平衡训练、静态和动态进展坐姿、物理治疗
Revised: May 20, 2024 修订日期：2024 年 5 月 20 日
Introduction 介绍
Sitting balance is a functional progression
from the supine and side-lying positions to standing and ambulation. Deficits
in pelvis and spine alignment, weight-bearing, or extensor muscle
weakness—possibly resulting from stroke or another neurologic deficit—can
impair sitting balance and increase the risk of falls.1
坐姿平衡是从仰卧位和侧卧位到站立和行走的功能进展。骨盆和脊柱对齐缺陷、负重或伸肌无力（可能由中风或其他神经功能缺损引起）会损害坐姿平衡并增加跌倒的风险。1
Good sitting balance promotes safe
participation in activities of daily living (ADLs). Sitting is necessary for
functional wheelchair use and is a preferred position for eating, toileting,
and grooming. Good sitting also improves lung volume and gas exchange and
reduces cardiac stress. Static and dynamic sitting balance training may be
especially valuable for patients who are frail or can't ambulate, helping them
to improve safety and maintain out-of-bed activities.
良好的坐姿平衡有助于安全地参与日常生活活动 （ADL）。坐着是功能性轮椅使用的必要条件，也是吃饭、如厕和梳理身体的首选姿势。良好的坐姿还可以改善肺容量和气体交换，并减轻心脏压力。静态和动态坐姿平衡训练对于虚弱或无法行走的患者可能特别有价值，帮助他们提高安全性并保持卧床活动。
The ability to balance is essential for
maintaining posture, moving, and recovering equilibrium.23To
be balanced while sitting, the patient's head and trunk should be in the
midline position, with the trunk's center of gravity situated over the pelvis,
buttocks, and thighs, which provide the base of support. A patient achieves
balance when the patient can maintain the center of gravity over the base
of support while static and during movement transitions, and can return
to that center of gravity in reaction to external forces.23
平衡能力对于保持姿势、移动和恢复平衡至关重要。23 为了在坐着时保持平衡，患者的头部和躯干应处于中线位置，躯干的重心位于骨盆、臀部和大腿上，骨盆、臀部和大腿是支撑的基础。当患者能够在静止和运动过渡期间保持支撑底座上的重心，并且可以在外力作用下返回该重心时，患者就会达到平衡。23
Core stability exercises combined with
conventional therapy improve trunk control, dynamic sitting balance, standing
balance, gait, and ADLs in subacute poststroke patients,4although
there's insufficient evidence to support a specific set of exercises for
improving sitting balance. Therapeutic interventions to improve static and
dynamic trunk control include tasks that challenge the patient's ability to
maintain the center of gravity over the base of support; examples are reaching,
responding to perturbation, and performing movement transitions. Treatment
interventions should also strengthen the trunk musculature to improve dynamic
sitting balance.45
核心稳定性练习与常规疗法相结合可改善亚急性卒中后患者的躯干控制、动态坐姿平衡、站立平衡、步态和 ADLs，4 尽管没有足够的证据支持一组特定的练习来改善坐姿平衡。改善静态和动态躯干控制的治疗性干预包括挑战患者在支撑底座上保持重心的能力的任务;示例包括 reaching、response
to perturbation 和 perform movement transitions。治疗干预还应加强躯干肌肉组织，以改善动态坐姿平衡。45
Assessment tools such as the Trunk
Impairment Scale can be used to help quantify a patient's baseline status and
monitor progress after a stroke.678(See Trunk
impairment scale.)
躯干损伤量表等评估工具可用于帮助量化患者的基线状态并监测中风后的进展。678 （见躯干损伤量表。
TRUNK IMPAIRMENT SCALE 躯干损伤量表 | ||
The
Trunk Impairment Scale, shown below, helps evaluate static and dynamic
sitting balance and trunk coordination after a stroke. The results help guide
treatment. When
using the Trunk Impairment scale, position the patient on the edge of the bed
or treatment table without back and arm support. Make sure that the patient's
thighs make full contact with the bed or table and that the feet are
positioned on the floor, hip-width apart. Ensure that the patient's head and
trunk are in the midline position, the knees are bent at a 90-degree angle,
and the arms are resting on the legs. If the patient has hemiplegia, use the
position of the hemiplegic arm as the starting position. If the patient
scores 0 on the first item, the total score is 0. Repeat each test item three
times (if necessary) and use the highest score. Don't allow practice
sessions, but correct the patient (if necessary) during attempts. | ||
Item 项目 | Description 描述 | Score 得分 |
Static sitting balance 静态坐姿平衡 | ||
1.
Begin in the starting position. | The
patient falls or can't maintain the starting position for 10 seconds without
arm support. | 0
(If the patient scores 0 in this section, then the total Trunk Impairment
Scale score is 0.) |
The
patient can maintain the starting position for 10 seconds. | 2 | |
2.
The patient begins in the starting position. The therapist crosses the
unaffected leg over the hemiplegic leg. | The
patient falls or can't maintain the sitting position for 10 seconds without
arm support. | 0 |
The
patient can maintain the sitting position for 10 seconds. | 2 | |
3.
From the starting position, the patient crosses the unaffected leg over the
hemiplegic leg. | The patient falls. 患者跌倒。 | 0 |
The
patient can't cross the legs without arm support on the bed or table. | 1 | |
The
patient crosses the legs but displaces the trunk more than 10 cm backwards or
assists crossing with the hand. | 2 | |
The
patient crosses the legs without trunk displacement or assistance. | 3 | |
Total
static sitting balance score | ||
Dynamic sitting balance 动态坐姿平衡 | ||
1.
