早期镜像治疗联合肌电生物反馈对亚急性脑梗死患者下肢运动及平衡功能的影响
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摘要
目的观察镜像治疗联合肌电生物反馈治疗对亚急性脑梗死患者下肢运动及平衡功能、日常生活能力等的影响。方法选取2016年11月～2018年3月在温州医科大学附属第一医院康复医学科住院治疗的亚急性期脑梗死患者29例,使用信封随机分组法将其分为镜像治疗联合肌电生物反馈治疗组(MT+EMGBF组,14例)和肌电生物反馈治疗组(EMGBF组,15例)。两组均进行常规治疗,在此基础上,EMGBF组采用肌电生物反馈治疗仪进行伸膝和踝背屈训练,MT+EMGBF组采用下肢镜像治疗同时结合肌电生物反馈治疗仪进行上述训练。每次治疗30 min,1次/d,5 d/周,共治疗8周。治疗前后分别使用简式Fugl-Meyer下肢运动功能评价表(FMA-LE)、Berg平衡量表(BBS),改良Barthel指数(MBI)对两组进行疗效评定。结果治疗后,两组的FMA-LE、BBS及MBI得分均较治疗前升高(P <0.01)。与EMGBF组比较,MT+EMGBF组在下肢运动能力和平衡功能方面显著提高(P <0.05),但在日常生活活动能力的改善方面两组差异无统计学意义(P> 0.05)。结论早期进行常规治疗结合肌电生物反馈治疗能有效提高脑梗死患者下肢运动功能、平衡功能以及日常生活活动能力,在此基础上联合镜像训练能进一步提高患者下肢运动和平衡功能。
Objective To observe the effective of mirror therapy combined with electromyographic biofeedback on lower extremity motor function and balance function and activities of daily living of subacute ischemic stroke patients. Methods From November 2016 to March 2018, 29 cases of subacute ischemic stroke patients in the Department of Rehabilitation Medicine, the First Affiliated Hospital of Wenzhou Medical University were selected, and they were divided into mirror therapy combined with electromyographic biofeedback group(MT+EMGBF, 14 cases) and electromyographic biofeedback group(EMGBF, 15 cases). The two groups were treated with conventional methods. On the basis of the former treatment, EMGBF group was given knee extension and ankle flexion training with myoelectric biofeedback therapy apparatus, and MT+EMGBF group was given the above training by using lower limb mirror treatment combined with myoelectric biofeedback therapy apparatus. The treatment sustained for 30 min, 1/d, 5 d/week, and the course was8 weeks. Fugl-Meyer assessment lower extremity(FMA-LE), Berg balance score(BBS) and modified Barthel index(MBI) was adopted to evaluate the motor function, balance function and activity of daily living, respectively. Results After treatment, scores of FMA-LE, BBS and MBI of the two groups had improved than those before treatment(P <0.01). Compared with the EMGBF group, motor function and balance function in the MT+EMGBF group improved significantly(P < 0.05), while there was no significant difference between the two groups in the improvement of activity of daily living(P > 0.05). Conclusion In the early stage, electromyographic biofeedback can significantly improve the motor function of the lower extremity, balance function and ability of daily living in subacute ischemic stroke patients.On that basis, electromyographic biofeedback combined with mirror therapy has more significant improvement in motor function and balance function in the lower extremity.
Objective To observe the effective of mirror therapy combined with electromyographic biofeedback on lower extremity motor function and balance function and activities of daily living of subacute ischemic stroke patients. Methods From November 2016 to March 2018, 29 cases of subacute ischemic stroke patients in the Department of Rehabilitation Medicine, the First Affiliated Hospital of Wenzhou Medical University were selected, and they were divided into mirror therapy combined with electromyographic biofeedback group(MT+EMGBF, 14 cases) and electromyographic biofeedback group(EMGBF, 15 cases). The two groups were treated with conventional methods. On the basis of the former treatment, EMGBF group was given knee extension and ankle flexion training with myoelectric biofeedback therapy apparatus, and MT+EMGBF group was given the above training by using lower limb mirror treatment combined with myoelectric biofeedback therapy apparatus. The treatment sustained for 30 min, 1/d, 5 d/week, and the course was8 weeks. Fugl-Meyer assessment lower extremity(FMA-LE), Berg balance score(BBS) and modified Barthel index(MBI) was adopted to evaluate the motor function, balance function and activity of daily living, respectively. Results After treatment, scores of FMA-LE, BBS and MBI of the two groups had improved than those before treatment(P <0.01). Compared with the EMGBF group, motor function and balance function in the MT+EMGBF group improved significantly(P < 0.05), while there was no significant difference between the two groups in the improvement of activity of daily living(P > 0.05). Conclusion In the early stage, electromyographic biofeedback can significantly improve the motor function of the lower extremity, balance function and ability of daily living in subacute ischemic stroke patients.On that basis, electromyographic biofeedback combined with mirror therapy has more significant improvement in motor function and balance function in the lower extremity.
