功能性电刺激对脑卒中所致偏瘫患者功能独立性和生活质量的影响
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摘要
本研究为探讨功能性电刺激(FES)对脑卒中所致偏瘫患者早期功能独立性和生活质量的影响,选择92例急性脑卒中患者,随机分为FES合并早期康复治疗组(n=46例)和单纯康复治疗组(n=46例)。两组常规治疗相同,对照组只采用单纯康复治疗,FES治疗组在单纯康复治疗的基础上合并功能性电刺激治疗。FES治疗采用分别在颈部,患侧面部、肩、上肢、下肢放置两块电极,分别以能引起甲状软骨上抬、面肌抽动、肩上抬、手腕背屈、足踝背屈外翻,患者能耐受为准。以上疗法,1日2次,每次20分钟。在治疗开始,用功能独立性量表(FIM)评定独立生活能力,用36条目简明健康调查量表(SF-36)评定患者的生活质量,用蒙特利尔认知评估量表(MoCA)评定轻度认知功能障碍。结果FES治疗组与对照组在治疗4周和8周后,组内治疗前后FIM的躯体、认知功能和总分评分、SF-36各维度评分均有显著性差异(P<0.05),治疗后明显优于治疗前;FES治疗组与对照组组间FIM评分(除认知功能外)、SF-36(除躯体疼痛维度外)均有显著性差异(P<0.05),FES治疗组明显优于对照组。可以得出FES治疗可明显提高脑卒中所致偏瘫患者的功能独立性,进而提高患者独立生活的自理能力,同时能提高患者的生活质量的结论,值得临床推广使用。
With the improvement of living standards, social progress and the acceleration of the pace of life, as well as the arrival of aging society, the incidence of cerebrovascular disease showed a rising trend year by year, and leads to more and more paralysis, function barriers of speech, swallowing, cognitive aspects. Cerebral vascular accident has become a member of the three major human health diseases. The other two are heart disease and cancer. The three constitute the three major causes of human death. The morbidity, mortality and disability of cerebrovascular disease are all high, although modern clinical rescue has improved continuously, so that the majority of patients kept their lives, but most patients were left with different dysfunctions, that severely affects the quality of life of patients, and has brought great suffering for patients and a heavy spirit and economic burden to families and the society. In addition, since cerebrovascular accident show a trend of becoming younger in porpulation, it may pose big threats to labor resources, so dysfunction of post-stroke has become a very serious social health problem, which must be actively solved. Although patients with early rehabilitation have got significant improvement in physical function and activities of daily living, it tooks a long time. Therefore, we medical research and clinical workers should find a good way or technique to dysfunctions, so that patients can increase in capacity for independent living and quality of life better and faster, and return to the family and society as soon as possible. Functional electrical stimulation (FES) has become a comparatively hot technology in nation and abroad in recent years, and is a effective treatment for stroke patients with hemiplegia. People try to apply the technology to solve more functional barriers caused by cerebral vascular accidents, which has achieved initial success. A hemiplegic patient who really wants to return to the family and society, must be able to carry out daily living activities such as eating, drinking, toileting, bathing, self-management of toileting, walking and other basic activities of daily living. More over, cognitive, social communication and many other features. All of these are called the patient's functional independence (FI). If a patient has functional independence, the quality of life will improve, so that he can truly return to society. So how to improve the patient's functional independence? Past studies have fully proved the early rehabilitation of patients with clinical treatment can improve functional independence. But no reports about how quickly to improve the quality of life and FI are seen by now. Functional electrical stimulation (FES) is a therapy which promotes functional re-built through the adjustment from high-level nerve center, using low-frequency pulse current to stimulate the body or organ with dysfunction, resulting in its immediate effect to replace or correct the function which has been lost. These scheduled programs with numerous repetitive movement patterns come to the nerve center, stimulate the reflex mechanism to leave a lasting memory traces. Therefore, FES has a lasting impact for the improvement of upper and lower limbs movement posture and voluntary movement control. Based on previous studies, early FES played an important role in improvement of hemiplegic limb function, so we want to use FES to treat hemiplegic patients to observe the impact of FES on FIM, in order to find an economical and practical treatment techniques to benefit the majority of patients with hemiplegia, promoting their earlier and faster return to the family and society, improving theirquality of life. According to the literature reference, no study was found about FES on FIM and the quality of life. However, these two elements are the ultimate goals of rehabilitation - returning to society, family, and work.