From the starting position, the patient touches the bed or table with the
hemiplegic elbow (by shortening the hemiplegic side and lengthening the
unaffected side) and then returns to the starting position. | The
patient falls or needs support from an upper extremity, or the elbow doesn't
touch the bed or table. | 0
(If the patient scores 0 in this section, then items 2 and 3 in this section
score 0.) |
The
patient moves actively without help, and the elbow touches the bed or table. | 1 | |
2.
Repeat item 1 in the dynamic sitting balance section. | The
patient demonstrates no or opposite shortening or lengthening. | 0
(If the patient scores 0 in this section, then item 3 in this section scores
0.) |
The
patient demonstrates appropriate shortening and lengthening. | 1 | |
3.
Repeat item 1 in the dynamic sitting balance section. | The
patient compensates. Possible compensations include the use of an upper
extremity, contralateral hip abduction, hip flexion (if the elbow touches the
bed or table further than the proximal half of the femur), knee flexion, and
sliding of the feet. | 0 |
The
patient moves without compensation. | 1 | |
4.
The patient begins in the starting position. The therapist instructs
the patient to touch the bed or table with the unaffected elbow (by
shortening the unaffected side and lengthening the hemiplegic side) and then
return to the starting position. | The
patient falls or needs support from an upper extremity, or the elbow doesn't
touch the bed or table. | 0
(If the patient scores 0 in this section, then items 5 and 6 in this section
score 0.) |
The
patient moves actively without help, and the elbow touches the bed or table. | 1 | |
5.
Repeat item 4 in the dynamic sitting balance section. | The
patient demonstrates no or opposite shortening or lengthening. | 0
(If the patient scores 0 in this section, then item 6 in this section scores
0.) |
The
patient demonstrates appropriate shortening and lengthening. | 1 | |
6.
Repeat item 4 in the dynamic sitting section. | The
patient compensates. Possible compensations include the use of an upper
extremity, contralateral hip abduction, hip flexion (if the elbow touches the
bed or table further than the proximal half of the femur), knee flexion, and
sliding of the feet | 0 |
The
patient moves without compensation. | 1 | |
7.
The patient begins in the starting position. The therapist instructs the
patient to lift the pelvis from the bed or table at the hemiplegic side (by
shortening the hemiplegic side and lengthening the unaffected side) and then
return to the starting position. | The
patient demonstrates no or opposite shortening or lengthening. | 0
(If the patient scores 0 in this section, then item 8 in this section scores
0.) |
The
patient demonstrates appropriate shortening and lengthening. | 1 | |
8.
Repeat item 7 in the dynamic sitting section. | The
patient compensates. Possible compensations include the use of upper
extremities and pushing off with the ipsilateral foot (heel loses contact
with the floor). | 0 |
The
patient moves without compensation. | 1 | |
9.
The patient begins in the starting position. The therapist instructs
the patient to lift the pelvis from the bed or table at the unaffected
side (by shortening the unaffected side and lengthening the hemiplegic side)
and then return to the starting position. | The
patient demonstrates no or opposite shortening or lengthening. | 0
(If the patient scores 0 in this section, then item 10 in this section scores
0.) |
The
patient demonstrates appropriate shortening and lengthening. | 1 | |
10.
Repeat item 9 in the dynamic sitting section. | The
patient compensates. Possible compensations include the use of upper
extremities and pushing off with the ipsilateral foot (heel loses contact
with the floor). | 0 |
The
patient moves without compensation. | 1 | |
Total
dynamic sitting balance score | ||
Coordination 协调 | ||
1.
The patient begins in the starting position. The therapist instructs the
patient to rotate the upper trunk six times (with each shoulder moving
forward three times), moving the hemiplegic side first, with the head fixated
in the starting position. | The
patient doesn't move the hemiplegic side three times. | 0
(If the patient scores 0 in this section, then item 2 in this section scores
0.) |
Rotation
is asymmetrical. | 1 | |
Rotation is symmetrical. 旋转是对称的。 | 2 | |
2.
Repeat item 1 in the coordination section within 6 seconds. | Rotation
is asymmetrical. | 0 |
Rotation is symmetrical. 旋转是对称的。 | 1 | |
3.
The patient begins in the starting position. The therapist instructs the
patient to rotate the lower trunk six times (with each knee moving
forward three times), moving the hemiplegic side first, with the upper trunk
fixated in the starting position. | The
patient doesn't move the hemiplegic side three times. | 0
(If the patient scores 0 in this section, then item 4 in this section scores
0.) |
Rotation
is asymmetrical. | 1 | |
Rotation is symmetrical. 旋转是对称的。 | 2 | |
4.
Repeat item 3 of the coordination section within 6 seconds. | Rotation
is asymmetrical. | 0 |
Rotation is symmetrical. 旋转是对称的。 | 1 | |
Total coordination score 协调总分 | ||
Total
Trunk Impairment Scale score | ||
Verheyden,
G., et al. (2004). The Trunk Impairment Scale: A new tool to measure motor
impairment of the trunk after stroke. Clinical Rehabilitation, 18(3),
326–334. Retrieved April 2024 from https://journals.sagepub.com/doi/10.1191/0269215504cr733oa Reprinted
by permission of SAGE Publications, Ltd. | ||
Equipment 设备
Chair, wheelchair, bed, or treatment mat or table
椅子、轮椅、床或治疗垫或桌子Facility-approved disinfectant
工厂认可的消毒剂Gloves 手套
Pillows 枕头
Watch or clock with second hand or stopwatch
带秒针或秒表的手表或时钟Optional: 1- to 2-lb (0.45- to 0.9-kg) weight, blood pressure cuff, facility-approved assessment tool, foam cushion, gait belt, handheld ball, inflated or weighted ball, large therapy ball, other personal protective equipment, reclining chair, stacking cones, stethoscope, stool or large book
可选：1 至 2 磅（0.45 至 0.9 千克）的重量、血压袖带、设施认可的评估工具、泡沫垫、步态带、手持球、充气或加重球、大型治疗球、其他个人防护设备、躺椅、堆叠锥体、听诊器、凳子或大书
Preparation of Equipment
设备准备
Inspect all equipment and supplies. If a
product is expired, is defective, or has compromised integrity, remove it from
patient use, label it as expired or defective, and report the expiration or
defect as directed by your facility.