引文
[1]中华医学会神经病学分会.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,4(48):246-257.
[2]吴兆苏,姚崇华,赵冬.我国人群脑卒中发病率、死亡率的流行病学研究[J].中华流行病学杂志,2003,24(3):71-74.
[3]杨阳,胡利杰,蔡西国,等.肌电生物反馈治疗对脑卒中患者肢体功能恢复的影响[J].中华物理医学与康复杂志,2016,38(2):144-146.
[4]陈建,李硕,闫成龙.表面肌电生物反馈结合本体感觉神经肌肉促进技术治疗脑卒中患者足下垂的临床观察[J].中国康复医学杂志,2016,31(8):899-902.
[5]王丽菊,陈立早,欧艺,等.镜像视觉反馈和肌电生物反馈对脑卒中偏瘫患者上肢功能的影响[J].中国康复理论与实践,2015,21(2):202-206.
[6]李梦晓,冯丽娟,张福蓉,等.镜像视觉反馈疗法在康复训练中的研究进展[J].中国康复理论与实践,2017,23(12):1403-1406.
[7]中华神经外科杂志.脑血管疾病分类(1995年)[J].中华神经外科杂志,1997,13(1):5-6.
[8]孙玉珠,苗芬,徐洁,等.针刺治疗脑梗死肌张力异常对Brunnstrom分期影响的优选[J].中华全科医学,2015,13(11):1853-1855.
[9]徐晓娅,郭晓聪,黄琳明,等.高血压病患者血管性轻度认知功能障碍的认知损害特点及危险因素分析[J].中外医学研究,2018,16(12):55-57.
[10]焦俊杰,郭洪亮,刘丽杰,等.强制性运动疗法对急性脑卒中后偏瘫患者早期神经功能的影响研究[J].中国全科医学,2016,19(16):1968-1971.
[11]王丹丹,林坚,刘晓林,等.视觉反馈结合核心稳定训练对脑卒中Pusher综合征患者的影响[[J].中国康复医学杂志,2016,31(34):426-429.
[12]何会超,张伟滨,吕政,等.早期护理干预对脑卒中偏瘫失语患者日常生活能力及负性情绪的影响[J].中国医药导报,2017,14(2):146-149.
[13]杨珺,彭涛,魏海棠,等.小脑卒中后静态平衡功能和稳定极限范围的临床研究[J].中国康复医学杂志,2018,33(2):220-222.
[14]郭洋洋,李义.头针同步进行MOTOmed训练对脑卒中偏瘫患者下肢功能的影响[J].中国医药导报,2018,15(1):106-108,126.
[15]Hyun CW,Han EY,Im SH,et al.Hemiparetic Knee Extensor Strength and Balance Function Are Predictors of Ambulatory Function in Subacute Stroke Patients[J].Ann Rehabil Med,2015,39(4):577-585.
[16]陈伟光,余刚,高绍青,等.生物反馈联合电刺激治疗盆底功能障碍性疾病的临床疗效[J].中国医药科学,2016,6(14):35-38.
[17]游国清,廖琳,梁慧英,等.功能性电刺激改善早期脑卒中患者偏瘫下肢功能的随机对照研究[J].中国实用医药,2013,8(3):4-7.
[18]郭英杰,程杨,丁华,等.表面肌电生物反馈训练在脑卒中足下垂患者功能训练中的应用[J].中国康复医学杂志,2010,25(10):981-983.
[19]叶阗芬,杜林娟,方明杰.肌电生物反馈对脑卒中偏瘫患者上肢神经传导功能的影响[J].医学综述,2016,22(22):4545-4548.