From 2008.8 to 2009.8 we treated 46 hemiplegic patients caused by acute stroke with motheds of FES combined with early rehabilitation and early rehabilitation therapy alone.
Objective: To explore the impact of functional electrical stimulation combined with early rehabilitation on early functional independence and quality of life in stroke patients with hemiplegia.
Methods: 92 cases of acute stroke patients were randomly divided into two groups: functional electrical stimulation combined with early rehabilitation group (FES treatment group, 46 cases, age: 63.5±15.0 years, time from symptom onset to treatment: 21.0±10.0 days) and simple rehabilitation group (control group, 46 cases, age: 62.0±16.0 years , time from symptom onset to treatment: 20.5±12.0 days). The two groups have the same conventional treatment. Control group was not given any electrical stimulation, using only simple rehabilitation. FES treatment group was treated by FES on the basis of simple rehabilitation therapy, using prescription of FES from K8832-T PC MTZ produced by Beijing Xiangyun Electronic Equipment Factory, Stimulation parameters: frequency 1~50Hz, pulse width 0.25ms, waveform: deformation index wave, power on/off ratio 1s/1s, wave up/wave down: 0.25s~12.5s/0.25s~12.5s, Output current 0~100mA adjustable, Output current stability 5%. Neck: two electrode plates were placed between the thyroid cartilage in the jaw and around each one in order to be able to cause thyroid cartilage swarmed, and the patient could tolerate. Face: an electrode plate on the external canthus, and the other on the cheek in order to be able to cause facial tic, and the patient could tolerate. Shoulder: an electrode plate on the supraspinatus muscle, the other one on the back of deltoid muscle in order to be able to give rise to the shoulders of outreach, and the patient can tolerate. Upper extremity: an electrode plate on the small radius head, the other side on a dorsal forearm extensors, in order to lead to wrist dorsiflexion, and the patient could tolerate. Lower limbs: an electrode plate on the small head of fibula, the other one on the anterior tibial muscle motor point, in order to be able to cause valgus ankle dorsiflexion, and the patient could tolerate. The treatments above were used twice a day, 20 minutes a time, 14 days for a course of treatment. At the beginning of treatment, we used functional independence measurement(FIM) to evaluate the patients’functional independence, and 36-items short form health survey(SF-36) evaluate thequality of life, and Montreal Cognitive Assessment (MoCA) to evaluate mild identify known dysfunction.
Results: The two groups before treatment had general information, and the evaluation results had no significant difference (P> 0.05). Before and after treatment, the score of FIM body, cognitive function and total score of FES treatment group and control group after treatment of 4 weeks and 8 weeks ( P<0.01). FES treatment group and control group in the treatment of 4 weeks and 8 weeks after the group before and after treatment FIM physical, cognitive function and total score (P <0.01). The posttreatment various dimensions of SF-36 score (except for bodily pain dimension, no significant difference between the beginning and 4 weeks later) had a significant difference from pretreatment score and was better; FES treatment group had significant differences from control group in FIM score(except for cognitive function), SF-36 score (P<0.01), and was much better.
Conclusion: This study concluded that
1. Functional electrical stimulation therapy can significantly improve physical function of stroke patients with hemiplegia, thus indirectly promote the patient's functional independence and improve self-care ability in patients’living independently. At the same time, the therapy can prevent paralysis caused by secondary damage, and is worth for clinical use. 2. Functional electrical stimulation therapy can significantly improve physical function, physical occupation, general health, energy, social function, mental health scores of stroke patients with hemiplegia. So it can significantly improve patients’quality of life. 3. Functional electrical stimulation therapy has little effect for cognitive function and bodily pain latitude of stroke patients with hemiplegia. Large samples of clinical trials are still needed to confirm that. 4. This study suggests that FES technology is a simple, applicable, economic, and appropriate treatment technique for stroke patients with hemiplegia, providing effective help to their self-care, quality of life, early return to society, families and jobs. So that it can remove heavy spirit and economic burden for families and society. It is of important social and economic value. The study is also suitable for putting forward the guiding ideology of Eleventh Five-Year plan of our country. 5. Our study broadens the scope of FES treatment, provides clinical and theoretical basis for future FES clinical use. Therefore, it has a certain academic value.