检查所有设备和用品。如果商品已过期、有缺陷或完整性受损，请将其从患者使用中移除，将其标记为已过期或有缺陷，并按照您的设施的指示报告过期或缺陷。
Implementation 实现
If required by your facility, verify the practitioner's order.
如果您的机构要求，请核实医生的医嘱。Review the patient's medical record for the patient's medical history, current diagnosis, and medication record.
查看患者的病历，了解患者的病史、当前诊断和用药记录。
Clinical
alert: If the patient is considered a fall
risk, apply a gait belt to help prevent injury to the patient.
临床警报：如果认为患者有跌倒风险，请系上步态带以帮助防止对患者造成伤害。
Gather and prepare the necessary equipment and supplies.
收集并准备必要的设备和用品。Perform hand hygiene.91011121314
保持手部卫生。91011121314Confirm the patient's identity using at least two patient identifiers.15
使用至少两个患者标识符确认患者的身份。15Provide privacy.16171819
提供隐私。票价：16171819Identify yourself and explain your role.
表明您的身份并说明您的角色。Observe the positioning of the patient's IV lines, catheters, tubes, and equipment to provide a clear treatment area and help prevent entanglement and accidental dislodgement.
观察患者静脉输液管、导管、管子和设备的位置，以提供清晰的治疗区域，并有助于防止缠结和意外移位。Explain the procedure to the patient and family (if appropriate) according to their individual communication and learning needs to increase their understanding, allay their fears, and enhance cooperation.20 Provide encouragement because the patient may be hesitant or fearful. Reassure the patient that there's no need to attempt more than is possible and that the patient can progress at an independent pace.
根据患者和家属的个人沟通和学习需要（如适用）向他们解释程序，以增加他们的理解、减轻他们的恐惧和加强合作。20 要鼓励病人，因为病人可能会犹豫或害怕。让患者放心，没有必要尝试更多可能的事情，并且患者可以独立地进步。Use a facility-approved assessment tool (if available) to assess the patient's balance status, guide training, and monitor progress.
使用机构认可的评估工具（如果有）来评估患者的平衡状态、指导训练和监测进展。Assist the patient into an appropriate sitting position.
帮助患者进入适当的坐姿。
Performing static basic sitting balance
进行静态基本坐姿平衡
Assist the patient who needs back or head support into a wheelchair or reclining chair. Sitting upright is a progression from the supine or side-lying position because the head is elevated and the legs are in a dependent position.
帮助需要背部或头部支撑的患者坐在轮椅或躺椅上。坐直是从仰卧或侧卧姿势开始的，因为头部抬高，双腿处于依赖位置。Advance the patient's static sitting tolerance by raising the upper body and trunk toward the vertical axis and lowering the legs with the thighs parallel to the floor and the lower legs perpendicular to the floor. Ask the patient to report any discomfort or dizziness during this activity, and check heart rate and blood pressure to assess for orthostatic hypotension.
通过将上半身和躯干朝垂直轴抬高，放下双腿，大腿平行于地板，小腿垂直于地板，提高患者的静态坐姿耐受性。要求患者报告此活动期间的任何不适或头晕，并检查心率和血压以评估直立性低血压。Time how long the patient can sit comfortably, and increase the length of time based on physiologic responses. (See the "Endurance training, progressive, physical therapy" procedure.)
时间 患者可以舒适地坐着多长时间，并根据生理反应增加时间长度。（参见 “耐力训练、渐进式物理治疗”程序）
Performing static
sitting control with upper extremity support
在上肢支持下进行 static 坐姿控制
Help the patient sit with upper extremity support (hands placed on either side of the hips on the bed) and with the feet on the floor at the edge of the bed or treatment table. If the patient has poor trunk control, two people may need to assist the patient to prevent falls.
帮助患者在上肢支撑下坐下（双手放在床上臀部的两侧），并将脚放在床或治疗台边缘的地板上。如果患者的躯干控制不佳，可能需要两个人协助患者以防止跌倒。Assist the patient in stabilizing a sitting position by placing your hands on top of the patient's hands, at the shoulders, at the pelvis, or on the knees. If two people are working with the patient, position one person behind the patient to provide trunk support while you remain in front of the patient to assist with lower body positioning and hand placement on the bed.
将双手放在患者的手上、肩膀、骨盆或膝盖上，帮助患者稳定坐姿。如果两个人与患者一起工作，则让一个人在患者后面提供躯干支撑，而您则留在患者前面，以协助下半身定位和将手放在床上。Use pillows for additional support as needed. A patient who has just progressed to unsupported sitting may have impaired postural control and may benefit from verbal and tactile cues, such as tapping on the trunk muscles, to improve alignment.
根据需要使用枕头提供额外的支撑。刚刚发展到无支撑坐姿的患者可能姿势控制受损，并且可能会受益于语言和触觉提示，例如敲击躯干肌肉，以改善对齐。Have the patient practice the static sitting position with upper extremity support for increasing increments of time (such as 10 seconds, 30 seconds, 1 minute) while you monitor the patient's physiologic and verbal responses.
让患者在上肢支撑下练习静态坐位，增加时间增量（例如 10 秒、30 秒、1 分钟），同时监测患者的生理和语言反应。
Performing static sitting control
without upper extremity support
在没有上肢支撑的情况下进行静态坐姿控制
Encourage the patient to sit at the edge of the bed or treatment table without holding onto it. If the patient can balance using both arms for support, allow progression to single-arm support (practice removing the left arm, then the right arm as able).
