| BACKGROUND:Stroke,also known as cerebrovascular accident,has become the first leading cause of disability and the second leading cause of death worldwide.Epidemiological studies in 2017 showed that the incidence of stroke in China was as high as 247/100,000,and the prevalence was as high as 1115/100,000.China is suffering from the world’s heaviest medical burden of stroke.Motor dysfunction is one of the common functional disorders in patients with stroke survival,which may limit their daily life and lead to a significant decline in the quality of life of patients.It not only brings great pain and heavy medical burden to patients themselves and their families,but also leads to a major social public health problem that needs to be solved urgently.It is of great significance to promote the rehabilitation of limb motor function in stroke patients with hemiplegia for improving the quality of life of patients and reducing the medical burden on families and society.Tai Chi is a national intangible cultural heritage of China and a shining pearl in the traditional culture of the Chinese nation.As a traditional Chinese exercise of mind and body health care,Tai Chi contains rich theories of traditional Chinese medicine,such as the theory of Yin and Yang,the theory of meridians and collaterals,and the theory of guided breathing.Therefore,some scholars have classified Tai Chi into the broad category of traditional Chinese medicine.In addition,the key points of Tai Chi are similar to modern rehabilitation techniques.Recent years,the clinical application value of Tai Chi has been widely concerned and recognized by the medical community at home and abroad.It has become a research hotspot to apply suitably modified Tai Chi to the rehabilitation of diseases of nervous system,respiratory system,circulatory system and bone and joint system.Because ischemic stroke is the most common type of stroke and has different rehabilitation mechanisms compared with cerebral hemorrhage,this study only focuses on cerebral infarction.It is very difficult for stroke patients with hemiplegia to carry out standard and complete Tai Chi training.Therefore,this study selected 6 of 24 simplified Tai Chi exercises and modified them appropriately to make them more clinical operable and more targeted for rehabilitation.In order to ensure the smooth completion of the study,we have improved the admission criteria based on the previous studies.The subjects were strictly limited to cerebral infarction hemiplegia patients with certain walking ability.OBJECTIVE:The aim of this study is to observe the rehabilitative effect of modified Tai Chi posture training for improving walking capability in patients with hemiplegia caused by ischemic stroke through a randomized controlled trial.METHOD:73 patients with ischemic cerebral infarction who met the inclusion criteria were randomly divided into the experimental group and the control group,including 43 patients in the experimental group and 30 patients in the control group.The control group was given modern rehabilitation training,and the experimental group was given improved Tai Chi posture training on the basis of modern rehabilitation training.In addition to performing gait acquisition using RSSCAN gait testing system which could measure temporal and spatial parameters including walking velocity,step length,stride length,step width,support time,swing time and gait cycle,we also evaluated Fugl-Meyer motor function assessment scale for paretic lower extremity(FMA-paretic lower extremity)and Berg balance scale(BBS).All evaluations were performed before and 4 weeks after treatment to compare intra-group and inter-group changes before and after treatment.RESULTS:Intra-group comparison before and after treatment,walking velocity,step length and stride length of the affected side,the FMA-paretic lower limbs and BBS scores in the two groups were significantly increased(P<0.05).The step width of the affected side of the subjects in both groups was reduced compared with that before treatment,but no significant difference was found(P>0.05 in the control group,P=0.050 in the experimental group).The support time of the affected side in the experimental group was significantly shortened(P<0.05),while the support time of the affected side in the control group was not significantly shortened(P>0.05).The swing time of the affected side in both groups had no significant change compared with that before treatment(P>0.05).There was no significant change in the swing time and gait cycle of the affected side in the two groups(P>0.05)compared with that before treatment,while there was a significant shortening tendency for gait cycle in experimental group compared with that before treatment(P=0.072).Comparison between two groups after treatment,the increasing difference value of walking speed in the experimental group was larger than that in the control group,but the difference between the two groups was not significant(P=0.058).The increase of step length and stride length in the experimental group was larger than that in the control group,and the difference between the two groups was significant(P<0.05).Besides,the score of FMA on the affected lower limbs and BBS in the experimental group were increased more,and the difference between the two groups was significant(P<0.05).The score of FMA on the affected side was positively correlated with step speed and step length(P<0.05).There was a significant tendency of positive correlation between the FMA score of the affected lower limb and the stride length(P=0.060).There was a significant tendency of negative correlation between the FMA score of the affected lower limb and the stride width(P=0.073).BBS showed a significant positive correlation with step speed,step length and stride length(P<0.05),and a significant negative correlation with step width(P<0.05).The score of FMA and BBS were significantly negatively correlated with the supporting time and gait cycle(P<0.05).No significant adverse reactions or experimental accidents occurred in either group during the treatment period.CONCLUSION:Both modern rehabilitation therapy and modified Tai Chi posture training combined with modern rehabilitation treatment,can effectively improve the lower limb movement and balance of ischemic stroke patients with hemiplegia,reduce movement disorders,improve walking ability,but the latter effect is more significant.The modified Tai Chi posture training can be a beneficial supplement to modern rehabilitation techniques.The modified Tai Chi posture training has high safety and is suitable for stroke patients with hemiplegia who have certain walking ability. |
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