指压穴位刺激对早期脑卒中偏瘫患者踝背屈功能的影响
|
摘要
目的:观察指压穴位刺激对早期脑卒中偏瘫患者踝背屈功能的影响。方法:45例偏瘫患者,随机分为指压穴位组、电针组和神经肌肉电刺激组各15例。3组在常规药物和物理治疗的基础上,指压穴位组增加前期系列研究制定的指压穴位刺激法提高偏瘫侧胫前肌、腓骨长短肌兴奋性的综合方案干预;电针组电针偏瘫侧足三里穴、足临泣穴;神经肌肉电刺激组电刺激偏瘫侧胫前肌、腓骨长短肌。3组踝关节干预时间均为每次10min,每天1次,每周5天,疗程8周。分别于治疗前、治疗4w后、治疗8w后,评估以下指标:患侧踝背屈协同收缩率(co-contraction ratio,CCR)、患侧踝背屈主动活动范围(active range of motion,AROM)、患侧简式Fugl-Meyer运动功能评分(踝关节运动控制部分)。结果:①3组治疗前后比较:3组的各项指标治疗前、治疗4w后、治疗8w后两两比较均有显著性差异(P<0.05),患侧踝背屈CCR逐步降低、患侧踝背屈AROM和简式Fugl-Meyer运动功能评分逐步增高;②3组间比较:患侧踝背屈CCR、AROM:3组间治疗前两两比较均无显著性差异(P>0.05);指压穴位组的治疗4w后、治疗8w后的患侧踝背屈CCR分别低于电针组、神经肌肉电刺激组,具有显著性差异(P<0.05),而AROM分别高于电针组、神经肌肉电刺激组,具有显著性差异(P<0.05);电针组较神经肌肉电刺激组的治疗4w后、治疗8w后均无显著性差异(P>0.05);简式Fugl-Meyer运动功能评分:3组间治疗前、治疗4w后、治疗8w后两两比较均无显著性差异(P>0.05)。结论:指压穴位刺激法可有效改善早期脑卒中偏瘫患者踝背屈功能。
Objective: To observe the effects of acupressure acupoint stimulation on ankle dorsiflexion in stroke patients within early stage.Method: Totally 45 hemiplegic patients were divided into 3 groups randomly: acupressure acupoint stimulation group(n=15), electroacupuncture group(n=15) and neuromuscular stimulation group(n=15). Three groups all accepted the traditional medication and physical treatment. Participants in acupressure acupoint stimulation group accepted integrated acupressure acupoint stimulation program which had been described in previous investigations to excite the tibialis anterior and fibula long, short muscle of affected side. Electroacupuncture was applied to Zusanli point(ST36) and Zulinqi point(GB41) of affected side in electroacupuncture group. Electrical stimulation was delivered to tibialis anterior and fibula long, short muscle of affected side in neuromuscular stimulation group. Each intervention lasted 10 minutes, once a day, 5 times per week for 8 weeks. Ankle dorsiflexion co-contraction ratio(CCR), active range of motion(AROM) of ankle dorsiflexion and ankle motor control on shorted Fugl-Meyer motor scale were accessed before, 4 and 8 weeks after intervention.Result:(1) The results between pre-,4 and 8 weeks after intervention showed significant difference(P<0.05).CCR of affected ankle decreased whereas AROM and shorted Fugl-Meyer motor function scale of affected ankle increased stage by stage.(2)CCR and AROM between 3 groups showed no significant differences before intervention(P>0.05). Compared to another two groups, CCR of affected ankle in acupressure acupoint stimulation group was lower at both 4 and 8 weeks after intervention(P<0.05) respectively. Furthermore, AROM of affected ankle in acupressure acupoint stimulation group was significantly higher compared to another two groups(P<0.05) respectively. There were no notable differences between electroacupuncture group and neuromuscular stimulation group at both 4 and 8 weeks after intervention(P>0.05). Referring to shorted Fugl-Meyer motor scale, no significant difference happened between 3 groups at any time nodes of assessment(P>0.05).Conclusion: Acupressure acupoint stimulation could significantly improve ankle dorsiflexion ability of affected side in hemiplegic patients within early stage.
