Balance function and its influencing factors in patients with post-stroke hemiplegia

doi:10.12307/2026.692

Abstract

Abstract: BACKGROUND: After a stroke, damage to the central nervous system can lead to abnormalities in motor control. Lesions in the visual, proprioceptive, and vestibular systems can cause abnormalities in sensory integration, and attention deficits and unilateral neglect can also affect sensory input.
OBJECTIVE: To investigate the status quo of balance function in patients with hemiplegia after stroke and to analyze its influencing factors.
METHODS: A total of 166 inpatients with stroke who were treated in the Department of Rehabilitation of Shandong Provincial Hospital of Traditional Chinese Medicine from January 2023 to October 2024 were selected by the convenience lottery method. The survey was performed using the General Information Questionnaire, Berg Balance Scale, Simplified Fugl-Meyer Scale of the Lower Extremity, National Institutes of Health Stroke Scale, Visual Analogue Scale, Modified Ashworth Scale, Concise International Fall Efficacy Scale, and Functional Walking Grading. Multiple linear regression was used to analyze the main influencing factors of balance function in stroke patients with hemiplegia.
RESULTS AND CONCLUSION: The balance function score of post-stroke hemiplegia patients was (28.39±8.69) points. The results of multiple linear regression analysis showed that the motor function, neurological deficit, spasticity of the lower limb, fall efficacy, unilateral neglect, and visual function were included in the regression equation (F=131.142, P < 0.001), which explained 90.4% of the total variation in balance function. In conclusion, the balance function of stroke patients with hemiplegia is at a low and medium level, with the lower limb motor function, neurological deficit, lower limb spasticity, fall efficiency, unilateral neglect and visual function as the main influencing factors.

Key words: stroke, balance function, motor function of the lower limbs, muscle tone, visual function, unilateral neglect, influencing factors

CLC Number:

Leng Xiaoxuan, Yu Zifu, Cao Xinyan, Gao Shiai, Chen Jinhui, Liu Xihua. Balance function and its influencing factors in patients with post-stroke hemiplegia[J]. Chinese Journal of Tissue Engineering Research, 2026, 30(18): 4611-4617.

Figures/Tables 2

2.1 参与者数量分析共调查患者174例，其中8例因个人原因退出研究，有效调查人数166例。 2.2 脑卒中患者的一般资料对纳入研究的脑卒中患者的平衡功能进行比较，结果显示：不同体质量指数、眩晕、坐位平衡、下肢肌力、视觉功能、单侧忽略情况的脑卒中患者平衡功能总分比较，差异有显著性意义(P < 0.05)，而不同性别、年龄、脑卒中类型、偏瘫侧、发病次数、合并其他疾病、感觉功能、注意力情况的脑卒中患者平衡功能总分比较，差异无显著性意义(P > 0.05)，见表1。 2.3 脑卒中患者平衡功能相关因素的相关性分析 Berg平衡量表得分为28.39±8.69，简易版下肢Fugl-meyer评定量得分为22.19±6.37，美国国立卫生研究院卒中量表得分为30.38±8.04，改良Ashworth量表得分为2.16±0.76，目测类比评分得分为4.31±1.83，简明国际跌倒效能感量表得分为16.75±2.59，功能性步行分级得分为2.29±1.22。脑卒中患者Berg平衡量表得分与简易版下肢Fugl-meyer评定量得分呈低度正相关(r=0.426，P < 0.01)，与功能性步行分级得分基本不相关(r=0.283，P < 0.01)，与美国国立卫生研究院卒中量表得分呈高度负相关(r=-0.934，P < 0.01)，与VAS得分呈中度负相关(r=-0.508，P < 0.01)，与改良Ashworth量表得分呈中度负相关(r=-0.701，P < 0.01)，与简明国际跌倒效能感量表得分呈中度负相关(r=-0.588，P < 0.01)，见表2。 2.4 脑卒中患者平衡功能的多元线性回归以Berg平衡量表得分为因变量，将单因素分析及相关性分析中具有统计学意义的12个因素(眩晕、坐位平衡、肌力减退、单侧忽略、体质量指数、视觉功能、简易版下肢Fugl-meyer评定量得分、美国国立卫生研究院卒中量表得分、目测类比评分得分、改良Ashworth量表得分、简明国际跌倒效能感量表得分、功能性步行分级)为自变量纳入回归分析中。共线性诊断结果显示：各模型的容忍度都< 1，提示12个自变量间不存在多重共线性。回归分析结果显示，下肢运动功能、神经功能缺损、下肢痉挛程度、跌倒效能、单侧忽略、视力减退是脑卒中患者平衡功能的主要影响因素(P < 0.05)，共解释总变异的90.4%，见表3。"

