Баланс туловища у пациентов с посттравматической цервикальной миелопатией

Бушков Ф.А., Романовская Е.В., Усанова Е.В., Федоткина Л.Е. Баланс туловища у пациентов с посттравматической цервикальной миелопатией. Consilium Medicum. 2020; 22 (2): 50–53. DOI: 10.26442/20751753.2020.2.200029

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Bushkov F.A., Romanovskaya E.V., Usanova E.V., Fedotkina L.E. Trunk balance in patients with cervical spinal cord injury. Consilium Medicum. 2020; 22 (2): 50–53. DOI: 10.26442/20751753.2020.2.200029

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Аннотация

Аннотация
Цель. Определить влияние баланса туловища в положении сидя на степень функциональной независимости у пациентов с посттравматической цервикальной миелопатией (ПЦМ).
Материалы и методы. В исследовании приняли участие 40 пациентов с ПЦМ, у которых выполнялась оценка динамического и статического баланса (двигательные задания теста Ван-Люшот, ангулометрия положения таза в положении сидя), оценка двигательных навыков функциональной независимости (двигательная субшкала FIM), неврологический статус (стандарт ASIA). В контрольную группу по оценке положения таза вошли 20 относительно здоровых испытуемых, сопоставимых по половому и возрастному признакам.
Результаты. Обнаружено влияние «сгибательного» положения таза и выраженности неврологического дефицита на баланс туловища, выявлена корреляция между способностью выполнять ряд навыков самообслуживания и показателями баланса туловища, а также положительная связь между сгибательным положением таза и увеличением давности спинальной травмы.
Выводы. Баланс туловища, положение таза являются важными компонентами, влияющими на степень функциональной независимости пациентов с ПЦМ.

Ключевые слова: баланс в положение сидя, цервикальная тетраплегия, функциональная независимость.

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Abstract
Aim. To determine the influence of the trunk balance in the sitting position on the degree of functional independence in patients with cervical spinal cord injury (SCI).
Materials and methods. The study involved 40 patients with SCI who were assessed for dynamic and static balance (motor tasks of the Van Luchot test, angulometry of the pelvis in the sitting position), motor skills of functional independence (motor subscale FIM) and neurological deficit (standard ASIA) were also observed. The control group for assessing the position of the pelvis included 20 relatively healthy subjects, comparable by sex and age.
Results. The influence of the pelvic flexion position and the severity of neurological deficit on the trunk balance was found, a correlation between the ability to perform a number of self-care skills and body balance indicators was found elso, a positive relationship was found between the flexion position of the pelvis and the time since SCI.
Conclusions. The balance of the body (reaching forward), the position of the pelvis are important components that affect the degree of functional independence of patients with cervical SCI.

Key words: trunk balance, cervical tetraplegia, functional independence.