Objective: To observe the effects of acupressure acupoint stimulation on ankle dorsiflexion in stroke patients within early stage.Method: Totally 45 hemiplegic patients were divided into 3 groups randomly: acupressure acupoint stimulation group(n=15), electroacupuncture group(n=15) and neuromuscular stimulation group(n=15). Three groups all accepted the traditional medication and physical treatment. Participants in acupressure acupoint stimulation group accepted integrated acupressure acupoint stimulation program which had been described in previous investigations to excite the tibialis anterior and fibula long, short muscle of affected side. Electroacupuncture was applied to Zusanli point(ST36) and Zulinqi point(GB41) of affected side in electroacupuncture group. Electrical stimulation was delivered to tibialis anterior and fibula long, short muscle of affected side in neuromuscular stimulation group. Each intervention lasted 10 minutes, once a day, 5 times per week for 8 weeks. Ankle dorsiflexion co-contraction ratio(CCR), active range of motion(AROM) of ankle dorsiflexion and ankle motor control on shorted Fugl-Meyer motor scale were accessed before, 4 and 8 weeks after intervention.Result:(1) The results between pre-,4 and 8 weeks after intervention showed significant difference(P<0.05).CCR of affected ankle decreased whereas AROM and shorted Fugl-Meyer motor function scale of affected ankle increased stage by stage.(2)CCR and AROM between 3 groups showed no significant differences before intervention(P>0.05). Compared to another two groups, CCR of affected ankle in acupressure acupoint stimulation group was lower at both 4 and 8 weeks after intervention(P<0.05) respectively. Furthermore, AROM of affected ankle in acupressure acupoint stimulation group was significantly higher compared to another two groups(P<0.05) respectively. There were no notable differences between electroacupuncture group and neuromuscular stimulation group at both 4 and 8 weeks after intervention(P>0.05). Referring to shorted Fugl-Meyer motor scale, no significant difference happened between 3 groups at any time nodes of assessment(P>0.05).Conclusion: Acupressure acupoint stimulation could significantly improve ankle dorsiflexion ability of affected side in hemiplegic patients within early stage.
引文
[1] Dyer JO, Maupas E, de Andrade Melo S, et al. Changes in activation timing of knee and ankle extensors during gait are related to changes in heteronymous spinal pathways after stroke[J]. J Neuroeng Rehabil,2014,11:148.
[2] Kluding PM, Dunning K, O’Dell MW, et al. Foot drop stimulation versus ankle foot orthosis after stroke:30-week outcomes[J]. Stroke, 2013,44:1660—1669.
[3] Bethoux F, Rogers HL, Nolan KJ, et al. The effects of peroneal nerve functional electrical stimulation versus ankle-foot orthosis in patients with chronic stroke:A randomized controlled trial[J]. Neurorehabil Neural Repair,2014,28:688—697.
[4]赵军,张通,芦海涛,等.脑卒中偏瘫步态分析的临床应用[J].中国康复理论与实践,2013,19(7):655—657.
[5] Manca M, Ferraresi G, Cosma M, et al. Gait patterns in hemiplegic patients with equinus foot deformity[J]. Biomed Res Int,2014,(30):939316.
[6] Kobayashi T, Singer ML, Orendurff MS, et al. The effect of changing plantarflexion resistive moment of an articulated ankle-foot orthosis on ankle and knee joint angles and moments while walking in patients post stroke[J]. Clinical Biomechanics(Bristol, Avon),2015,30(8):775—780.
[7]曹莲瑛,张伟,崔晓,等.独取足少阳胆经穴治疗脑卒中后足内翻的疗效观察[J].针灸临床杂志,2013,29(9):1—3.