References

[1] SAINI V, GUADA L, YAVAGAL DR. Global Epidemiology of Stroke and Access to Acute Ischemic Stroke Interventions. Neurology. 2021;97(20 Suppl 2):S6-S16.
[2] GUAN T, MA J, LI M, et al. Rapid transitions in the epidemiology of stroke and its risk factors in China from 2002 to 2013. Neurology. 2017;89(1):53-61.
[3] [No authors listed]. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2019;50(8):e239.
[4] VAN DUIJNHOVEN HJ, HEEREN A, PETERS MA, et al. Effects of Exercise Therapy on Balance Capacity in Chronic Stroke:Systematic Review and Meta-Analysis.Stroke. 2016;47(10):2603-2610.
[5] BRUYNEEL AV, DUBÉ F. Best Quantitative Tools for Assessing Static and Dynamic Standing Balance after Stroke: A Systematic Review. Physiother Can. 2021;73(4):329-340.
[6] 方娟.脑卒中偏瘫患者平衡功能恢复的影响因素[J].中国实用神经疾病杂志,2015,18(19):51-52.
[7] 石凯,丁建东,曾文琳.太极拳改善老年人平衡功能的研究进展[J].中国老年学杂志,2024,44(22):5621-5624.
[8] 国家卫生健康委脑卒中防治工程委员会制定. 中国脑卒中防治指导规范[M].2版. 北京:人民卫生出版社,2021．
[9] 陈彬.医学多因素分析设计样本例数估算：多因素分析设计样本例数综合估算法[J].伤害医学(电子版),2012,1(4):58-60.
[10] DOWNS S. The Berg Balance Scale. J Physiother. 2015;61(1):46.
[11] 张建红,祝翠霞.Holden量表联合跌倒专科管理对康复期脑卒中患者跌倒发生率的影响[J].中国药物与临床,2019,19(4):540-542.
[12] FIEDOROVÁ I, MRÁZKOVÁ E, ZÁDRAPOVÁ M, et al. Receiver Operating Characteristic Curve Analysis of the Somatosensory Organization Test, Berg Balance Scale, and Fall Efficacy Scale-International for Predicting Falls in Discharged Stroke Patients. Int J Environ Res Public Health. 2022;19(15):9181.
[13] WADE DT, HEWER RL.Functional abilities after stroke: measurement, natural history and prognosis. J Neurol Neurosurg Psychiatry. 1987; 50(2):177-182.
[14] 郭辉,王剑桥,苏国栋,等.神经肌肉本体感觉促进疗法对脑卒中患者平衡、运动和日常生活活动效果的Meta分析[J].中国康复理论与实践,2021,27(5):530-541.
[15] 李冬,张皓,刘楠,等.认知-运动双任务训练对脑卒中恢复期患者平衡功能和步态效果的随机对照试验[J].中国康复理论与实践,2024,30(9):1082-1091.
[16] 陈瑞全,吴建贤,沈显山.中文版Fugl-Meyer运动功能评定量表的最小临床意义变化值的研究[J].安徽医科大学学报,2015,50(4):519-522.
[17] 解益宁,姜素兰,张晶晶. 介入溶栓联合高压氧对急性闭塞性脑梗死患者NHISS评分和生活质量的影响[J]. 中风与神经疾病杂志, 2022,39(11):982-985.
[18] 侯东哲,张颖,巫嘉陵,等. 中文版美国国立卫生院脑卒中量表的信度与效度研究[J]. 中华物理医学与康复杂志,2012,34(5):372-374.
[19] GOUDMAN L, PILITSIS JG, BILLET B, et al. The level of agreement between the numerical rating scale and visual analogue scale for assessing pain intensity in adults with chronic pain. Anaesthesia. 2024;79(2):128-138.
[20] 雷木清,王媛,程亚.磁吸式疼痛评估尺与视觉模拟评分法在全髋关节置换术后护理中的应用对比[J].中国医药导报,2021,18(30): 193-196.
[21] 梁浈,何美瑭,吴小欣,等.岭南飞针疗法对脑卒中后痉挛性偏瘫患者的肢体功能和生活能力的影响研究[J].辽宁中医杂志,2024, 51(11):176-179.
[22] 郭铁成,卫小梅,陈小红. 改良Ashworth量表用于痉挛评定的信度研究[J].中国康复医学杂志,2008,23(10):906-909.
[23] 曾鹛婷,尹玥,黄钟晓.正念认知干预对老年脑卒中患者跌倒恐惧感和康复信心的影响[J].保健医学研究与实践,2023,20(3):57-60+73.
[24] 邓宁,张彤,史宝欣. 简明国际跌倒效能感量表在脑梗死患者中的信度和效度检验[J].中国康复理论与实践,2015(12):1438-1442.
[25] PARK CS, AN SH. Reliability and validity of the modified functional ambulation category scale in patients with hemiparalysis. J Phys Ther Sci. 2016;28(8):2264-2267.
[26] 史明英,车睿,杨若澜,等.老年帕金森病患者平衡功能变化的影响因素分析[J].老年医学与保健,2023,29(3):524-527±533.
[27] 杜金霞,刘晓莉,雷丽梅,等.老年结核病患者平衡功能的影响因素分析[J].现代临床医学,2023,49(5):349-352.