鼓励患者坐在床边或治疗台边，不要扶着它。如果患者可以使用双臂支撑来平衡，则允许进展到单臂支撑（练习移除左臂，然后尽可能移除右臂）。If the patient can sit successfully with single-arm support and without losing balance, tell the patient to try putting both hands on the lap or folding them across the chest as you guard the shoulders or pelvis, and use tactile cues for trunk muscle facilitation.
如果患者可以在单臂支撑下成功坐下并且不会失去平衡，请告诉患者尝试将双手放在膝盖上或折叠在胸部，同时保护肩膀或骨盆，并使用触觉提示促进躯干肌肉。If the patient can sit successfully without upper extremity support, ask the patient to sit with the feet on a foam cushion and then sit on a foam cushion to increase the challenge of static sitting balance.
如果患者可以在没有上肢支撑的情况下成功坐下，请患者双脚坐在泡沫垫上，然后坐在泡沫垫上，以增加静态坐姿平衡的挑战。Have the patient practice the static sitting position without upper extremity support for increasing increments of time.
让患者在没有上肢支撑的情况下练习静态坐姿，以增加时间增量。
Performing static
sitting control with a vestibular system challenge
通过前庭系统挑战进行 static 坐姿控制
Encourage the patient to sit at the edge of the bed or treatment table with the eyes closed for a few seconds while you remain in front of the patient, ready to assist at the shoulders in case the patient loses balance. Watch the patient's face to determine whether the eyes remain closed. If the patient can sit unsupported easily with the eyes open but loses balance quickly upon closing the eyes, then the patient may be relying heavily on vision for balance.
鼓励患者坐在床边或治疗台上，闭上眼睛几秒钟，而您则保持在患者面前，随时准备在患者失去平衡的情况下协助肩膀。观察患者的面部以确定眼睛是否保持闭着。如果患者可以在睁开眼睛时轻松坐着，但在闭上眼睛时很快失去平衡，那么患者可能严重依赖视觉来保持平衡。Gradually increase the time that the patient keeps the eyes closed, up to 30 seconds.
逐渐增加患者闭上眼睛的时间，最多 30 秒。Increase the level of difficulty by telling the patient to turn the head to the right and then to the left, first with the eyes open and then with the eyes closed.
通过告诉患者先睁开眼睛，然后再向左转动头部，先睁开眼睛，然后再闭上眼睛，来增加难度。Increase the level of difficulty by telling the patient to turn the head and shoulders to the right and then to the left.
通过告诉患者将头部和肩膀向右转动，然后再向左转动来增加难度。Observe the patient's facial expression, and watch for the patient to close the eyes while performing head turns as well as head and shoulder turns.
观察患者的面部表情，并观察患者在进行头部转动以及头部和肩部转动时闭上眼睛。Monitor the patient's physiologic responses. Ask whether these motions cause dizziness.
监测患者的生理反应。询问这些动作是否会导致头晕。
Clinical
alert: Head or trunk rotation may be
contraindicated in a patient with osteoporosis or who's undergone spinal
surgery or spinal immobilization.
临床提示：骨质疏松症患者或接受过脊柱手术或脊柱固定的患者可能禁忌头部或躯干旋转。
Performing trunk
control in response to perturbations
执行 trunk 控制以响应扰动
For trunk stabilizing reversals, place your hands gently on the patient's shoulders or at the sides of the patient's trunk at the axillary borders. Ask the patient to resist you as you apply light pressure by saying, "Don't let me move you," as the patient maintains an upright sitting posture.
对于躯干稳定反转，将手轻轻放在患者的肩膀上或患者躯干两侧的腋窝缘处。当您轻轻按压时，让患者抵抗您，说“不要让我移动您”，因为患者保持直立的坐姿。Increase the level of difficulty by applying increased pressure and by adding anterior-posterior, medial-lateral, and diagonal directions of pressure.
通过施加更大的压力和增加前后、内侧和对角线方向的压力来增加难度。For rhythmic stabilization, add resisted movements in rotational directions. At the start, inform the patient when you're going to change the direction of your pressure so that you can observe the responses. Then increase the level of difficulty by applying pressure in rotational directions without first informing the patient.
对于节奏稳定，请在旋转方向上添加阻力运动。开始时，告知患者您何时要改变压力方向，以便您可以观察反应。然后通过在旋转方向上施加压力而不先通知患者来增加难度。
Performing dynamicsitting control with weight shifting
通过重量转移进行 dynamic 坐姿控制
Tell the patient to fold the arms across the chest.
告诉患者将手臂交叉在胸部。Ask the patient to shift the upper trunk to the right while slightly lifting the left buttock off of the sitting surface, and then tell the patient to return to midline position. Then ask the patient to shift the upper trunk to the left while slightly lifting the right buttock off of the sitting surface, and tell the patient to return to midline position. Assist the patient at the pelvis, if necessary.
让患者将上躯干向右移动，同时将左臀部稍微抬离坐面，然后告诉患者回到中线位置。然后让患者将上躯干向左移动，同时将右臀部稍微抬离坐面，并告诉患者回到中线位置。如有必要，在骨盆处协助患者。Increase the level of difficulty by asking the patient to scoot to the left and then to the right, using the hands to push down on the sitting surface while lifting the pelvis slightly up and over in the intended direction.
通过要求患者向左然后向右滑行，用手向下推坐面，同时沿预期方向稍微向上和翻转骨盆来增加难度。Increase the level of difficulty by asking the patient to try shifting weight in anterior-posterior and diagonal directions.
通过要求患者尝试前后和对角线方向转移重心来增加难度。If a large therapy ball is available, facilitate anterior-posterior and diagonal weight shifts by asking the patient to hold the ball in front of the body and then to push the ball so that it rolls in the direction of the desired weight shift. Make sure that you properly guard the patient to avoid falls.
