Abstract:

Objective: To explore the effect of vestibular rehabilitation treatment on subjective symptoms, walking function and dynamic balance function of ischemic stroke patients with vestibular symptoms. Methods: A total of 27 patients with vestibular symptoms who underwent vestibular rehabilitation treatment in Tianjin Huanhu Hospital from January 2022 to December 2024 were included, and they underwent individualized vestibular rehabilitation treatment, including optokinetic training, gaze stabilization, head and posture stabilization training and walking training for 30 times. Before and after the treatment, a wearable sensor inertial measurement unit was used to perform a 7 Meter Walk Test (7MWT) to assess gait, recorded the gait parameters including stride length, gait speed, percentage of double support phase time, foot strike angle (FSA), toe off angle (TOA), and turning angle velocity. The Activities-Specific Balance Confidence Scale (ABC) to assess subjective balance confidence in completing various tasks, the dizziness/vertigo Visual Analog Scores (VAS) to assess the degree of dizziness/vertigo, the Bucket Test to assess the angle of subjective visual vertical (SVV) deviation, the Dizziness Handicap Inventory (DHI) to assess the degree of dizziness disability, Dynamic Gait Index (DGI) to assess objective balance function, and Timed Up-Go Test (TUGT) to assess dynamic balance and turning ability. Spearman rank correlation analysis to explore the correlation of gait parameter differences with subjective tests and dynamic balance function before and after vestibular rehabilitation treatment. Results: After vestibular rehabilitation treatment, stride length (t = -4.877, P = 0.000), gait speed (t = -4.458, P = 0.000), bipedal FSA (left foot t = -5.590, P = 0.000; right foot t = -4.751, P = 0.000) and TOA (left foot t = -3.855, P = 0.001; right foot t = -3.648, P = 0.001), turning angle velocity (t = -5.140, P = 0.000), ABC score (Z = -3.861, P = 0.000) and DGI score (Z = -4.381, P = 0.000) were higher, while percentage of double support phase time (t = -3.940, P = 0.000), dizziness/vertigo VAS score (Z = -2.952, P = 0.003), SVV (Z = -3.499, P = 0.000), DHI score (Z = -3.397, P = 0.001) and TUGT time (Z = -3.327, P = 0.001) were lower than those of pre-treatment. Spearman rank correlation analysis showed that increase in step length was associated with improvement in ABC (r_s = 0.464, P = 0.015), SVV (r_s = -0.469, P = 0.014), DGI (r_s = 0.685, P = 0.000) and TUGT (r_s = -0.569, P = 0.002). The increase in gait speed was associated with improvement in ABC (r_s = 0.525, P = 0.005), SVV (r_s = -0.381, P = 0.049), DGI (r_s = 0.734, P = 0.000) and TUGT (r_s = -0.523, P = 0.005). The decrease in percentage of double support phase time was significantly associated with improvement in ABC (r_s = -0.504, P = 0.007), SVV (r_s = 0.405, P = 0.036), DGI (r_s = -0.702, P = 0.000) and TUGT (r_s = 0.559, P = 0.002). Conclusions: Vestibular rehabilitation treatment can significantly improve the subjective perception of dizziness/vertigo, improve walking ability, ability to perform daily activities, confidence in balance, and dynamic balance function, and reduce the risk of falls in ischemic stroke patients with vestibular symptoms. It provides a basis for the implementation of precise individualized vestibular rehabilitation treatment in ischemic stroke patients with vestibular symptoms.

Key words: Ischemic stroke, Vestibular diseases, Postural balance, Vertigo, Rehabilitation

摘要：

目的: 探讨前庭康复治疗对伴前庭症状的缺血性卒中患者主观症状、步行能力及动态平衡功能的作用。方法: 纳入2022年1月至2024年12月在天津市环湖医院行前庭康复治疗的27例伴前庭症状的缺血性卒中患者，予以个性化前庭康复治疗包括凝视稳定训练、头部和姿势稳定训练及步态训练（共30次），治疗前后通过可穿戴传感器行7米步行试验记录步态参数[包括步长和步速、双支撑相时间百分比、足击地角（FSA）和足离地角（TOA）、转身角速度]，特异性活动平衡信心量表（ABC）评估完成各项任务时主观平衡信心，头晕/眩晕视觉模拟评分（VAS）评估头晕/眩晕程度，水桶测验评估主观视觉垂直偏斜角度，头晕残障量表（DHI）评估头晕残障程度，动态步态指数（DGI）和起立-行走计时测验（TUGT）评估动态平衡功能。Spearman秩相关分析探讨治疗前后步态参数变化与主观测验和动态平衡功能的相关性。结果: 治疗后步长（t = -4.877，P = 0.000）、步速（t = -4.458，P = 0.000）、双足FSA（左足t = -5.590，P = 0.000；右足t = -4.751，P = 0.000）和TOA（左足t = -3.855，P = 0.001；右足t = -3.648，P = 0.001）、转身角速度（t = -5.140，P = 0.000），ABC评分（Z = -3.861，P = 0.000），DGI评分（Z = -4.381，P = 0.000）增加；双支撑相时间百分比（t = -3.940，P = 0.000），头晕/眩晕VAS评分（Z = -2.952，P = 0.003），主观视觉垂直偏斜角度（Z = -3.499，P = 0.000），DHI评分（Z = -3.397，P = 0.001），TUGT时间（Z = -3.327，P = 0.001）减少。Spearman秩相关分析显示，步长的增加与ABC评分（r_s = 0.464，P = 0.015）、主观视觉垂直偏斜角度（r_s = -0.469，P = 0.014）、DGI评分（r_s = 0.685，P = 0.000）和TUGT时间（r_s = -0.569，P = 0.002）的改善相关，步速的增快与ABC评分（r_s = 0.525，P = 0.005）、主观视觉垂直偏斜角度（r_s = -0.381，P = 0.049）、DGI评分（r_s = 0.734，P = 0.000）和TUGT时间（r_s = -0.523，P = 0.005）的改善相关，双支撑相时间百分比的降低与ABC评分（r_s = -0.504，P = 0.007）、主观视觉垂直偏斜角度（r_s = 0.405，P = 0.036）、DGI评分（r_s = 0.702，P = 0.000）和TUGT时间（r_s = 0.559，P = 0.002）的改善相关。结论: 前庭康复治疗可以显著改善伴前庭症状的缺血性卒中患者头晕/眩晕主观感受，提高步行能力、日常生活活动能力、主观平衡信心和动态平衡功能，降低跌倒风险，为患者实施精准的个性化前庭康复治疗提供依据。

关键词: 缺血性卒中, 前庭疾病, 姿势平衡, 眩晕, 康复