等速肌力训练联合肌电生物反馈治疗对卒中后偏瘫患者上下肢运动功能的影响
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摘要
目的观察等速肌力训练联合肌电生物反馈治疗(EMGBFT)对卒中后偏瘫患者上下肢运动功能的影响。方法前瞻性选取成都市第五人民医院收治的90例脑卒中后偏瘫患者,随机分为对照组(n=45)和观察组(n=45),对照组予以常规康复治疗及EMGBFT疗法,观察组在此基础上增加等速肌力训练。比较两组治疗前后Fugl-Meyer量表(FMA)、改良Ashworth量表(MAS)评分、关节活动度(AROM)、Berg平衡量表(BBS)评分、改良Barthel指数(MBI)评分、患侧上肢力学指标[肘屈伸时峰力矩(PT)、总功(TW)]及生活质量评定简表(WHOQO-BREF)评分。结果治疗8周后,观察组肘屈肌、膝伸肌MAS评分明显低于对照组(P <0. 05),腕关节与踝关节AROM值及上肢下肢FMA评分、BBS评分、MBI评分、患侧上肢肘屈肌与肘伸肌PT和TW、WHOQO-BREF评分均明显高于对照组(P <0. 05)。结论等速肌力训练联合EMGBFT疗法能够提高脑卒中后偏瘫患者上下肢运动功能,改善日常生活能力。
Objective To observe the effects of isokinetic strength training combined with electromyography biofeedback therapy( EMGBFT) on the motor function of upper and lower extremities in patients with hemiplegia after stroke. Methods 90 patients with hemiplegia after stroke were randomly divided into control group( n = 45) and observation group( n = 45). The control group was given routine rehabilitation and EMGBFT therapy. The observation group was given isokinetic strength training on this basis. The scores of Fugl-Meyer scale( FMA),modified Ashworth scale( MAS),active range of motion( AROM),Berg balance scale( BBS),modified Barthel index( MBI),mechanical parameters of upper limb on the affected side [peak torque( PT),total work( TW) ] and quality of life assessment( WHOQO-BREF) before and after treatment in the two groups were compared. Results After 8 weeks of treatment,the MAS scores of elbow flexor and knee extensors in the observation group were significantly lower than those in the control group( P < 0. 05). The AROM of wrist and ankle,FMA score,BBS score,MBI score,PT and TW of upper limb elbow flexor and elbow extensor and WHOQO-BREF score of the upper limb lower limb in the observation group were significantly higher than those in the control group( P < 0. 05). Conclusion Isokinetic strength training combined with EMGBFT therapy can improve the upper and lower extremity motor function in patients with hemiplegia after stroke,improve daily living ability.
Objective To observe the effects of isokinetic strength training combined with electromyography biofeedback therapy( EMGBFT) on the motor function of upper and lower extremities in patients with hemiplegia after stroke. Methods 90 patients with hemiplegia after stroke were randomly divided into control group( n = 45) and observation group( n = 45). The control group was given routine rehabilitation and EMGBFT therapy. The observation group was given isokinetic strength training on this basis. The scores of Fugl-Meyer scale( FMA),modified Ashworth scale( MAS),active range of motion( AROM),Berg balance scale( BBS),modified Barthel index( MBI),mechanical parameters of upper limb on the affected side [peak torque( PT),total work( TW) ] and quality of life assessment( WHOQO-BREF) before and after treatment in the two groups were compared. Results After 8 weeks of treatment,the MAS scores of elbow flexor and knee extensors in the observation group were significantly lower than those in the control group( P < 0. 05). The AROM of wrist and ankle,FMA score,BBS score,MBI score,PT and TW of upper limb elbow flexor and elbow extensor and WHOQO-BREF score of the upper limb lower limb in the observation group were significantly higher than those in the control group( P < 0. 05). Conclusion Isokinetic strength training combined with EMGBFT therapy can improve the upper and lower extremity motor function in patients with hemiplegia after stroke,improve daily living ability.
引文
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[9]李宁宁,勾丽洁,郭华平,等.镜像疗法联合肌电生物反馈对脑卒中偏瘫患者下肢功能的影响[J].中华物理医学与康复杂志,2018,40(4):278-281.