如果有大型治疗球，请患者将球放在身体前方，然后推动球，使其沿所需重量转移的方向滚动，从而促进前后和对角线的重量转移。确保妥善保护患者以避免跌倒。
Performing dynamicsitting control
with upper extremity movement
通过上肢运动进行动态坐姿控制
Ask the patient to lift one arm while sitting at the edge of the bed or on a treatment mat. Then tell the patient to lower the arm. Repeat with the other arm.
让患者坐在床边或治疗垫上抬起一只手臂。然后告诉患者放下手臂。对另一只手臂重复上述步骤。Increase the level of difficulty by asking the patient to lift both arms to shoulder level and then over the head.
通过要求患者将双臂抬高到肩膀水平，然后举过头部来增加难度。Increase the level of difficulty by asking the patient to lift a 1- to 2-lb (0.45- to 0.9-kg) weight, first with one arm at a time and then both arms at the same time.
通过要求患者举起 1 至 2 磅（0.45 至 0.9 公斤）的重量来增加难度，先用一只手臂举起，然后同时举起双臂。Increase the level of difficulty by asking the patient to throw and catch an inflated or weighted ball.
通过要求患者投掷和接住充气或加重的球来增加难度。Incorporate functional tasks, such as grooming, reaching to retrieve objects, and feeding, to improve patient participation and motivation.
结合功能性任务，例如梳理、伸手取回物品和喂食，以提高患者的参与度和积极性。
Clinical
alert: Overhead upper extremity movement
with resistance weights may be contraindicated in a patient who has a
peripherally inserted central catheter, hemiplegia or osteoporosis, an upper
extremity amputation, recent shoulder or spinal surgery, or cardiac precautions
that include avoiding sternal resistance.
临床提示：对于有外周插入中心导管、偏瘫或骨质疏松症、上肢截肢、近期肩部或脊柱手术或包括避免胸骨阻力在内的心脏预防措施的患者，可能禁忌使用阻力重量进行头顶上肢运动。
Performing dynamic
sitting control with upper extremity movement
通过上肢运动进行 dynamic 坐姿控制
Tell the patient to reach forward a few inches with a straight arm, allowing the trunk to lean forward, while trying to touch your hand held in front of the patient as a target.
告诉患者伸直手臂向前伸出几英寸，让躯干向前倾斜，同时尝试触摸以患者面前的手为目标。Increase the level of difficulty by moving your hand farther away from the patient and by asking the patient to reach to the sides and diagonally.
将手移离患者更远，并要求患者伸向两侧和对角线，以增加难度。Increase the level of difficulty by asking the patient to reach laterally until resting on one elbow and then returning to midline alignment. Assist the patient at the shoulders and pelvis as needed.
通过要求患者横向伸展直到靠在一个肘部上，然后返回到中线对齐来增加难度。根据需要协助患者的肩部和骨盆。Increase the level of difficulty by asking the patient to reach across the midline with trunk rotation to retrieve an object, such as a stacking cone or handheld ball, from your hand. If you're using a cone, the patient can retrieve a cone from one side and stack it on the other side. If you're using a ball, ask the patient to hold the ball in front of them with two hands and then to move the ball from side to side, twisting the trunk while tapping your outstretched hands with the ball.
通过要求患者通过躯干旋转越过中线，从您的手中取回物体，例如堆叠锥体或手持球，从而增加难度。如果您使用的是锥体，患者可以从一侧取回锥体并将其堆叠在另一侧。如果您使用的是球，请让患者用两只手将球放在他们面前，然后将球从一侧移动到另一侧，扭动躯干，同时用球敲击伸出的手。Increase the level of difficulty by asking the patient to reach forward to pick up an object on the floor. Have the patient try reaching part way to the floor if unable to reach all the way and to try reaching down to the right and left sides.
通过要求患者向前伸手捡起地板上的物体来增加难度。如果无法完全够到，让患者尝试将身体伸到地板的一部分，并尝试向下伸向右侧和左侧。Increase the level of difficulty by asking the patient to perform upper extremity exercises while sitting on a large therapy ball.
通过要求患者坐在大型治疗球上进行上肢锻炼来增加难度。
Clinical
alert: Reaching forward or to the sides
may be contraindicated in a patient who's had hip arthroplasty or another
lumbopelvic condition. Reaching with trunk rotation may be contraindicated in a
patient who's had spinal surgery. Reaching down to the floor may be
contraindicated in a patient with hypertension, syncope, vertigo, or limited
range of motion in the hip; who's had spinal surgery, lower extremity
amputation, hip arthroplasty, or open hip reduction with internal fixation; or
who shouldn't perform the Valsalva maneuver because reaching down to
the floor can trigger this maneuver.
临床提示：对于接受过髋关节置换术或其他腰盆疾病的患者，向前或向两侧伸展可能是禁忌的。在接受过脊柱手术的患者中，躯干旋转伸展可能是禁忌的。高血压、晕厥、眩晕或髋关节活动度受限的患者可能禁忌伸手到地板;接受过脊柱手术、下肢截肢、髋关节置换术或开腹髋关节复位术内固定术的人;或者谁不应该执行 Valsalva 动作，因为伸手到地板会触发这个动作。
Performing dynamicsitting control
with lower extremity movement
通过下肢运动进行动态坐姿控制
Tell the patient to alternately raise one knee and then the other in a marching pattern while sitting.
告诉患者坐着时交替抬起一个膝盖，然后以行进模式交替抬起另一个膝盖。Increase the level of difficulty by asking the patient to raise the knee higher or by increasing the number of repetitions.
