第一部分智能化多态平衡测试训练系统的研发智能化多态平衡测试训练系统重测信度研究目的：观察在不同试验条件下智能化多态平衡测试训练系统的重测信度,探讨该系统在临床应用中的可靠性。方法：在6个不同的状态(背部支撑减重闭眼、背部支撑减重睁眼视参照物、背部支撑减重视觉反馈、正常承重闭眼、正常承重睁眼视参照物和正常承重视觉反馈)下对45名健康成年人进行静态平衡参数(平均重心、额状面最大摆幅、额状面平均摆幅、重心移动轨迹总长度、重心移动轨迹总面积和额状面侧方摆速)测定,测试分两次进行,在第一次测试后的7天进行第二次测试。结果：1背部支撑减重闭眼状态下的ICC值介于0.487至0.885,重测信度一般。2背部支撑减重睁眼视参照物状态下的ICC值介于0.652至0.944,重测信度尚可。3背部支撑减重视觉反馈状态下的ICC值介于0.653至0.791,重测信度尚可。4正常承重闭眼状态时的ICC值介于0.795至0.880,具有良好的重测信度。5正常承重睁眼视参照物状态下的ICC值介于0.759至0.889,具有良好的重测信度。6正常承重视觉反馈状态下的ICC值介于0.769至0.983,具有良好的重测信度。结论：智能化多态平衡测定训练系统经初步信度分析,在评价受试者的静态平衡能力方面具有良好的信度,即在反映受试者的静态平衡能力方面具有较好的可重复性,可以用于临床工作中进行静态平衡功能的评价。视觉和承重对健康人静态平衡的影响分析目的：观察不同视觉输入和承重状态时健康人静态平衡的情况,探讨不同视觉输入和承重对健康人静态平衡的影响。方法：对45名健康成年人进行静态平衡测定,观察他们在背部支撑减重闭眼、背部支撑减重睁眼视参照物、背部支撑减重视觉反馈、正常承重闭眼、正常承重睁眼视参照物和正常承重视觉反馈状态下静态平衡参数(平均重心、额状面最大摆幅、额状面平均摆幅、重心移动轨迹总长度、重心移动轨迹总面积和额状面侧方摆速)的变化,并比较不同视觉输入和承重对静态平衡的影响。结果：1背部支撑减重状态下,闭眼和睁眼视参照物时的静态平衡能力无统计学差异,视觉反馈时静态平衡能力要显著优于闭眼和睁眼视参照物状态。2正常承重状态下,闭眼和睁眼视参照物时的静态平衡能力无统计学差异,视觉反馈时静态平衡能力要显著优于闭眼和睁眼视参照物状态。3承重对于闭眼、睁眼视参照物和视觉反馈刺激条件下的静态平衡能力无显著影响。结论：无论是在背部支撑减重还是正常承重状态,闭眼和睁眼视参照物对静态平衡能力无明显影响,但视觉反馈对静态平衡能力的影响显著优于闭眼和睁眼视参照物,提示视觉反馈对静态平衡的良好的即时影响作用。承重对闭眼、睁眼视参照物和视觉反馈时的静态平衡能力无显著性影响。年龄和性别对于健康人静态平衡的影响分析目的：观察不同年龄段和不同性别的健康人静态平衡的情况,探讨年龄和性别对于健康人静态平衡的影响。方法：对45名健康成年人进行静态平衡测定,观察他们在背部支撑减重闭眼、背部支撑减重睁眼视参照物、背部支撑减重视觉反馈、正常承重闭眼、正常承重睁眼视参照物和正常承重视觉反馈状态下静态平衡参数(平均重心、额状面最大摆幅、额状面平均摆幅、重心移动轨迹总长度、重心移动轨迹总面积和额状面侧方摆速),比较年龄和性别对于静态平衡的影响。结果：1背部支撑减重状态下,年龄对不同的视觉信息输入(闭眼、睁眼视参照物和视觉反馈)时的静态平衡能力无显著影响。2正常承重状态下,年龄对不同的视觉信息输入(闭眼、睁眼视参照物和视觉反馈)时的静态平衡能力无影响。3背部支撑减重状态下,性别对于闭眼和视觉反馈时的静态平衡能力无影响,而睁眼视参照物状态下男性的静态平衡控制力要显著优于女性。4正常承重状态下,性别对不同的视觉信息输入(闭眼、睁眼视参照物和视觉反馈)时的静态平衡能力无影响。结论：无论背部支撑减重还是正常承重,青年组和中年组的静态平衡参数的差异无统计学意义；正常承重条件下,男女静态平衡能力没有差异。健康人下肢力量与静态平衡的相关性探讨目的：测量健康成年人双下肢关键肌肉力量及正常承重状态下的静态平衡参数,探讨下肢肌肉的力量与静态平衡的关系。方法：采用电子测力计对45名健康成年人进行双下肢关键肌肉(髂腰肌、股四头肌、股二头肌、臀大肌、胭绳肌、胫前肌、腓肠肌、比目鱼肌和腓骨长短肌)力量测定,同时测定他们正常承重状态下静态平衡参数(平均重心、额状面最大摆幅、额状面平均摆幅、重心移动轨迹总长度、重心移动轨迹总面积和额状面侧方摆速)。结果：1健康成年人除了髂腰肌以外其他下肢关键肌肉力量左右两侧无差异,髂腰肌表现为右侧力量>左侧力量。2正常承重状态下,腓肠肌的力量与平均重心、额状面平均摆幅、重心移动轨迹总长度和重心移动轨迹总面积呈正相关,暂未发现下肢其他肌肉与静态平衡能力存在相关性。结论：在正常承重时,腓肠肌与静态平衡的对称性和稳定性呈正相关,提示应针对腓肠肌易痉挛、易疲劳等特点制定合理的治疗方案来增加腓肠肌肌力从而增强静态平衡能力。第二部分脑卒中偏瘫患者静态平衡不对称性力学特征分析和干预研究目的：观察不同治疗干预下患者静态平衡能力的变化,探讨平衡训练仪治疗对脑卒中偏瘫患者的运动、平衡及日常生活活动能力改善的影响。方法：将10例明确诊断为脑卒中(缺血性脑梗死／脑实质出血)的患者,在应用相同运动疗法进行康复训练的基础上,随机分入2组(普通平衡训练组和平衡训练仪组)。采用Fugel-Meyer量表进行运动功能评价,Berg量表、RMAS量表、RMI进行平衡能力评价,Barthel100评价ADL能力,智能化多态平衡测定训练系统测定不同状态下静态平衡参数,经过28天治疗后,再次评定运动、平衡和日常生活活动能力。结果：1在治疗前,普通平衡训练组和平衡训练仪组在病程、运动、平衡、日常生活活动能力、不同状态下静态平衡参数等方面无差别。2经过28天治疗后,组内比较显示平衡训练仪组Fugel-Meyer评分、Berg评分和RMI评分较治疗前显著改善,RMAS评分和ADL评分无显著改善；普通平衡训练组Berg评分和RMI评分较治疗前显著改善,Fugel-Meyer评分、RMAS评分和ADL评分无显著改善。3经过28天治疗后,组内比较显示普通平衡训练组的静态平衡参数治疗前后无明显改善；平衡训练仪组在背部支撑减重视觉反馈时的稳定性较治疗前显著改善,其余状态下的静态平衡参数的变化无统计学意义。4经过28天的治疗后,平衡训练仪组的运动能力和平衡能力改善显著优于对照组：背部支撑减重闭眼状态时平衡训练仪组静态平衡控制力改善显著优于对照组；背部支撑减重睁眼视参照物和视觉反馈时平衡训练仪组静态平衡能力较对照组无显著改善；正常承重闭眼、睁眼视参照物和视觉反馈时平衡训练仪组和普通平衡训练组静态平衡能力无区别。结论：脑卒中偏瘫患者通过智能化多态平衡测定练习系统的训练后,其运动能力、平衡能力和日常生活活动能力较普通平衡训练组患者为佳。但具体的静态平衡参数尚未出现有显著意义的统计学差异,需要扩大样本量和增加训练时间来进行进一步的研究。第三部分脑机接口技术在中枢神经系统康复中的应用目的：通过检测脊髓损伤及脑卒中患者肢体运动想象时脑电信号,与健康人脑电信号特征相比,探求脑机接口技术在运动障碍患者康复中的应用前景。方法：采集5名健康人、4名脊髓损伤及2名脑卒中患者进行运动想象时的脑电信号,通过计算机系统分析。结果：5名健康人进行运动想象时,在大脑运动相关皮层α、β频率段上出现事件相关同步／去同步现象；4名脊髓损伤者中3名表现出类似健康人的特征,其中1人有明显稳定的特征分布；2名脑卒中患者均未发现有意义的类似的特征。结论：脊髓损伤患者进行运动想象时产生的特征脑电与健康人相似,而脑卒中患者运动想象时损伤侧皮层的脑电不具有与健康人类似的特征,这为进一步研究脑机接口技术在运动康复中的应用提供依据。更多还原

【Abstract】 Part One The reasearch on the intellectual polymorphic balance measure and training systemⅠResearch on the test-retest reliability of the intellectual polymorphic balance measure and training systemObject:Observe the test-retest reliability of the intellectual polymorphic balance measure and training system in different conditions, and discuss the reliability of the system in clinical use.Method:In 6 different conditions (back-support weight reduction with eyes closed, back-support weight reduction with eyes opened watching a referent, back-support weight reduction with visual feed back, normal weight bearing with eyes closed, normal weight bearing with eyes opened watching a referent, normal weight bearing with visual feed back), the parameter of static balance of 45 healthy adults was tested. The static balance parameter included center of gravity, the max oscillation in frontal plane, the mean oscillation in frontal plane, the total length of the track of the COG, the total square of the track of the COG and the lateral velocity in frontal plane. The test was divided into 2 parts. The second one was carried out in 7 days after the first one.Result:1 The ICC for the back-support weight reduction with eyes closed was between 0.487 and 0.885, the test-retest reliability was general credible.2 The ICC for the back-support weight reduction with eyes opened watching a referent was between 0.652 and 0.944, the test-retest reliability was fair.3 The ICC for the back-support weight reduction with visual feed back was between 0.653 and 0.791, the test-retest reliability was fair.4 The ICC for the normal weight bearing with eyes closed was between 0.795 and 0.880, the test-retest reliability was fine.5 The ICC for the normal weight bearing with eyes opened watching a referent was between 0.0.759 and 0.889, the test-retest reliability was fine.6 The ICC for the normal weight bearing with visual feed back was between 0.769 and 0.983, the test-retest reliability was fine. Conclusion:A primary analysis was done on the reliability of intellectual polymorphic balance measure and training system, and it had a fine reliability when testing the static balance, which meant it had a fine repeatability when reflecting the ability of static balance. It could be used to assess the ability of the static balance in clinical work.ⅡAnalysis of the effcet of visual and weight bearing on static balance of the healthyObject:Observe the static balance of the healthy in the conditions of different visual input and weight bearing, and discuss the effect of the visual input and weight bearing on static balance.Method:The static balance of 45 healthy people was tested, and their change of static balance parameter was observed in different conditions, including back-support weight reduction with eyes closed, back-support weight reduction with eyes opened watching a referent, back-support weight reduction with visual feed back, normal weight bearing with eyes closed, normal weight bearing with eyes opened watching a referent and normal weight bearing with visual feed back. The static balance parameter included center of gravity, the max oscillation in frontal plane, the mean oscillation in frontal plane, the total length of the track of the COG, the total square of the track of the COG and the lateral velocity in frontal plane. And the different visual input and weight bearing effect on static balance was compared.Result:1 In the condition of back-support weight reduction with eye closed, there appeared no statistic difference between the ability of static balance with eye closed and eye opened watching a referent, but the ability of static balance with visual feed back was obviously better than that of eye closed and eye opened watching a referent.2 In the condition of normal weight bearing, there appeared no statistic difference between the ability of static balance with eye closed and eye opened watching a referent, but the ability of static balance with visual feed back was obviously better than that of eye closed and eye opened watching a referent.3 Weight bearing had no effect on the ability of static balance regardless what kind of visual input. Conclusion:No matter in weight reduction condition or normal weight bearing condition, there was no obvious difference between the ability of static balance with eyes closed or eyes opened watching a referent, but the ability of static balance with visual feed back was significantly better than that in the conditions of eyes closed or eyes opened watching a referent, which indicated that visual feed back had a fine immediate effect on static balance. Weight bearing had no effect on the ability of static balance with eyes closed or eyes open watching a referent or with visual feedback.ⅢAnalysis of the effect of age and gender on static balance of the healthyObject:Observe the condition of the static balance in different age and gender, and discuss the effect of age and gender on static balance.Method:The static balance of 45 healthy adults was tested, and their change of static balance parameter was observed in different conditions, including back-support weight reduction with eyes closed, back-support weight reduction with eyes opened watching a referent, back-support weight reduction with visual feed back, normal weight bearing with eyes closed, normal weight bearing with eyes opened watching a referent and normal weight bearing with visual feed back. The static balance parameter included center of gravity, the max oscillation in frontal plane, the mean oscillation in frontal plane, the total length of the track of the COG, the total square of the track of the COG and the lateral velocity in frontal plane. The effect of age and gender on static balance were compared.Result:1 In the condition of back-support weight reduction, age had no obvious effect on static balance regardless what kind of visual input.2 In the condition of normal weight bearing, age had no obvious effect on static balance regardless what kind of visual input.3 In the condition of back-support weight reduction, gender had no effect on static balance of eye closed and visual feed back. In the condition of eye opened watching a referent, the control ability of the male was significantly better than that of the female.4 In the condition of normal weight bearing, gender had no effect on static balance no matter with what kind of visual input. Conclusion:No matter in the condition of weight reduction or normal weight bearing, there was no significant difference in the static balance parameter between the young and the middle-aged. There was no difference in the static balance ability between the male and the female in the condition of normal weight bearing.IV Discuss on the relationship between muscle strength and static balance of the healthyObject:Measure healthy adults’muscle strength of the key muscles of the lower limbs and the static balance, and discuss the relationship between the muscle strength and the static balance(symmetry, stability and the control ability).Method:An electronic dynamometer was used to measure the strength of the key muscles of the lower limbs. The key muscles included iliopsoas, quadriceps femoris, biceps femoris, gluteus maximus, semitemdinosus and semimenbranosus, tibialis anterior, gastrocnemius, soleus and peroneus longus and peroneus brevis. And their static balance parameter in normal weight bearing was also tested. The static balance parameter included center of gravity, the max oscillation in frontal plane, the mean oscillation in frontal plane, the total length of the track of the COG, the total square of the track of the COG and the lateral velocity in frontal plane.Result:1 There was no difference in the muscle strength between the right limb and the left limb except the iliopsoas. When referring to about the iliopsoas, the right limb was stronger than the left one.2 In the condition of normal weight bearing, the strength of the gastrocnemius had a positive correlation with the COG, the mean oscillation in frontal plane, the total length of the track of the COG and the total square of the track of the COG. There was no further correlation was found between the other key muscle strength and the static ability yet.Conclusion:In the condition of normal weight bearing, the strength of gastrocnemius had a positive correlation with the symmetry and stability of the static balance, which indicated that a reasonable therapy plan should be carried out to increase the strength of the gastrocnemius to improve the ability of static balance. Part Two The research on character analysis of asymmetry mechanics and intervention of paralysis after strokeObject:Observe the change of the ability of static balance of the paralysis patient under different intervention, and discuss whether the balance training system could improve the motor, balance and ADL ability of the paralysis patients after stroke.Method:10 patient who were definitely diagnosed as stroke(cerebral infarction/ hemorrhage) were randomized divided into 2 groups(ordinary balance training group and balance training