弓箭步训练对脑卒中偏瘫患者小腿肌群收缩功能的影响
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摘要
目的探讨弓箭步训练对脑卒中偏瘫患者小腿肌群收缩功能的影响。方法选取2016年6月～2018年1月于温州医科大学附属第一医院康复科治疗的60例脑卒中偏瘫患者,依据随机数字表法将患者分为对照组与观察组,每组30例,对照组给予常规康复训练并配合小腿肌群牵伸运动,观察组在对照组治疗的基础上增加弓箭步训练。两组患者均连续训练8周。分别采用痉挛指数(CSI)、平衡量表(Berg)、Fugl-Meyer量表(FMA-L)评价患侧痉挛程度、平衡能力以及下肢功能;同时采用霍尔德步行功能评分(Hollde)评价步行功能,并计算治疗前后步幅与最大步速;采用表面肌电图(s EMG)用于评价两组患者小腿肌群收缩功能。结果治疗后,两组患者FMA-L评分、Berg评分、Hollde评分、积分肌电值(iEMG)、步幅与最大步速均较治疗前显著增高(P <0.05);治疗后,CSI指数与胫骨前肌、腓肠肌、比目鱼肌表面肌电信号均方根值(RMS)较治疗前显著降低(P <0.05);观察组的FMA-L评分、Berg评分、Hollde评分、iEMG、步幅与最大步速明显高于对照组,CSI指数与胫骨前肌、腓肠肌、比目鱼肌RMS明显低于对照组(P <0.05)。结论弓箭步训练能够提升脑卒中偏瘫患者小腿肌群收缩功能,提高运动、平衡能力,改善患肢痉挛,提高步行能力。
Objective To explore the effect of bow and arrow step training on the contraction function of shank muscles in stroke patients with hemiplegia. Methods Sixty stroke patients with hemiplegia treated in Department of Rehabilitation, the First Affiliated Hospital of Wenzhou Medical University from June 2016 to January 2018 were enrolled in this study, and they were divided into control group and observation group by random number table method with 30 cases in each group. The control group received routine rehabilitation training combined with the stretching exercise of shank muscles. Bow and arrow step training was added to the observation group on the basis of the training in the control group. Both groups trained for eight weeks continuously. The composite spasticity index(CSI), balance scale(Berg) and Fugl-Meyer scale(FMA-L) were used to evaluate the degree of spasm, balance ability and lower extremity function respectively. Meanwhile, the Hollde scale was used to evaluate walking function, the stride and maximum speed were counted. The surface electromyogram(SEMG) signals was used to evaluate the function of shank muscles. Results After treatment, FMA-L score, Berg score, Hollde score, iEMG, stride and maximum speed significantly increased in the two groups than those before treatment(P < 0.05); after treatment, the CSI index, RMS of tibialis anterior, gastrocnemius,soleus significantly decreased than those before treatment(P < 0.05). Meanwhile, FMA-L score, Berg score, Hollde score, iEMG, stride and maximum speed in the observation group were higher than those in the control group(P <0.05), and the CSI index, RMS of tibialis anterior, gastrocnemius and soleus were lower than those in the control group significantly(P < 0.05). Conclusion Bow and arrow step training can improve the contractile function of shank muscles,exercise ability and balance ability in stroke patients with hemiplegia, as well as paralysis and improve walking ability.
Objective To explore the effect of bow and arrow step training on the contraction function of shank muscles in stroke patients with hemiplegia. Methods Sixty stroke patients with hemiplegia treated in Department of Rehabilitation, the First Affiliated Hospital of Wenzhou Medical University from June 2016 to January 2018 were enrolled in this study, and they were divided into control group and observation group by random number table method with 30 cases in each group. The control group received routine rehabilitation training combined with the stretching exercise of shank muscles. Bow and arrow step training was added to the observation group on the basis of the training in the control group. Both groups trained for eight weeks continuously. The composite spasticity index(CSI), balance scale(Berg) and Fugl-Meyer scale(FMA-L) were used to evaluate the degree of spasm, balance ability and lower extremity function respectively. Meanwhile, the Hollde scale was used to evaluate walking function, the stride and maximum speed were counted. The surface electromyogram(SEMG) signals was used to evaluate the function of shank muscles. Results After treatment, FMA-L score, Berg score, Hollde score, iEMG, stride and maximum speed significantly increased in the two groups than those before treatment(P < 0.05); after treatment, the CSI index, RMS of tibialis anterior, gastrocnemius,soleus significantly decreased than those before treatment(P < 0.05). Meanwhile, FMA-L score, Berg score, Hollde score, iEMG, stride and maximum speed in the observation group were higher than those in the control group(P <0.05), and the CSI index, RMS of tibialis anterior, gastrocnemius and soleus were lower than those in the control group significantly(P < 0.05). Conclusion Bow and arrow step training can improve the contractile function of shank muscles,exercise ability and balance ability in stroke patients with hemiplegia, as well as paralysis and improve walking ability.