通过要求患者将膝盖抬高或增加重复次数来增加难度。Increase the level of difficulty by asking the patient to alternately lift the leg and tap the forefoot on a stool or large book placed on the floor in front of the patient. You can combine this activity with reciprocating anterior arm lifts.
通过要求患者交替抬起腿和前脚掌敲击放置在患者面前地板上的凳子或大书，增加难度。您可以将此活动与往复式前臂提升术相结合。Increase the level of difficulty by asking the patient to perform lower extremity exercises while sitting on a large therapy ball. Guard the patient at the trunk to prevent loss of balance and falls.
通过要求患者坐在大型治疗球上进行下肢锻炼来增加难度。在躯干处保护患者，以防止失去平衡和跌倒。
Completing the procedure完成过程
Perform hand hygiene.91011121314
保持手部卫生。91011121314Put on gloves and, as needed, other personal protective equipment to comply with manufacturer's instructions.21
戴上手套，并根据需要佩戴其他个人防护装备，以符合制造商的说明。21Clean and disinfect other reusable equipment according to the manufacturer's instructions to prevent the spread of infection.2223
根据制造商的说明对其他可重复使用的设备进行清洁和消毒，以防止感染传播。2223Remove and discard your gloves and, if worn, other personal protective equipment.21
取下并丢弃您的手套，如果佩戴了其他个人防护装备。21Perform hand hygiene.91011121314
保持手部卫生。91011121314Document the procedure.24252627
记录过程。票价：24252627 元
Special Considerations
特别注意事项
If the patient completes one balance activity easily, use your clinical judgment to determine whether advancing to the next, more challenging, activity is appropriate.
如果患者轻松完成一项平衡活动，请使用您的临床判断来确定是否适合进行下一个更具挑战性的活动。Adjust the activity level based on the patient's physiologic responses. Stop the activity when balance responses are unsafe and may precipitate a fall or if the challenge is too difficult.
根据患者的生理反应调整活动水平。当平衡反应不安全且可能导致跌倒或挑战太难时，请停止活动。Use caution if the patient exhibits signs of orthostatic hypotension or has a low tolerance for exercise or activity.
如果患者出现直立性低血压的体征或对运动或活动的耐受性低，请谨慎使用。If faintness occurs, return the patient to a supine position as quickly as possible to help blood pressure stabilize and resolve symptoms.
如果出现昏厥，请尽快将患者恢复到仰卧位，以帮助稳定血压和解决症状。Monitor the patient's responses constantly to determine if the patient is exceeding the cardiopulmonary threshold. If the patient exceeds the cardiopulmonary threshold, stop the activity and reassess the patient's response. Depending on the recovery, the patient may be able to resume the balance activity after resting. Alternatively, you may need to stop the activity.
持续监测患者的反应，以确定患者是否超过心肺阈值。如果患者超过心肺阈值，则停止活动并重新评估患者的反应。根据恢复情况，患者可能能够在休息后恢复平衡活动。或者，您可能需要停止该活动。If the patient begins to fall, try to break the fall by easing the patient to the bed or floor while protecting the head from impact. Then summon help. Don't leave the patient alone; provide comfort and reassurance.
如果患者开始跌倒，请尝试将患者放松到床上或地板上，同时保护头部免受撞击，从而阻止跌倒。然后寻求帮助。不要让患者独自一人;提供安慰和保证。Prevent falls by asking for additional assistance (when needed), applying a gait belt to the patient, and using good clinical judgment when advancing balance challenges.
P revent 通过寻求额外的帮助（需要时）、为患者应用步态带以及在推进平衡挑战时使用良好的临床判断而下降。Assess the patient's distress by observing verbal and nonverbal cues.
通过观察语言和非语言线索来评估患者的痛苦。Monitor the patient's neurologic status, and notify the practitioner and nurse immediately of any mental status changes (such as cognitive deterioration).
监测患者的神经系统状态，并立即通知医生和护士任何精神状态变化（如认知能力下降）。If you observe any pressure injuries, wounds, or skin breakdown, be sure to avoid pressure and shearing when the patient is in a sitting position.
如果您观察到任何压力性损伤、伤口或皮肤破损，请务必在患者坐姿时避免压力和剪切。
Patient Teaching
患者教学
If a patient with impaired sitting balance
will return home with a caregiver who's capable and willing to assist with
activities, teach them together about sitting balance activities. Demonstrate
and teach the appropriate exercises and then have the caregiver perform a
return demonstration to make sure that the patient and caregiver can safely
perform exercises without a therapist present. If the caregiver can't perform
the activities correctly, then the patient shouldn't perform home sitting
balance exercises without a therapist present.
如果坐姿平衡受损的患者在有能力并愿意协助活动的照护者的帮助下回家，请一起教他们关于坐姿平衡活动。演示和教授适当的练习，然后让护理人员进行回归演示，以确保患者和护理人员可以在没有治疗师在场的情况下安全地进行锻炼。如果护理人员无法正确进行活动，那么患者不应在没有治疗师在场的情况下进行家庭坐姿平衡练习。
Complications 并发症
Complications associated with static and
dynamic progression sitting balance training may include:
与静态和动态进展坐姿平衡训练相关的并发症可能包括：
dizziness or other negative physiologic responses (initially)
头晕或其他负面生理反应（最初）exceeding cardiopulmonary threshold
超过心肺阈值falls. 瀑布。
Documentation 文档
Documentation associated with static and
dynamic progression sitting balance training includes:
与静态和动态进展坐姿平衡训练相关的文档包括：
position and posture 位置和姿势
specific balance activities performed
执行的特定余额活动amount of time spent on each activity
在每个活动上花费的时间量repetitions completed 完成的重复
tolerance of the therapy 治疗的耐受性
physiologic responses 生理反应
whether the patient experiences a loss of balance
患者是否失去平衡whether the patient regained balance independently or required assistance (including the level of assistance you provided)
患者是否独立恢复平衡或需要帮助（包括您提供的帮助水平）teaching provided to the patient and family (if applicable)
为患者和家属提供教学（如适用）understanding of that teaching
对该教义的理解follow-up teaching needed.