[8]刘鹏.腓神经松动术加丘墟穴按压对改善偏瘫踝关节背屈功能的疗效观察[J].中国康复医学杂志,2013,28(7):659—660.
[9]葛瑞东,郭京伟,王思远,等.指压穴位刺激对脑卒中患者胫前肌和腓骨长、短肌的表面肌电影响[J].中国康复医学杂志,2014,29(3):234—237.
[10]葛瑞东,王思远,白硕,等.不同体位下指压不同穴位对脑卒中患者胫前肌和腓骨长、短肌的表面肌电影响[J].中国康复医学杂志,2015,30(6):562—566.
[11]葛瑞东,白硕,郭京伟,等.指压穴位频率对偏瘫侧胫前肌、腓骨长短肌的表面肌电影响[J].中日友好医院学报,2018,32(5):275—278.
[12]全国脑血管会议.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379—380.
[13]恽晓平.康复疗法评定学[M].北京:华夏出版社,2005.391—392.
[14]白硕,葛瑞东,崔婷捷,等.电针委中穴缓解腰背肌疲劳的表面肌电研究[J].中国康复医学杂志,2016,31(12):1350—1354.
[15]李建华,王健.表面肌电图诊断技术临床应用[M].杭州:浙江大学出版社,2015.104.
[16]缪鸿石,朱镛连.脑卒中的康复评定和治疗[M].北京:华夏出版社,1996.9—12.
[17] Hong Z, Sui M, Zhuang Z, et al. Effectiveness of neuromuscular electrical stimulation on lower limb hemiplegic patients following chronic stroke:A systematic review[J].Arch Phys Med Rehabil, 2018,99(5):1011—1022.
[18]吴玉玲,谢君杰,龚艳菲,等.肌电生物反馈疗法对脑卒中偏瘫患者步行能力的影响[J].中国康复理论与实践,2014,20(4):318—321.
[19] Marietta L. van der Linden, Thomas H. et al. Functional electrical stimulation to treat foot drop as a result of an upper motor neuron lesion[J]. Electroceuticals,2017,11:257—282.
[20] Cai Y, Zhang CS, Liu S, et al. Electroacupuncture for poststroke spasticity:A systematic review and meta-analysis[J].Archives of Physical Medicine and Rehabilitation,2017,98(12):2578—2589.
[21] Ikeda AJ, Abel MF, Granata KP, et al. Quantification of co-contractions in spastic cerebral palsy[J]. Electromyography and Clinical Neurophysiology,1998,38:497—504.
[22]郭京伟,谢欲晓,黄学英,等.不同恢复期脑卒中患者胫骨前肌和腓肠肌表面肌电信号的研究[J].中国康复医学杂志,2007,22(9):802—804.
[23] Hammond MC, Fitts SS, Kraft GH, et al. Co-contraction in the hemiparetic forearm:Quantitative EMG evaluation[J]. Arch Phys Med Rehabil,1988,69(5):348—351.
[24] Peacock WJ, Arens LJ. Selective posterior rhizotomy for the relief of spasticity in cerebral palsy[J]. S Afr Med J,1982,62(4):119—124.
[25] Choi H. Quantitative assessment of co-contraction in cervical musculature[J]. Med Eng Phys,2003,25(2):133—140.
[2] Kluding PM, Dunning K, O’Dell MW, et al. Foot drop stimulation versus ankle foot orthosis after stroke:30-week outcomes[J]. Stroke, 2013,44:1660—1669.
[3] Bethoux F, Rogers HL, Nolan KJ, et al. The effects of peroneal nerve functional electrical stimulation versus ankle-foot orthosis in patients with chronic stroke:A randomized controlled trial[J]. Neurorehabil Neural Repair,2014,28:688—697.
[4]赵军,张通,芦海涛,等.脑卒中偏瘫步态分析的临床应用[J].中国康复理论与实践,2013,19(7):655—657.
