骨盆、髋关节周围肌群等长收缩训练对脑卒中后遗症期患者步行功能的影响
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摘要
目的观察骨盆、髋关节周围肌群等长收缩训练对脑卒中后遗症期患者步行功能的影响。方法根据康复方法将脑卒中后遗症期患者21例分为收缩训练组(11例)和对照组(10例)。两组均予常规脑卒中药物治疗和常规康复治疗;收缩训练组在此基础上,采用仰卧位、侧卧位和俯卧位下的多组骨盆、髋关节周围肌群的等长收缩训练。两组均接受治疗6个月。治疗前后采用下肢Fugl-Meyer量表(FMA)、Berg平衡功能量表(BBS)、步态评估量表(TGA)和10 m最大步行速度(MWS)评价患者的步行功能。结果与治疗前比较,收缩训练组及对照组治疗后下肢FMA、BBS及TGA评分均显著升高,MWS速度显著加快(P<0.05~0.01)。两组患者治疗前下肢FMA、BBS、TGA评分及MWS速度差异无统计学意义(均P>0.05)。与对照组比较,收缩训练组治疗前后下肢FMA、TGA评分及MWS速度差值显著升高(t=2.28,P=0.04;t=3.85,P=0.00;Z=2.17,P=0.03),治疗前后BBS评分差值无统计学意义(t=-0.08,P=0.94)。结论仰、侧、俯卧位下骨盆、髋关节周围肌群等长收缩可提高脑卒中后遗症期患者下肢运动和步行能力。
Objective To observe the effect of isometric exercise( IE) of muscle groups around pelvic and hip on walking function in patients with stroke in sequelae period. Methods According to different rehabilitation therapies,21 patients with stroke in sequelae period were divided into IE group( 11 cases) and control group( 10 cases). Both groups were accepted routine medication and rehabilitation therapies. IE group patients,based on treatments above-mentioned,were received isometric exercise of muscle groups around pelvic and hip in three positions including supine,unaffected side-lying and prone position at same time. Both groups were treated for 6 months. Before and after treatment, both groups were evaluated walking function by lower limb Fugl-Meyer assessment( FMA) scale,Berg balance scale( BBS),tinetti gait analysis( TGA) scale and 10 m maximum walking speed( MWS). