| BACKGROUND:It is summarized in China Stroke Prevention Report 2018 that the incidence rate and disability-adjusted life expectancy of ischemic stroke patients in China are higher than those of hemorrhagic stroke patients,and the overall situation shows a significant upward trend.Hemiplegia is a common limb dysfunction in patients with cerebral infarction.Gait test system can quantitatively analyze the gait characteristics of patients with cerebral infarction hemiplegia,and is of great significance for the assessment of the patient’s condition and the formulation and adjustment of rehabilitation programs.The changes of gait in patients with hemiplegia due to cerebral infarction are the result of reestablishment of gait balance between the unaffected and affected feet.In clinical studies on hemiplegic gait,much attention has been paid to the evaluation of gait parameters of the affected foot,while the observation of the unaffected foot or the difference between the two feet is ignored.Tai Ji postural training is an improvement made by Zongheng Li,director of Dongzhimen Hospital of Beijing University of Chinese Medicine on the basis of 24-type Yang Tai Ji Chuan according to the characteristics of stroke patients and combining his long-term clinical observation on stroke patients with limb dysfunction and his own experience in the clinical application of Tai Ji Chuan training.Previous studies have confirmed that Tai Ji postural training can effectively improve the lower limb motor function and balance function of patients with cerebral infarction hemiplegia.Therefore,in this study,based on the previous research results,the biomechanical parameters of gait were included in the observation indexes,and the difference in gait parameters of the affected and unaffected foot was taken as the index for evaluating the difference in biped gait,so as to preliminarily explore the effect of Tai Ji postural training on the difference in biped gait of patients with hemiplegia due to cerebral infarction.OBJECTIVE:Based on RSSCAN gait system,investigating the gait characteristics of patients with cerebral infarction hemiplegia and the difference of biped gait,preliminarily explored the effect of Tai Ji postural training on the difference of biped gait of patients with cerebral infarction hemiplegia.METHODS:A total of 134 patients who met the inclusion criteria with hemiplegia due to cerebral infarction were randomly divided into the experimental group(n=67)and the control group(n=67).The control group received routine rehabilitation training,and the experimental group received Tai Ji postural training on the basis of the control group.Treatment cycle was 4 weeks.The research stage was divided into two parts.One was the foreshadowing research stage:Clinical scale evaluation and gait test were conducted for subjects who met the inclusion criteria.Based on the gait test results,the biped differences in gait temporo-spatial parameters(pace,foot axis angle,step length,step width,stride,stance phase time,swing phase time,gait cycle)and gait biomechanical related parameters(maximum force,maximum pressure,contact area,and impulse)of patients with cerebral infarction hemiplegia were compared and analyzed.Based on the scale scores,we investigated the correlation between common stroke assessment scales(NIHSS,simplified Fugl-Meyer motor function assessment scale,Berg balance scale,Bathel Index,modified Ashworth scale,Brunnstrom rating scale,modified Rankin scale,and Quality Of Life table for Stroke Specialization)and gait parameters of hemiplegic patients with two feet.The gait biomechanical parameters of the foot area with obvious statistical difference between the unaffected and the affected foot were selected as the target analysis index.Second,the thematic research stage:the subjects who have completed the treatment plan are tested again.Based on the results of the foreshadowing research,the target analysis index is selected to calculate the gait parameter difference between the affected foot and the unaffected foot in the corresponding foot area before and after treatment as the evaluation index,intra-group comparison and inter-group analysis were performed on the experimental group and the control group to explore the changes of the gait difference between the two groups before and after treatment and the influence of Tai Ji postural training on the gait difference of the patients with cerebral infarction and hemiplegia.RESULTS:1 comparative analysis of gait parameters of patients with cerebral infarction hemiplegia:the stance phase time of the unaffected foot was longer than that of the affected foot(P<0.01),and the swing phase time and step length of the affected foot were larger than those of the unaffected foot(P<0.05).compared with the affected foot,the maximum force and maximal pressure of the unaffected foot in the first toe,the second to fifth toes,and the fist metatarsal were significantly increased(P<0.01),and the maximum force in the lateral heel were significantly increased(P<0.05),the impulse in the fist toe,the second to fifth toes,and the first metatarsal area,the medial heel and the lateral heel increased significantly(P<0.05).2 Correlation analysis between biped gait parameters of patients with cerebral infarction hemiplegia and clinical scales:temporo-spatial parameters:Simplified Fugl-Meyer motor function assessment scale,Berg balance scale,Bathel Index and modified Rankin scale had significant correlation with pace,biped stance phase time,biped gait cycle,biped step length and biped stride of patients with cerebral infarction hemiplegia(P<0.01)and unaffected and affected feet showed good consistency;Biomechanical parameters:Compared with the gait temporo-spatial parameters,the correlation between clinical scores of each scale and the biped gait biomechanical parameters was low,and the results of correlation analysis between the unaffected and affected feet showed some differences.3 Comparison of the differences of both feet before and after treatment between the two groups:intra-group comparison:Compared with the situation before treatment,the maximum force difference,impulse difference and maximum pressure difference in the second to fifth toes of the Tai Ji postural training group were significantly reduced(P<0.05);Inter-group comparison:Compared with the routine rehabilitation training group,the maximum force difference,impulse difference and maximum pressure difference in the lateral heel area of the Tai Ji postural training group were significantly reduced and the differences were statistically significant(P’<0.05).The force parameters,impulse parameters and pressure parameters showed good consistency in the intra-group comparison and inter-group analysis.CONCLUSION:1 The gait characteristics of patients with cerebral infarction hemiplegia show as a whole that the stress on the forefoot region and heel region of the healthy foot is increased significantly;2 Correlation analysis results show that,compared with gait time-space parameters,individual differences of biomechanical parameters of biped gait of patients with stroke hemiplegia are larger,which may not be conducive to correlation analysis with clinical scale;3 The intensive training mode of Tai Ji postural training for patients with hemiplegia due to cerebral infarction can effectively reduce the difference in plantar load of both feet in the 2nd-5th toe region and the lateral region of heel of patients with hemiplegia. |
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