[20]阚秀丽,吴建贤.肌电生物反馈对小儿脑瘫膝过伸的临床研究[J].中国医药科学,2016,6(19):28-31.
[21]刘玉海,张淑珍,格日乐.肌电生物反馈治疗偏瘫患者踝背屈障碍的临床观察[J].中国康复医学杂志,2005(5):379.
[22]简静雯,朱丽娟,茅新蕾,等.不同时间的生物反馈联合吞咽功能训练对脑卒中后吞咽障碍的疗效评价[J].中国现代医生,2018,56(13):78-81.
[23]Lee D,Lee G,Jeong J.Mirror Therapy with Neuromuscular Electrical Stimulation for improving motor function of stroke survivors:A pilot randomized clinical study[J].Technol Health Care,2016,24(4):503-511.
[24]Nozoe M,Kanai M,Kubo H,et al.Changes in quadriceps muscle thickness in acute non-ambulatory stroke survivors[J].Top Stroke Rehabilitation,2016,23(1):8-14.
[25]Nozoe M,Kanai M,Kubo H,et al.Efficacy of neuromuscular electrical stimulation for preventing quadriceps muscle wasting in patients with moderate or severe acute stroke:A pilot study[J].NeuroRehabilitation,2017,41(1):143-149.
[26]Kim MK,Ji SG,Cha HG.The effect of mirror therapy on balance ability of subacute stroke patients[J].Hong Kong Physiotherapy Journal,2016,34:27-32.
[27]Salhab G,Sarraj AR,Saleh S.Mirror therapy combined with functional electrical stimulation for rehabilitation of stroke survivors′ankle dorsiflexion[J].Conf Proc IEEEEng Med Biol Soc,2016:4699-4702.
[28]Xu Q,Guo F,Salem HMA,et al.Effects of mirror therapy combined with neuromuscular electrical stimulation on motor recovery of lower limbs and walking ability of patients with stroke:a randomized controlled study[J].Clin Rehabil,2017,31(12):1583-1591.
[29]Arya KN,Pandian S,Kumar V.Effect of activity-based mirror therapy on lower limb motor-recovery and gait in stroke:A randomised controlled trial[J].Neuropsychol Rehabil,2017:1-18.
[30]Mohan U,Babu SK,Kumar KV,et al.Effectiveness of mirror therapy on lower extremity motor recovery,balance and mobility in patients with acute stroke:A randomized sham-controlled pilot trial[J].Ann Indian Acad Neurol,2013,16(4):634-639.
[2]吴兆苏,姚崇华,赵冬.我国人群脑卒中发病率、死亡率的流行病学研究[J].中华流行病学杂志,2003,24(3):71-74.
[3]杨阳,胡利杰,蔡西国,等.肌电生物反馈治疗对脑卒中患者肢体功能恢复的影响[J].中华物理医学与康复杂志,2016,38(2):144-146.
[4]陈建,李硕,闫成龙.表面肌电生物反馈结合本体感觉神经肌肉促进技术治疗脑卒中患者足下垂的临床观察[J].中国康复医学杂志,2016,31(8):899-902.
[5]王丽菊,陈立早,欧艺,等.镜像视觉反馈和肌电生物反馈对脑卒中偏瘫患者上肢功能的影响[J].中国康复理论与实践,2015,21(2):202-206.
[6]李梦晓,冯丽娟,张福蓉,等.镜像视觉反馈疗法在康复训练中的研究进展[J].中国康复理论与实践,2017,23(12):1403-1406.
[7]中华神经外科杂志.脑血管疾病分类(1995年)[J].中华神经外科杂志,1997,13(1):5-6.
[8]孙玉珠,苗芬,徐洁,等.针刺治疗脑梗死肌张力异常对Brunnstrom分期影响的优选[J].中华全科医学,2015,13(11):1853-1855.
[9]徐晓娅,郭晓聪,黄琳明,等.高血压病患者血管性轻度认知功能障碍的认知损害特点及危险因素分析[J].中外医学研究,2018,16(12):55-57.
[10]焦俊杰,郭洪亮,刘丽杰,等.强制性运动疗法对急性脑卒中后偏瘫患者早期神经功能的影响研究[J].中国全科医学,2016,19(16):1968-1971.