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Список литературы

1. Лившиц А.В., Гольфанд В.Б. Сов. Медицина. 1976; 3: 77–80.
[Livshits A.V., Gol'fand V.B. Sov. Meditsina. 1976; 3: 77–80 (in Russian).]
2. Kirshblum SC et al. Predicting neurological recovery in traumatic cervical spinal cord injury. Arch Phys Med Rehabil 1998; 79 (11): 1456–66.
3. Ditunno J. Predicting recovery after spinal cord injury: a rehabilitation imperative. Arch Phys Med Rehab 1999; 80 (4): 361–4.
4. Post MWM, van Asbeck FWA, van Dijk AJ, Schrijvers AJP. Services for spinal cord injured: availability and satisfaction. Spinal Cord 1997; 35: 109–15.
5. Anderson KD. Targeting recovery: Priorities of the spinal cord-injured population. J Neurotrauma. 2004; 21 (10): 1371–83.
6. Kamper D, Barin K, Parnianpour M et al. Preliminary investigation of the lateral postural stability of spinal cord-injured individuals subjected to dynamic perturbations. Spinal Cord. 1999; 37 (1): 40–6.
7. Sprigle S, Maurer C, Holowka M. Development of valid and reliable measures of postural stability. J Spinal Cord Med. 2007; 30 (1): 40–9.
8. Curtis KF, Kindlin COM, Reich KM, Whit DE. Functional reach in wheelchair users: the effects of trunk and lower extremity stabilization. Arch Phys Med Rehabil 1995; 76: 360–67.
9. Maurer CL et al. Effect of seat inclination on seated pressure of individuals with spinal cord injury. Phys Ther 2004; 84: 255–61.
10. Harms M. Effect on wheelchair design on posture and comfort of users. Physiotherapy 1990; 76: 226–71.
11. Hobson DA, Tooms RE. Seated lumbar/pelvic alignment. A comparison between spinal-cord injured and non injured groups. Spine 1992; 17: 293–98.
12. Samuelsson K, Larson H, Thyberg M, Tropp H. Back pain and spinal deformity – common among wheelchair users with spinal cord injuries. Scand J Occupational Ther 1996; 3: 28–32.
13. Bolin I, Bodin P, Kreuter M. Sitting position – Posture and performance in C5-C6 tetraplegia. Spinal Cord 2000; 38: 425–34.
14. Jørgensen V, Elfving B, Opheim A. Assessment of unsupported sitting in patients with spinal cord injury. Spinal Cord 2011; 49 (7): 838–43.
15. Kirshblum SC, Burns SP, Biering-Sorensen F et al. International standards for neurological classification of spinal cord injury (Revised 2011). J Spinal Cord Med 2011; 34 (6): 535–46. DOI:10.1179/204577211X13207446293695
16. Hall KM, Cohen ME, Wright J et al. Characteristics of the Functional Independence Measure in traumaticspinal cord injury. Arch Phys Med Rehabil 1999; 80 (11): 1471–6.
17. Бушков Ф.А., Романовская Е.В., Усанова Е.В., Федоткина Л.Е. Значение теста Ван-Люшот в оценке функции верхней конечности у пациентов с цервикальной тетраплегией. Фарматека. Журн. для практикующих врачей. 2019; 3; 51–6. DOI: https: //dx.doi.org/10.18565/pharmateca. 2019.3.00-00
[Bushkov F.A., Romanovskaia E.V., Usanova E.V., Fedotkina L.E. Znachenie testa Van-Liushot v otsenke funktsii verkhnei konechnosti u patsientov s tservikal'noi tetraplegiei. Farmateka. Zhurn. dlia praktikuiushchikh
vrachei. 2019; 3; 51–6. DOI: https: //dx.doi.org/10.18565/pharmateca.2019.3.00-00 (in Russian).]
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19. Sprigle S, Wootten M, Sawacha Z, Thielman G. Relationships among cushion type, backrest height, seated posture, and reach of wheelchair users with spinal cord injury. J Spinal Cord Med. 2003; 26 (3): 236–43.
20. Michaelsen SM, Luta A, Roby-Brami A, Levin MF. Effect of trunk restraint on the recovery of reaching movements in hemiparetic patients. Stroke 2001; 32 (8): 1875–83. DOI: 10.1161/01.str.32.8.1875
21. Lynch SM, Leahy P, Barker SP. Reliability of measurements obtained with a modified functional reach test in subjects with spinal cord injury. Phys Ther 1998; 78: 128–33.