引文
[1]王班,关天嘉,尤莉莉,等.我国缺血性脑卒中残疾情况及其影响因素分析[J].中国全科医学,2016,19(2):216-219.
[2]贾秀贤,雷少军,刘卫霞,等.早期康复训练在脑卒中偏瘫患者治疗中的应用[J].广东医学,2016,37(18):2806-2808.
[3]王红娟,陈丙坤,吕政.早期康复护理对脑卒中患者运动功能及认知功能的影响[J].中国医药导报,2017,14(17):156-159.
[4]Yoon SW.Analysis of the muscular activities of the tibialis anterior andgastrocnemius muscles in functional reach[J].J Phy Ther Sci,2017,29(5):851-853.
[5]Psurny M,Svoboda Z,Janura M,et al.The effects of nordic walking and slope of the ground on lower limb muscle activity[J].J Strength Cond Res,2018,32(1):217-222.
[6]张志杰,王季,洪文侠,等.深层肌肉刺激对小腿三头肌张力影响的短期效果[J].中国康复医学杂志,2016,31(11):1253-1254.
[7]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,2015,48(4):246-257.
[8]中华医学会神经病学分会.中国脑出血诊治指南(2014)[J]中华神经科杂志,2015,48(6):435-444.
[9]许轶,王楚怀,韩秀兰,等.连续型对称指数应用于健康青年女性矢状面下肢关节角度对称性的研究[J].实用医学杂志,2017,33(1):87-91.
[10]杨雅琴,周亚楠,邢德利,等.Berg平衡量表应用于帕金森病患者的信度分析[J].中国康复理论与实践,2016,22(3):303-305.
[11]陈培荣,李奎,吴丹丽,等.多通路功能性电刺激四肢联动对于脑卒中患者下肢功能恢复的影响[J].中国康复,2017,32(6):476-478.
[12]许林海,蒋松鹤,韩丽雅.减重支持步行训练联合本体感觉训练改善CIS患者平衡及步行能力的效果[J].浙江医学,2017,39(13):1097-1101.
[13]许志生,刘远标,李建华.脑卒中后偏瘫患者步行能力及其影响[J].中华物理医学与康复杂志,2006,28(7):490-492.
[14]刘文辉,李瑾,李楠,等.不同角度股四头肌等速肌力训练对骨科术后康复治疗疗效的影响研究[J].中国医学装备,2018,15(2):78-81.
[15]林君,宋成宪,李舜,等.核心稳定性训练对脑卒中患者平衡功能及腹肌厚度的影响[J].中国临床研究,2017,30(4):498-501.
[16]宋倩,彭莉,秦渝珂,等.基于步态周期下跨栏运动员步态及下肢表面肌电特征分析[J].中国组织工程研究,2017,21(24):3851-3857.
[17]庄霁雯,郑洁皎,陈秀恩,等.脑卒中平衡功能障碍治疗的研究进展[J].中国康复理论与实践,2016,22(10):1127-1131.
[18]张晓辉,娄镇,廖八根,等.力量训练与神经肌肉训练对运动员内侧半月板部分切除术后运动功能的影响[J].中国骨与关节杂志,2017,6(10):773-779.
[19]唐洪渊.专业运动康复在前交叉韧带重建术后的应用效果[J].中国医药导报,2016,13(12):77-80.
[20]Park BS,Noh JW,Kim MY,et al.A comparative study of the effects of trunk exercise program in aquatic andlandbased therapy on gait in hemiplegic stroke patients[J].JPhys Ther Sci,2016,28(6):1904-1908.
[21]Kilby J,Prasad K,Mawston G.Multi-Channel Surface Electromyography Electrodes:A Review[J].IEEE Sens J,2016,16(14):5510-5519.
[22]Spratford W,Campbell R.Postural stability,clicker reaction time and bow draw force predict performance in elite recurve archery[J].Eur J Sport Sci,2017,17(5):539-545.
[23]Nam S,Kim W,Yun C.The effects of a multisensory dynamic balance training on the thickness of lower limb muscles in ultrasonography in children with spastic diplegic cerebral palsy[J].J Phy Ther Sci,2017,29(4):775-778.
[24]Unhjem RJ,Nygard M,Lt VD,et al.Lifelong strength training mitigates the age-related decline in efferent drive[J].J Appl Physiol,2016,121(2):415-423.
[25]Ruivo RM,Carita AI,Pezarat-Correia P.Effects of a 16-week strength-training program on soccer players[J].Sci Sport,2016,31(5):107-113.
[26]廖志平,李建华,魏爽.脑卒中患者桥式运动下竖脊肌与多裂肌表面肌电图信号特征研究[J].中国康复医学杂志,2016,31(2):189-193.