[11]王丹丹,林坚,刘晓林,等.视觉反馈结合核心稳定训练对脑卒中Pusher综合征患者的影响[[J].中国康复医学杂志,2016,31(34):426-429.
[12]何会超,张伟滨,吕政,等.早期护理干预对脑卒中偏瘫失语患者日常生活能力及负性情绪的影响[J].中国医药导报,2017,14(2):146-149.
[13]杨珺,彭涛,魏海棠,等.小脑卒中后静态平衡功能和稳定极限范围的临床研究[J].中国康复医学杂志,2018,33(2):220-222.
[14]郭洋洋,李义.头针同步进行MOTOmed训练对脑卒中偏瘫患者下肢功能的影响[J].中国医药导报,2018,15(1):106-108,126.
[15]Hyun CW,Han EY,Im SH,et al.Hemiparetic Knee Extensor Strength and Balance Function Are Predictors of Ambulatory Function in Subacute Stroke Patients[J].Ann Rehabil Med,2015,39(4):577-585.
[16]陈伟光,余刚,高绍青,等.生物反馈联合电刺激治疗盆底功能障碍性疾病的临床疗效[J].中国医药科学,2016,6(14):35-38.
[17]游国清,廖琳,梁慧英,等.功能性电刺激改善早期脑卒中患者偏瘫下肢功能的随机对照研究[J].中国实用医药,2013,8(3):4-7.
[18]郭英杰,程杨,丁华,等.表面肌电生物反馈训练在脑卒中足下垂患者功能训练中的应用[J].中国康复医学杂志,2010,25(10):981-983.
[19]叶阗芬,杜林娟,方明杰.肌电生物反馈对脑卒中偏瘫患者上肢神经传导功能的影响[J].医学综述,2016,22(22):4545-4548.
[20]阚秀丽,吴建贤.肌电生物反馈对小儿脑瘫膝过伸的临床研究[J].中国医药科学,2016,6(19):28-31.
[21]刘玉海,张淑珍,格日乐.肌电生物反馈治疗偏瘫患者踝背屈障碍的临床观察[J].中国康复医学杂志,2005(5):379.
[22]简静雯,朱丽娟,茅新蕾,等.不同时间的生物反馈联合吞咽功能训练对脑卒中后吞咽障碍的疗效评价[J].中国现代医生,2018,56(13):78-81.
[23]Lee D,Lee G,Jeong J.Mirror Therapy with Neuromuscular Electrical Stimulation for improving motor function of stroke survivors:A pilot randomized clinical study[J].Technol Health Care,2016,24(4):503-511.
[24]Nozoe M,Kanai M,Kubo H,et al.Changes in quadriceps muscle thickness in acute non-ambulatory stroke survivors[J].Top Stroke Rehabilitation,2016,23(1):8-14.
[25]Nozoe M,Kanai M,Kubo H,et al.Efficacy of neuromuscular electrical stimulation for preventing quadriceps muscle wasting in patients with moderate or severe acute stroke:A pilot study[J].NeuroRehabilitation,2017,41(1):143-149.
[26]Kim MK,Ji SG,Cha HG.The effect of mirror therapy on balance ability of subacute stroke patients[J].Hong Kong Physiotherapy Journal,2016,34:27-32.
[27]Salhab G,Sarraj AR,Saleh S.Mirror therapy combined with functional electrical stimulation for rehabilitation of stroke survivors′ankle dorsiflexion[J].Conf Proc IEEEEng Med Biol Soc,2016:4699-4702.
[28]Xu Q,Guo F,Salem HMA,et al.Effects of mirror therapy combined with neuromuscular electrical stimulation on motor recovery of lower limbs and walking ability of patients with stroke:a randomized controlled study[J].Clin Rehabil,2017,31(12):1583-1591.
[29]Arya KN,Pandian S,Kumar V.Effect of activity-based mirror therapy on lower limb motor-recovery and gait in stroke:A randomised controlled trial[J].Neuropsychol Rehabil,2017:1-18.
[30]Mohan U,Babu SK,Kumar KV,et al.Effectiveness of mirror therapy on lower extremity motor recovery,balance and mobility in patients with acute stroke:A randomized sham-controlled pilot trial[J].Ann Indian Acad Neurol,2013,16(4):634-639.