需要后续教学。
Related Procedures
相关程序
Balance training, static and dynamic progression standing, physical therapy
平衡训练、静态和动态进展站立、物理治疗
Related Lexicomp and UpToDate Patient Teaching Handouts
相关Lexicomp和UpToDate患者教学讲义
Standing Balance Exercises, Advanced
站立平衡练习 - 高级Standing Balance Exercises, Beginner
站立平衡练习，初级
References 引用
(Rating
System for the Hierarchy of Evidence for Intervention/Treatment Questions)
（干预/治疗问题证据层次结构的评级系统）
O'Sullivan, S. B., et al. (2019). Physical rehabilitation (7th ed.). F. A. Davis.
O'Sullivan， SB 等人（2019 年）。假肢康复（第 7 版）。FA 戴维斯。Mancini, M., & Horak, F. B. (2010). The relevance of clinical balance assessment tools to differentiate balance deficits. European Journal of Physical and Rehabilitation Medicine, 46(2), 239–248. Retrieved April 2024 from https://www.minervamedica.it/en/journals/europa-medicophysica/article.php?cod=R33Y2010N02A0239 (Level VII)
Mancini， M.， & Horak， F. B. （2010）.临床平衡评估工具区分平衡缺陷的相关性。欧洲物理与康复医学杂志，46（2），239-248。2024 年 4 月从 https://www.minervamedica.it/en/journals/europa-medicophysica/article.php?cod=R33Y2010N02A0239 检索（VII 级）
Abstract 抽象 | | Complete
Reference | | Full Text |全文 |
McLay, R., et al. (2020). Validity of balance and mobility screening tests for assessing fall risk in COPD. Chronic Respiratory Disease, 17, Article 1479973120922538. Retrieved April 2024 from https://doi.org/10.1177/1479973120922538 (Level IV)
McLay， R. 等人（2020 年）。平衡和活动度筛查测试用于评估 COPD 跌倒风险的有效性。慢性呼吸系统疾病，17，第 1479973120922538 条。2024 年 4 月从 https://doi.org/10.1177/1479973120922538 检索（IV 级）Cabanas-Valdés, R., et al. (2021). The effectiveness of additional core stability exercises in improving dynamic sitting balance, gait and functional rehabilitation for subacute stroke patients (CORE-Trial): Study protocol for a randomized controlled trial. International Journal of Environmental Research and Public Health, 18(12), Article 6615. Retrieved April 2024 from https://doi.org/10.3390/ijerph18126615 (Level II)
Cabanas-Valdés， R. 等人（2021 年）。额外的核心稳定性练习在改善亚急性中风患者的动态坐姿平衡、步态和功能康复方面的有效性（CORE 试验）：随机对照试验的研究方案。国际环境研究与公共卫生杂志，18（12），第 6615 条。2024 年 4 月从 https://doi.org/10.3390/ijerph18126615 检索（II 级）Van Criekinge, T., et al. (2019). The effectiveness of trunk training on trunk control, sitting and standing balance and mobility post-stroke: A systematic review and meta-analysis. Clinical Rehabilitation, 33(6), 992–1002. Retrieved April 2024 from https://doi.org/10.1177/0269215519830159 (Level I)
Van Criekinge， T. 等人（2019 年）。躯干训练对中风后躯干控制、坐姿和站立平衡以及活动能力的有效性：系统评价和荟萃分析。临床康复，33（6），992-1002。2024 年 4 月从 https://doi.org/10.1177/0269215519830159 检索（I 级）Medley, A., & Thompson, M. (2011). Development, reliability, and validity of the Sitting Balance Scale. Physiotherapy Theory and Practice, 27(7), 471–481. Retrieved April 2024 from https://doi.org/10.3109/09593985.2010.531077 (Level IV)
Medley， A. 和 Thompson， M. （2011）。坐姿平衡量表的开发、可靠性和有效性。物理治疗理论与实践，27（7），471-481。2024 年 4 月从 https://doi.org/10.3109/09593985.2010.531077 检索（IV 级）
Abstract 抽象 | | Complete
Reference |
Wadhwa, G., & Aikat, R. (2016). Development, validity and reliability of the 'Sitting Balance Measure' (SBM) in spinal cord injury. Spinal Cord, 54(4), 319–323. Retrieved April 2024 from https://www.nature.com/articles/sc2015148 (Level IV)
Wadhwa， G.， & Aikat， R. （2016年）。脊髓损伤中“坐姿平衡测量”（SBM） 的开发、有效性和可靠性。脊髓，54（4），319-323。2024 年 4 月从 https://www.nature.com/articles/sc2015148 检索（IV 级）Gillen, G., & Nilsen, D. M. (2021). Stroke rehabilitation: A function-based approach (5th ed.). Elsevier.