With the improvement of living standards, social progress and the acceleration of the pace of life, as well as the arrival of aging society, the incidence of cerebrovascular disease showed a rising trend year by year, and leads to more and more paralysis, function barriers of speech, swallowing, cognitive aspects. Cerebral vascular accident has become a member of the three major human health diseases. The other two are heart disease and cancer. The three constitute the three major causes of human death. The morbidity, mortality and disability of cerebrovascular disease are all high, although modern clinical rescue has improved continuously, so that the majority of patients kept their lives, but most patients were left with different dysfunctions, that severely affects the quality of life of patients, and has brought great suffering for patients and a heavy spirit and economic burden to families and the society. In addition, since cerebrovascular accident show a trend of becoming younger in porpulation, it may pose big threats to labor resources, so dysfunction of post-stroke has become a very serious social health problem, which must be actively solved. Although patients with early rehabilitation have got significant improvement in physical function and activities of daily living, it tooks a long time. Therefore, we medical research and clinical workers should find a good way or technique to dysfunctions, so that patients can increase in capacity for independent living and quality of life better and faster, and return to the family and society as soon as possible. Functional electrical stimulation (FES) has become a comparatively hot technology in nation and abroad in recent years, and is a effective treatment for stroke patients with hemiplegia. People try to apply the technology to solve more functional barriers caused by cerebral vascular accidents, which has achieved initial success. A hemiplegic patient who really wants to return to the family and society, must be able to carry out daily living activities such as eating, drinking, toileting, bathing, self-management of toileting, walking and other basic activities of daily living. More over, cognitive, social communication and many other features. All of these are called the patient's functional independence (FI). If a patient has functional independence, the quality of life will improve, so that he can truly return to society. So how to improve the patient's functional independence? Past studies have fully proved the early rehabilitation of patients with clinical treatment can improve functional independence. But no reports about how quickly to improve the quality of life and FI are seen by now. Functional electrical stimulation (FES) is a therapy which promotes functional re-built through the adjustment from high-level nerve center, using low-frequency pulse current to stimulate the body or organ with dysfunction, resulting in its immediate effect to replace or correct the function which has been lost. These scheduled programs with numerous repetitive movement patterns come to the nerve center, stimulate the reflex mechanism to leave a lasting memory traces. Therefore, FES has a lasting impact for the improvement of upper and lower limbs movement posture and voluntary movement control. Based on previous studies, early FES played an important role in improvement of hemiplegic limb function, so we want to use FES to treat hemiplegic patients to observe the impact of FES on FIM, in order to find an economical and practical treatment techniques to benefit the majority of patients with hemiplegia, promoting their earlier and faster return to the family and society, improving theirquality of life. According to the literature reference, no study was found about FES on FIM and the quality of life. However, these two elements are the ultimate goals of rehabilitation - returning to society, family, and work.
From 2008.8 to 2009.8 we treated 46 hemiplegic patients caused by acute stroke with motheds of FES combined with early rehabilitation and early rehabilitation therapy alone.
Objective: To explore the impact of functional electrical stimulation combined with early rehabilitation on early functional independence and quality of life in stroke patients with hemiplegia.