system group). They had the same motor rehabilitation therapy. Fugel-Meyer scale was used to assess the motor ability, while the BBS, RMAS and RMI were used to assess the balance ability, and the Barthel 100 was used to assess the ADL. The intellectual polymorphic balance measure and training system was used to test the static balance parameter. After 28 days’treatment, all the data above were tested again.Result:1 Before the therapy, there were no difference in the course of the disease, the motor ability, the balance ability, the ADL and the static balance parameters in different conditions between the ordinary balance training group and balance training system group.2 After the 28 days’treatment, comparison between the balance training system group showed that Fugel-Meyer score, Berg score, and RMI score were significantly improved, while RMAS score and ADL score had a trend to have been improved but without statistic difference. For the ordinary balance training group, Berg score and RMI score were obviously improved, while Fugel-Meyer score, RMAS score and ADL score had a trend to have been improved but with no statistic difference.3 After the 28 days’treatment, static balance parameter for the ordinary balance training group showed no obvious difference before and after treatment. Stability for the research group showed a obvious improvement in the condition of back-support weight reduction with visual feed back comparing with that before the treatment. And other data showed no difference before and after the treatment.4 After the 28 days’treatment, comparing ordinary balance training group and the balance training system group, the latter had a obviously improvement with motor and balance ability. In the condition of back-support weight reduction with eyes closed, the improvement of control ability of the balance training system group was significantly better than that of the ordinary balance training group. In the condition of back-support weight reduction with eyes opened watching a referent and with visual feed back, the balance training system group showed no significant difference to the ordinary balance training group. In the conditions of normal weight bearing with eyes closed, eyes opened watching a referent and visual feed back, the ability of static balance showed no difference among the three groups.Conclusion:After paralysis patients were trained by the intellectual polymorphic balance measure and training system, their motor ability, balance ability and ADL were better than that of the ordinary balance training group. But when testing the static balance parameter, there showed no significant statistic difference. A larger sample and a longer training time were needed to work on the further research.Part Three The research on the application of brain-computer interface technology in rehabilitation of central nerve system diseaseObject:Discuss the prospect of the applications of the brain-computer interface system in the rehabilitation of those with dyskinesia by testing the brain electricity signals of the spinal cord injury patients and stroke patients and comparing with the healthy people.Method:Motor imaginary brain electricity signals of 5 healthy people,4 spinal cord injury patients and 2 stroke patients were tested, and the results were analyzed by computer.Result:All the 5 healthy people showed event related synchronization/event related desynchronization(ERS/ERD) phenomena in the aandβband in the motor related cortex, when they are doing motor imaginary.3 in 4 spinal cord injury patents showed the similar characters, and 1 showed obvious and stable character.2 stroke patients did not show meaningful characters.Conclusion:The spinal cord injury patients have the similar brain electricity character with the healthy people when they are experiencing motor imaginary, whilst the stroke patients do not show the similar brain electricity character with the healthy people in the affected hemisphere. These have provided evidences on the further research of the application of the brain computer interface technology in motor rehabilitation.更多还原