[28] BOTTINI G,KARNATH HO, VALLAR G,et al.Cerebral representations for egocentric space: Functional-anatomical evidence from caloric vestibular stimulation and neck vibration.Brain. 2001;124(Pt 6):1182-1196.
[29] HORAK FB. Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls?. Age Ageing. 2006;35 Suppl 2:ii7-ii11.
[30] SRIVASTAVA A, TALY AB, GUPTA A, et al.Post-stroke balance training: role of force platform with visual feedback technique. J Neurol Sci. 2009;287(1-2):89-93.
[31] 林夏妃,丘卫红,窦祖林.脑卒中后平衡功能障碍的研究进展[J].中国康复医学杂志,2011,26(2):191-194.
[32] 胡丙成.经颅重复针刺促进大鼠坐骨神经损伤再生修复的实验研究[D].哈尔滨:黑龙江中医药大学,2004.
[33] 李经纬,张立波,王海璐,等.脊髓刺激重建运动功能:治疗效果和作用机制[J].科学通报,2025,70(Z1):556-566.
[34] 吴奇,程光宇,薛国威,等.针灸治疗脑卒中后肌张力增高的研究进展[J].世界中西医结合杂志,2024,19(12):2530-2534.
[35] 夏丽伟,韦广源,蒋慧韬,等.有限软组织手术联合Ilizarov技术治疗中枢神经损伤后痉挛性马蹄内翻足的临床效果[J].广西医学, 2019,41(20):2583-2585.
[36] 刘加鹏,王卫宁,吴军发,等.A型肉毒毒素结合深层肌肉刺激对脑卒中患者下肢运动功能和步行功能的影响[J].中国康复医学杂志,2021,36(6):698-701.
[37] 胡寅虎,孟婷婷,夏佳怡,等.重复经颅磁刺激联合新Bobath运动疗法治疗脑卒中后下肢痉挛的效果研究[J].检验医学与临床, 2025,22(2):272-275.
[38] 陈立霞,李承家,王亭亭,等.“通脑活络”针刺疗法配合中频脉冲治疗仪对脑卒中后偏瘫患者肢体运动功能及肌张力的影响[J].针灸临床杂志,2024,40(12):15-21.
[39] 杨田野,王磊,牛华.中药熏蒸联合针灸对缺血性脑卒中后下肢肌张力增高患者肌痉挛、下肢关节活动度及步行功能的影响[J].天津中医药,2024,41(9):1103-1107.
[40] YANG X W,XUE X L,TU H,et al.Effect of whole-body vibration training on the recovery of lower limb function in people with stroke:a systematic review and meta-analysis. Disabil Rehabil. 2023;45(23):3823-3832.
[41] 崔建英,刘燕,熊英.老年综合评估护理方案在老年人院外跌倒防范中的应用[J].护理研究,2020,34(24):4473-4475.
[42] 管强,韩红杰,靳令经,等.脑卒中患者跌倒恐惧的影响因素分析[J].中华老年心脑血管病杂志,2013,15(1):39-41.
[43] VERDON V, SCHWARTZ S, LOVBLAD KO, et al. Neuroanatomy of hemispatial neglect and its functional components: a study using voxel-based lesion-symptom mapping. Brain. 2010;133(Pt 3):880-894.
[44] SIBLEY KM, BEAUCHAMP MK, VAN OOTEGHEM K, et al. Using the systems framework for postural control to analyze the components of balance evaluated in standardized balance measures: a scoping review. Arch Phys Med Rehabil. 2015;96(1):122-132.e29.
[45] 申嘉怡,张通,胡雪艳,等.动作观察疗法对脑卒中后单侧忽略的效果[J].中国康复理论与实践,2018,24(8):930-937.
[46] 张庆,肖洪奇,余佳丹,等.重复经颅磁刺激对脑卒中患者单侧忽略康复疗效的系统评价[J].中国循证医学杂志,2018,18(2):163-171.
[47] 范星月,徐若男,韩露,等.强制性使用运动疗法结合电刺激对脑卒中单侧忽略的作用[J].中国康复,2017,32(4):281-284.
[48] 沈滢,殷稚飞,孟殿怀,等.康复临床实践指南•脑卒中患者立位平衡障碍[J].康复学报,2024,34(3):195-210.
[49] 侯敬贤,曲斯伟,宋为群.本体感觉训练在脑卒中患者康复中的研究进展[J].中国康复,2024,39(10):631-635.
[50] 林嘉滢,涂舒婷,林嘉莉,等.不同年龄脑卒中患者躯体感觉功能与运动功能相关性及全周期康复思考：一项多中心横断面研究[J].中国全科医学,2024,22(10):1127-1131.
[51] 庄霁雯,郑洁皎,陈秀恩,等.脑卒中平衡功能障碍治疗的研究进展[J].中国康复理论与实践,2016,27(23):2838-2845.
[52] ALI M, HAZELTON C, LYDEN P, et al.Recovery from poststroke visual impairment: evidence from a clinical trials resource.Neurorehabil Neural Repair. 2013;27(2):133-141.
[53] BORT-MARTÍ AR, ROWE FJ, RUIZ SIFRE L,et al.Botulinum toxin for the treatment of strabismus. Cochrane Database Syst Rev. 2023;3(3):CD006499.
[54] ROWE F, WRIGHT D, BRAND D, et al. Reading difficulty after stroke: ocular and non ocular causes. Int J Stroke. 2011;6(5):404-411.