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1. Livshits A.V., Gol'fand V.B. Sov. Meditsina. 1976; 3: 77–80 (in Russian).
2. Kirshblum SC et al. Predicting neurological recovery in traumatic cervical spinal cord injury. Arch Phys Med Rehabil 1998; 79 (11): 1456–66.
3. Ditunno J. Predicting recovery after spinal cord injury: a rehabilitation imperative. Arch Phys Med Rehab 1999; 80 (4): 361–4.
4. Post MWM, van Asbeck FWA, van Dijk AJ, Schrijvers AJP. Services for spinal cord injured: availability and satisfaction. Spinal Cord 1997; 35: 109–15.
5. Anderson KD. Targeting recovery: Priorities of the spinal cord-injured population. J Neurotrauma. 2004; 21 (10): 1371–83.
6. Kamper D, Barin K, Parnianpour M et al. Preliminary investigation of the lateral postural stability of spinal cord-injured individuals subjected to dynamic perturbations. Spinal Cord. 1999; 37 (1): 40–6.
7. Sprigle S, Maurer C, Holowka M. Development of valid and reliable measures of postural stability. J Spinal Cord Med. 2007; 30 (1): 40–9.
8. Curtis KF, Kindlin COM, Reich KM, Whit DE. Functional reach in wheelchair users: the effects of trunk and lower extremity stabilization. Arch Phys Med Rehabil 1995; 76: 360–67.
9. Maurer CL et al. Effect of seat inclination on seated pressure of individuals with spinal cord injury. Phys Ther 2004; 84: 255–61.
10. Harms M. Effect on wheelchair design on posture and comfort of users. Physiotherapy 1990; 76: 226–71.
11. Hobson DA, Tooms RE. Seated lumbar/pelvic alignment. A comparison between spinal-cord injured and non injured groups. Spine 1992; 17: 293–98.
12. Samuelsson K, Larson H, Thyberg M, Tropp H. Back pain and spinal deformity – common among wheelchair users with spinal cord injuries. Scand J Occupational Ther 1996; 3: 28–32.
13. Bolin I, Bodin P, Kreuter M. Sitting position – Posture and performance in C5-C6 tetraplegia. Spinal Cord 2000; 38: 425–34.
14. Jørgensen V, Elfving B, Opheim A. Assessment of unsupported sitting in patients with spinal cord injury. Spinal Cord 2011; 49 (7): 838–43.
15. Kirshblum SC, Burns SP, Biering-Sorensen F et al. International standards for neurological classification of spinal cord injury (Revised 2011). J Spinal Cord Med 2011; 34 (6): 535–46. DOI:10.1179/204577211X13207446293695
16. Hall KM, Cohen ME, Wright J et al. Characteristics of the Functional Independence Measure in traumaticspinal cord injury. Arch Phys Med Rehabil 1999; 80 (11): 1471–6.
17. Bushkov F.A., Romanovskaia E.V., Usanova E.V., Fedotkina L.E. Znachenie testa Van-Liushot v otsenke funktsii verkhnei konechnosti u patsientov s tservikal'noi tetraplegiei. Farmateka. Zhurn. dlia praktikuiushchikh
vrachei. 2019; 3; 51–6. DOI: https: //dx.doi.org/10.18565/pharmateca.2019.3.00-00 (in Russian).
18. Do MC, Bouisset S, Moynot C. Are paraplegics handicapped in the execution of a manual task? Ergonomics. 1985; 28: 1365–75.
19. Sprigle S, Wootten M, Sawacha Z, Thielman G. Relationships among cushion type, backrest height, seated posture, and reach of wheelchair users with spinal cord injury. J Spinal Cord Med. 2003; 26 (3): 236–43.
20. Michaelsen SM, Luta A, Roby-Brami A, Levin MF. Effect of trunk restraint on the recovery of reaching movements in hemiparetic patients. Stroke 2001; 32 (8): 1875–83. DOI: 10.1161/01.str.32.8.1875
21. Lynch SM, Leahy P, Barker SP. Reliability of measurements obtained with a modified functional reach test in subjects with spinal cord injury. Phys Ther 1998; 78: 128–33.

Авторы

Ф.А. Бушков*, Е.В. Романовская, Е.В. Усанова, Л.Е. Федоткина

АО «Реабилитационный центр для инвалидов “Преодоление”», Москва, Россия
*bushkovfedor@mail.ru

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Fedor A. Bushkov*, Elena V. Romanovskaya, Elena V. Usanova, Liia A. Fedotkina

Rehabilitation center for disabled people “Overcoming”, Moscow, Russia
*bushkovfedor@mail.ru

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