Gillen， G. 和 Nilsen， D. M. （2021）。中风康复：基于功能的方法（第 5 版）。爱思唯尔。Centers for Disease Control and Prevention. (2002). Guideline for hand hygiene in health-care settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR Recommendations and Reports, 51(RR-16), 1–45. Retrieved April 2024 from https://www.cdc.gov/mmwr/pdf/rr/rr5116.pdf (Level VII)
疾病控制和预防中心。（2002）. 医疗保健机构手部卫生指南：医疗保健感染控制实践咨询委员会和 HICPAC/SHEA/APIC/IDSA 手部卫生工作组的建议。MMWR 建议和报告，51（RR-16），1-45。2024 年 4 月从 https://www.cdc.gov/mm wr/pdf/rr/rr5116.pdf 检索（VII 级）World Health Organization (WHO). (2009). WHO guidelines on hand hygiene in health care: First global patient safety challenge, clean care is safer care. Retrieved April 2024 from https://apps.who.int/iris/bitstream/handle/10665/44102/9789241597906_eng.pdf?sequence=1 (Level VII)
世界卫生组织 （WHO）。（2009）. 世卫组织卫生保健手部卫生指南：首个全球患者安全挑战，清洁护理更安全。2024 年 4 月从 https://apps.who.int/iris/bitstream/handle/10665/44102/9789241597906_eng.pdf?sequence=1 检索（VII 级）The Joint Commission. (2024). Standard NPSG.07.01.01. Comprehensive accreditation manual for hospitals. (Level VII)
联合委员会。（2024）. 标准 NPSG.07.01.01。医院综合认证手册。（VII 级）Accreditation Commission for Health Care. (2023). Standard 07.01.21. Healthcare Facilities Accreditation Program: Accreditation requirements for acute care hospitals. (Level VII)
医疗保健认证委员会。（2023）. 标准 07.01.21。医疗机构认证计划：急症护理医院的认证要求。（VII 级）Centers for Medicare and Medicaid Services. (2020). Condition of participation: Infection control. 42 C.F.R. § 482.42.
医疗保险和医疗补助服务中心。（2020）. 参与条件：感染控制。《联邦法规》第 42 卷第 482.42 条。DNV GL-Healthcare USA, Inc. (2023). IC.1.SR.1. NIAHO® accreditation requirements, interpretive guidelines and surveyor guidance – revision 23-1. (Level VII)
DNV GL-Healthcare USA， Inc. （2023 年）。IC.1.SR.1. NIAHO® 认证要求、解释指南和验船师指南 – 修订版 23-1。（VII 级）The Joint Commission. (2024). Standard NPSG.01.01.01. Comprehensive accreditation manual for hospitals. (Level VII)
联合委员会。（2024）. 标准 NPSG.01.01.01。医院综合认证手册。（VII 级）Accreditation Commission for Health Care. (2023). Standard 15.01.16. Healthcare Facilities Accreditation Program: Accreditation requirements for acute care hospitals. (Level VII)
医疗保健认证委员会。（2023）. 标准 15.01.16。医疗机构认证计划：急症护理医院的认证要求。（VII 级）Centers for Medicare and Medicaid Services. (2020). Condition of participation: Patient’s rights. 42 C.F.R. § 482.13(c)(1).
医疗保险和医疗补助服务中心。（2020）. 参与条件：患者的权利。《联邦法规》第 42 卷第 482.13（c）（1） 款。DNV GL-Healthcare USA, Inc. (2023). PR.2.SR.5. NIAHO® accreditation requirements, interpretive guidelines and surveyor guidance – revision 23-1. (Level VII)
DNV GL-Healthcare USA， Inc. （2023 年）。PR.2.SR.5. NIAHO® 认证要求、解释指南和验船师指南 – 修订版 23-1。（VII 级）The Joint Commission. (2024). Standard RI.01.01.01. Comprehensive accreditation manual for hospitals. (Level VII)
联合委员会。（2024）. 标准 RI.01.01.01.医院综合认证手册。（VII 级）The Joint Commission. (2024). Standard PC.02.01.21. Comprehensive accreditation manual for hospitals. (Level VII)
联合委员会。（2024）. 标准 PC.02.01.21。医院综合认证手册。（VII 级）Occupational Safety and Health Administration. (2019). Bloodborne pathogens, standard number 1910.1030. Retrieved April 2024 from https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030 (Level VII)
职业安全与健康管理局。（2019）. 血源性病原体，标准编号 1910.1030。2024 年 4 月从 https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030 检索（VII 级）Accreditation Commission for Health Care. (2023). Standard 07.02.03. Healthcare Facilities Accreditation Program: Accreditation requirements for acute care hospitals. (Level VII)
医疗保健认证委员会。（2023）. 标准 07.02.03。医疗机构认证计划：急症护理医院的认证要求。（VII 级）Rutala, W. A., et al. (2008, revised 2019). Guideline for disinfection and sterilization in healthcare facilities, 2008. Retrieved April 2024 from https://www.cdc.gov/infectioncontrol/pdf/guidelines/disinfection-guidelines-H.pdf (Level I)
Rutala， WA 等人（2008 年，2019 年修订）。2008 年医疗机构消毒和灭菌指南。2024 年 4 月从 https://www.cdc.gov/infectioncontrol/pdf/guidelines/disinfection-guidelines-H.pdf 检索（I 级）The Joint Commission. (2024). Standard RC.01.03.01. Comprehensive accreditation manual for hospitals. (Level VII)
联合委员会。（2024）. 标准 RC.01.03.01。医院综合认证手册。（VII 级）Centers for Medicare and Medicaid Services. (2020). Condition of participation: Medical record services. 42 C.F.R. § 482.24(b).
医疗保险和医疗补助服务中心。（2020）. 参与条件：病历服务。《联邦法规》第 42 卷第 482.24（b） 条。Accreditation Commission for Health Care. (2023). Standard 10.00.03. Healthcare Facilities Accreditation Program: Accreditation requirements for acute care hospitals. (Level VII)
医疗保健认证委员会。（2023）. 标准 10.00.03。医疗机构认证计划：急症护理医院的认证要求。（VII 级）DNV GL-Healthcare USA, Inc. (2023). MR.2.SR.1. NIAHO® accreditation requirements, interpretive guidelines and surveyor guidance – revision 23-1. (Level VII)
DNV GL-Healthcare USA， Inc. （2023 年）。MR.2.SR.1. NIAHO® 认证要求、解释指南和验船师指南 – 修订版 23-1。（VII 级）
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