双任务对后循环缺血性脑卒中伴前庭症状患者步行能力的影响研究

doi:10.12114/j.issn.1007-9572.2023.0229

摘要/Abstract

摘要： 背景后循环缺血性脑卒中伴前庭症状患者常无明显的肢体瘫痪，眩晕、头晕症状改善后具备一定的行走能力，但跌倒风险高，临床缺乏对其步行能力的关注。双任务模式的功能评估能更好地发现患者潜在的步态异常，为早期康复干预提供依据。目的探究双任务对后循环缺血性脑卒中伴前庭症状患者步行能力的影响。方法选取2021—2022年在天津市环湖医院神经内科住院治疗的后循环缺血性脑卒中伴前庭症状患者40例为研究对象。采用单任务步行、运动-运动双任务步行、认知-运动双任务步行模式，采集患者步态参数，包括步速、步频、步幅、双支撑相时间占比、步长时间、躯干冠状面、矢状面摆动角度，比较3种任务条件下患者的步态参数差异，同时比较两种双任务步行下双任务成本差异。结果与单任务步行比较，患者进行运动-运动双任务步行时，躯干冠状面、矢状面摆动角度减小（P<0.05）；在进行认知-运动双任务步行时，步速降低、双支撑相时间占比延长，躯干冠状面摆动角度增加（P<0.05）。与运动-运动双任务步行相比，认知-运动双任务步行的步速双任务成本、步幅双任务成本、双支撑相时间占比双任务成本增加（P<0.05）。结论双任务导致后循环缺血性脑卒中伴前庭症状患者步态稳定性下降，且认知-运动双任务比运动-运动双任务需要消耗更多的注意力资源，更容易出现步态障碍。

关键词: 卒中, 脑梗死, 前庭症状, 步态, 双任务, 双任务成本

Abstract:

Background

Posterior circulation ischemic stroke patients with vestibular symptoms usually do not present with obvious limb paralysis with certain walking ability after improvement of dizziness and vertigo symptoms, however, their fall risk is high and clinical attention to walking ability is lacking. Functional assessment using dual-task paradigms can better detect potential gait abnormalities in patients and provide a basis for early rehabilitation intervention.

Objective

To investigate the effect of dual task on walking ability of posterior circulation ischemic stroke patients with vestibular symptoms.

Methods

Forty patients diagnosed with posterior circulation ischemic stroke accompanied by vestibular symptoms and treated at Tianjin Huanhu Hospital from 2021 to 2022 were selected as the study subjects. Gait parameters including gait speed, step frequency, step size, proportion of double support phase time, step duration, trunk coronal plane and sagittal plane swing angles were collected using single-task walking, motor-motor dual-task walking, and cognitive-motor dual-task walking paradigms. The differences in gait parameters among the three task conditions and the differences in dual-task costs between the two dual-task walking.

Results

Compared to single-task walking, the trunk coronal plane and sagittal plane swing angles were decreased in patients during motor-motor dual-task walking (P<0.05) ; the gait speed was increased, proportion of double support phase time and trunk coronal plane swing angle were increased in patients during cognitive-motor dual-task walking (P<0.05). Compared to motor-motor dual-task walking, the dual-task costs of cognitive-motor dual-task walking in terms of gait speed, step size and the proportion of double support phase time were increased (P<0.05) .

Conclusion

Dual task leads to decreased gait stability in posterior circulation ischemic stroke patients with vestibular symptoms. Additionally, cognitive-motor dual-task walking requires more attentional resources and is more likely to result in gait disturbances compared to motor-motor dual-task walking.

Key words: Stroke, Brain infarction, Vestibular symptoms, Gait, Dual-task, Dual-task cost

尹苗苗,崔立玲,李雅晴,等. 双任务对后循环缺血性脑卒中伴前庭症状患者步行能力的影响研究[J]. 中国全科医学, 2023, 26(33): 4207-4212. DOI: 10.12114/j.issn.1007-9572.2023.0229.
YIN Miaomiao,CUI Liling,LI Yaqing, et al. Effect of Dual Task on Walking Ability in Posterior Circulation Ischemic Stroke Patients with Vestibular Symptoms[J]. Chinese General Practice, 2023, 26(33): 4207-4212. DOI: 10.12114/j.issn.1007-9572.2023.0229.

图/表 2

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类型	步速（m/s）	步频（步/min）	步幅（m）	步长时间（s）	双支撑相时间占比（%）	躯干冠状面摆动角度	躯干矢状面摆动角度
单任务步行	0.80±0.20	105.89±13.90	0.90±0.17	0.56±0.08	26.33±5.61	4.41°±1.43°	4.30°±1.04°
运动-运动双任务步行	0.71±0.17	108.25±11.96	0.87±0.20	0.58±0.07	26.38±5.01	3.00°±1.06°^a	3.61°±0.72°^a
认知-运动双任务步行	0.66±0.17^a	103.72±12.23	0.81±0.19	0.60±0.08	29.60±5.27^a	5.36°±2.01°^a	4.59°±0.92°
F值	4.674	0.996	1.998	2.774	4.242	19.205	10.180
P值	0.012	0.373	0.141	0.067	0.017	<0.001	<0.001

类型	步速（m/s）	步频（步/min）	步幅（m）	步长时间（s）	双支撑相时间占比（%）	躯干冠状面摆动角度	躯干矢状面摆动角度
单任务步行	0.80±0.20	105.89±13.90	0.90±0.17	0.56±0.08	26.33±5.61	4.41°±1.43°	4.30°±1.04°
运动-运动双任务步行	0.71±0.17	108.25±11.96	0.87±0.20	0.58±0.07	26.38±5.01	3.00°±1.06°^a	3.61°±0.72°^a
认知-运动双任务步行	0.66±0.17^a	103.72±12.23	0.81±0.19	0.60±0.08	29.60±5.27^a	5.36°±2.01°^a	4.59°±0.92°
F值	4.674	0.996	1.998	2.774	4.242	19.205	10.180
P值	0.012	0.373	0.141	0.067	0.017	<0.001	<0.001

DTC项目	运动-运动双任务步行	认知-运动双任务步行	Z（t_配对）值	P值
步速DTC〔M（P₂₅，P₇₅）〕	-7.00（-16.02，-2.53）	-16.00（-27.61，-6.04）	-2.373	0.018
步频DTC〔M（P₂₅，P₇₅）〕	2.00（-0.84，4.64）	0（-8.40，5.66）	-1.282	0.200
步幅DTC〔M（P₂₅，P₇₅）〕	-2.33（-5.98，3.74）	-12.20（-19.11，2.29）	-2.494	0.013
步长时间DTC	3.91±8.94	8.69±12.34	-1.804^a	0.076
双支撑相时间占比DTC	0.75±11.45	14.55±18.71	-3.613^a	0.001

DTC项目	运动-运动双任务步行	认知-运动双任务步行	Z（t_配对）值	P值
步速DTC〔M（P₂₅，P₇₅）〕	-7.00（-16.02，-2.53）	-16.00（-27.61，-6.04）	-2.373	0.018
步频DTC〔M（P₂₅，P₇₅）〕	2.00（-0.84，4.64）	0（-8.40，5.66）	-1.282	0.200
步幅DTC〔M（P₂₅，P₇₅）〕	-2.33（-5.98，3.74）	-12.20（-19.11，2.29）	-2.494	0.013
步长时间DTC	3.91±8.94	8.69±12.34	-1.804^a	0.076
双支撑相时间占比DTC	0.75±11.45	14.55±18.71	-3.613^a	0.001