Methods: 92 cases of acute stroke patients were randomly divided into two groups: functional electrical stimulation combined with early rehabilitation group (FES treatment group, 46 cases, age: 63.5±15.0 years, time from symptom onset to treatment: 21.0±10.0 days) and simple rehabilitation group (control group, 46 cases, age: 62.0±16.0 years , time from symptom onset to treatment: 20.5±12.0 days). The two groups have the same conventional treatment. Control group was not given any electrical stimulation, using only simple rehabilitation. FES treatment group was treated by FES on the basis of simple rehabilitation therapy, using prescription of FES from K8832-T PC MTZ produced by Beijing Xiangyun Electronic Equipment Factory, Stimulation parameters: frequency 1~50Hz, pulse width 0.25ms, waveform: deformation index wave, power on/off ratio 1s/1s, wave up/wave down: 0.25s~12.5s/0.25s~12.5s, Output current 0~100mA adjustable, Output current stability 5%. Neck: two electrode plates were placed between the thyroid cartilage in the jaw and around each one in order to be able to cause thyroid cartilage swarmed, and the patient could tolerate. Face: an electrode plate on the external canthus, and the other on the cheek in order to be able to cause facial tic, and the patient could tolerate. Shoulder: an electrode plate on the supraspinatus muscle, the other one on the back of deltoid muscle in order to be able to give rise to the shoulders of outreach, and the patient can tolerate. Upper extremity: an electrode plate on the small radius head, the other side on a dorsal forearm extensors, in order to lead to wrist dorsiflexion, and the patient could tolerate. Lower limbs: an electrode plate on the small head of fibula, the other one on the anterior tibial muscle motor point, in order to be able to cause valgus ankle dorsiflexion, and the patient could tolerate. The treatments above were used twice a day, 20 minutes a time, 14 days for a course of treatment. At the beginning of treatment, we used functional independence measurement(FIM) to evaluate the patients’functional independence, and 36-items short form health survey(SF-36) evaluate thequality of life, and Montreal Cognitive Assessment (MoCA) to evaluate mild identify known dysfunction.
Results: The two groups before treatment had general information, and the evaluation results had no significant difference (P> 0.05). Before and after treatment, the score of FIM body, cognitive function and total score of FES treatment group and control group after treatment of 4 weeks and 8 weeks ( P<0.01). FES treatment group and control group in the treatment of 4 weeks and 8 weeks after the group before and after treatment FIM physical, cognitive function and total score (P <0.01). The posttreatment various dimensions of SF-36 score (except for bodily pain dimension, no significant difference between the beginning and 4 weeks later) had a significant difference from pretreatment score and was better; FES treatment group had significant differences from control group in FIM score(except for cognitive function), SF-36 score (P<0.01), and was much better.
Conclusion: This study concluded that
1. Functional electrical stimulation therapy can significantly improve physical function of stroke patients with hemiplegia, thus indirectly promote the patient's functional independence and improve self-care ability in patients’living independently. At the same time, the therapy can prevent paralysis caused by secondary damage, and is worth for clinical use. 2. Functional electrical stimulation therapy can significantly improve physical function, physical occupation, general health, energy, social function, mental health scores of stroke patients with hemiplegia. So it can significantly improve patients’quality of life. 3. Functional electrical stimulation therapy has little effect for cognitive function and bodily pain latitude of stroke patients with hemiplegia. Large samples of clinical trials are still needed to confirm that. 4. This study suggests that FES technology is a simple, applicable, economic, and appropriate treatment technique for stroke patients with hemiplegia, providing effective help to their self-care, quality of life, early return to society, families and jobs. So that it can remove heavy spirit and economic burden for families and society. It is of important social and economic value. The study is also suitable for putting forward the guiding ideology of Eleventh Five-Year plan of our country. 5. Our study broadens the scope of FES treatment, provides clinical and theoretical basis for future FES clinical use. Therefore, it has a certain academic value.
引文
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[2]蓝宁,肖志雄,聂开宝.功能性电刺激的原理,设计与应用(二)[J].中国康复理论与实践,1998,4(1):7-9.
[3] Lan N, Daroux M, Mortimer JT. Pitting corrosion of high strength alloy stimulation electrodes under dynamic conditions[J]. Journal of The Electrochemical Society,1989,136(4): 947-954.
[4] Brummer SB, McHardy J. Current problems in electrode development in functional electrical stimulation[M]. New York: Dekker, 1977.
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