[5] Manca M, Ferraresi G, Cosma M, et al. Gait patterns in hemiplegic patients with equinus foot deformity[J]. Biomed Res Int,2014,(30):939316.
[6] Kobayashi T, Singer ML, Orendurff MS, et al. The effect of changing plantarflexion resistive moment of an articulated ankle-foot orthosis on ankle and knee joint angles and moments while walking in patients post stroke[J]. Clinical Biomechanics(Bristol, Avon),2015,30(8):775—780.
[7]曹莲瑛,张伟,崔晓,等.独取足少阳胆经穴治疗脑卒中后足内翻的疗效观察[J].针灸临床杂志,2013,29(9):1—3.
[8]刘鹏.腓神经松动术加丘墟穴按压对改善偏瘫踝关节背屈功能的疗效观察[J].中国康复医学杂志,2013,28(7):659—660.
[9]葛瑞东,郭京伟,王思远,等.指压穴位刺激对脑卒中患者胫前肌和腓骨长、短肌的表面肌电影响[J].中国康复医学杂志,2014,29(3):234—237.
[10]葛瑞东,王思远,白硕,等.不同体位下指压不同穴位对脑卒中患者胫前肌和腓骨长、短肌的表面肌电影响[J].中国康复医学杂志,2015,30(6):562—566.
[11]葛瑞东,白硕,郭京伟,等.指压穴位频率对偏瘫侧胫前肌、腓骨长短肌的表面肌电影响[J].中日友好医院学报,2018,32(5):275—278.
[12]全国脑血管会议.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379—380.
[13]恽晓平.康复疗法评定学[M].北京:华夏出版社,2005.391—392.
[14]白硕,葛瑞东,崔婷捷,等.电针委中穴缓解腰背肌疲劳的表面肌电研究[J].中国康复医学杂志,2016,31(12):1350—1354.
[15]李建华,王健.表面肌电图诊断技术临床应用[M].杭州:浙江大学出版社,2015.104.
[16]缪鸿石,朱镛连.脑卒中的康复评定和治疗[M].北京:华夏出版社,1996.9—12.
[17] Hong Z, Sui M, Zhuang Z, et al. Effectiveness of neuromuscular electrical stimulation on lower limb hemiplegic patients following chronic stroke:A systematic review[J].Arch Phys Med Rehabil, 2018,99(5):1011—1022.
[18]吴玉玲,谢君杰,龚艳菲,等.肌电生物反馈疗法对脑卒中偏瘫患者步行能力的影响[J].中国康复理论与实践,2014,20(4):318—321.
[19] Marietta L. van der Linden, Thomas H. et al. Functional electrical stimulation to treat foot drop as a result of an upper motor neuron lesion[J]. Electroceuticals,2017,11:257—282.
[20] Cai Y, Zhang CS, Liu S, et al. Electroacupuncture for poststroke spasticity:A systematic review and meta-analysis[J].Archives of Physical Medicine and Rehabilitation,2017,98(12):2578—2589.
[21] Ikeda AJ, Abel MF, Granata KP, et al. Quantification of co-contractions in spastic cerebral palsy[J]. Electromyography and Clinical Neurophysiology,1998,38:497—504.
[22]郭京伟,谢欲晓,黄学英,等.不同恢复期脑卒中患者胫骨前肌和腓肠肌表面肌电信号的研究[J].中国康复医学杂志,2007,22(9):802—804.
[23] Hammond MC, Fitts SS, Kraft GH, et al. Co-contraction in the hemiparetic forearm:Quantitative EMG evaluation[J]. Arch Phys Med Rehabil,1988,69(5):348—351.
[24] Peacock WJ, Arens LJ. Selective posterior rhizotomy for the relief of spasticity in cerebral palsy[J]. S Afr Med J,1982,62(4):119—124.
[25] Choi H. Quantitative assessment of co-contraction in cervical musculature[J]. Med Eng Phys,2003,25(2):133—140.