[27]Basri R,Alam MK,Imanishi T,et al.Functional Ability of Masticatory Muscles in Treated Mandibular Fracture Cases Using Surface Electromyography(sEMG)[J].JHard Tissue Biol,2016,25(4):431-436.
[2]贾秀贤,雷少军,刘卫霞,等.早期康复训练在脑卒中偏瘫患者治疗中的应用[J].广东医学,2016,37(18):2806-2808.
[3]王红娟,陈丙坤,吕政.早期康复护理对脑卒中患者运动功能及认知功能的影响[J].中国医药导报,2017,14(17):156-159.
[4]Yoon SW.Analysis of the muscular activities of the tibialis anterior andgastrocnemius muscles in functional reach[J].J Phy Ther Sci,2017,29(5):851-853.
[5]Psurny M,Svoboda Z,Janura M,et al.The effects of nordic walking and slope of the ground on lower limb muscle activity[J].J Strength Cond Res,2018,32(1):217-222.
[6]张志杰,王季,洪文侠,等.深层肌肉刺激对小腿三头肌张力影响的短期效果[J].中国康复医学杂志,2016,31(11):1253-1254.
[7]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,2015,48(4):246-257.
[8]中华医学会神经病学分会.中国脑出血诊治指南(2014)[J]中华神经科杂志,2015,48(6):435-444.
[9]许轶,王楚怀,韩秀兰,等.连续型对称指数应用于健康青年女性矢状面下肢关节角度对称性的研究[J].实用医学杂志,2017,33(1):87-91.
[10]杨雅琴,周亚楠,邢德利,等.Berg平衡量表应用于帕金森病患者的信度分析[J].中国康复理论与实践,2016,22(3):303-305.
[11]陈培荣,李奎,吴丹丽,等.多通路功能性电刺激四肢联动对于脑卒中患者下肢功能恢复的影响[J].中国康复,2017,32(6):476-478.
[12]许林海,蒋松鹤,韩丽雅.减重支持步行训练联合本体感觉训练改善CIS患者平衡及步行能力的效果[J].浙江医学,2017,39(13):1097-1101.
[13]许志生,刘远标,李建华.脑卒中后偏瘫患者步行能力及其影响[J].中华物理医学与康复杂志,2006,28(7):490-492.
[14]刘文辉,李瑾,李楠,等.不同角度股四头肌等速肌力训练对骨科术后康复治疗疗效的影响研究[J].中国医学装备,2018,15(2):78-81.
[15]林君,宋成宪,李舜,等.核心稳定性训练对脑卒中患者平衡功能及腹肌厚度的影响[J].中国临床研究,2017,30(4):498-501.
[16]宋倩,彭莉,秦渝珂,等.基于步态周期下跨栏运动员步态及下肢表面肌电特征分析[J].中国组织工程研究,2017,21(24):3851-3857.
[17]庄霁雯,郑洁皎,陈秀恩,等.脑卒中平衡功能障碍治疗的研究进展[J].中国康复理论与实践,2016,22(10):1127-1131.
[18]张晓辉,娄镇,廖八根,等.力量训练与神经肌肉训练对运动员内侧半月板部分切除术后运动功能的影响[J].中国骨与关节杂志,2017,6(10):773-779.
[19]唐洪渊.专业运动康复在前交叉韧带重建术后的应用效果[J].中国医药导报,2016,13(12):77-80.
[20]Park BS,Noh JW,Kim MY,et al.A comparative study of the effects of trunk exercise program in aquatic andlandbased therapy on gait in hemiplegic stroke patients[J].JPhys Ther Sci,2016,28(6):1904-1908.
[21]Kilby J,Prasad K,Mawston G.Multi-Channel Surface Electromyography Electrodes:A Review[J].IEEE Sens J,2016,16(14):5510-5519.
[22]Spratford W,Campbell R.Postural stability,clicker reaction time and bow draw force predict performance in elite recurve archery[J].Eur J Sport Sci,2017,17(5):539-545.
[23]Nam S,Kim W,Yun C.The effects of a multisensory dynamic balance training on the thickness of lower limb muscles in ultrasonography in children with spastic diplegic cerebral palsy[J].J Phy Ther Sci,2017,29(4):775-778.
[24]Unhjem RJ,Nygard M,Lt VD,et al.Lifelong strength training mitigates the age-related decline in efferent drive[J].J Appl Physiol,2016,121(2):415-423.
[25]Ruivo RM,Carita AI,Pezarat-Correia P.Effects of a 16-week strength-training program on soccer players[J].Sci Sport,2016,31(5):107-113.
[26]廖志平,李建华,魏爽.脑卒中患者桥式运动下竖脊肌与多裂肌表面肌电图信号特征研究[J].中国康复医学杂志,2016,31(2):189-193.
[27]Basri R,Alam MK,Imanishi T,et al.Functional Ability of Masticatory Muscles in Treated Mandibular Fracture Cases Using Surface Electromyography(sEMG)[J].JHard Tissue Biol,2016,25(4):431-436.