[10]许伟威,张呜生,白文芳,等.踝关节等速肌力训练对老年脑卒中患者平衡功能的影响[J].中国临床解剖学杂志,2017,35(4):466-468.
[11]廖建国.踝关节等速肌力训练对老年女性平衡能力的影响[J].中国老年学,2016,36(13):3250-3251.
[12] Sin M,Kim WS,Park D,et al. Electromyographic analysis of upper limb muscles during standardized isotonic and isokinetic robotic exercise of spastic elbow in patients with stroke[J]. J Electromyogr Kinesiol,2014,24(1):11-17.
[13]董仁卫,郭琪,刘诗琦,等.等速肌力测试和训练技术在脑卒中偏瘫患者临床康复中的应用[J].中国康复医学杂志,2015,30(2):207-210.
[14] Lee YH,Park SH,Yoon ES,et al. Effects of combined aerobic and resistance exercise on central arterial stiffness and gait velocity in patients with chronic poststroke hemiparesis[J]. Am J Phys Med Rehabil,2015,94(9):687-695.
[15]杨华中,吴莹莹,周永生,等.等速肌力训练对脑卒中偏瘫患者下肢功能恢复的影响[J].中国康复,2015,30(2):94-97.
[2]黄犇,王俊.等速肌力测试在单侧偏瘫患者躯干肌肉力量与平衡功能障碍关系分析中的应用[J].中国伤残医学,2017,25(20):25-28..
[3]张志茹,李宇,芦宇.下肢康复机器人训练在脑卒中偏瘫患者康复中的应用[J].临床和实验医学杂志,2018,17(4):412-415.
[4]各类脑血管疾病诊断要点(1995)[J].临床和实验医学杂志,2013,12(7):559
[5]许林海,韩丽雅.功能强化训练结合肌电生物反馈对急性脑卒中患者上肢功能的影响[J].中国康复,2015,30(3):185-188.
[6]吴运景,刘晓霞,韩丽雅,等.操作性肌电生物反馈联合康复训练对脑卒中偏瘫患者上肢功能的影响[J].中国康复医学杂志,2016,31(1):86-88.
[7]杨玺,刘进,马明.深层咽肌神经刺激和表面肌电生物反馈在脑卒中后咽期吞咽障碍中的应用[J].中国康复医学杂志,2016,31(4):451-453.
[8]张朝兵,王秀元,吴伟,等.肌电生物反馈结合针刺治疗脑卒中偏瘫足下垂临床疗效观察[J].安徽中医药大学学报,2018,37(3):56-59.
[9]李宁宁,勾丽洁,郭华平,等.镜像疗法联合肌电生物反馈对脑卒中偏瘫患者下肢功能的影响[J].中华物理医学与康复杂志,2018,40(4):278-281.
[10]许伟威,张呜生,白文芳,等.踝关节等速肌力训练对老年脑卒中患者平衡功能的影响[J].中国临床解剖学杂志,2017,35(4):466-468.
[11]廖建国.踝关节等速肌力训练对老年女性平衡能力的影响[J].中国老年学,2016,36(13):3250-3251.
[12] Sin M,Kim WS,Park D,et al. Electromyographic analysis of upper limb muscles during standardized isotonic and isokinetic robotic exercise of spastic elbow in patients with stroke[J]. J Electromyogr Kinesiol,2014,24(1):11-17.
[13]董仁卫,郭琪,刘诗琦,等.等速肌力测试和训练技术在脑卒中偏瘫患者临床康复中的应用[J].中国康复医学杂志,2015,30(2):207-210.
[14] Lee YH,Park SH,Yoon ES,et al. Effects of combined aerobic and resistance exercise on central arterial stiffness and gait velocity in patients with chronic poststroke hemiparesis[J]. Am J Phys Med Rehabil,2015,94(9):687-695.
[15]杨华中,吴莹莹,周永生,等.等速肌力训练对脑卒中偏瘫患者下肢功能恢复的影响[J].中国康复,2015,30(2):94-97.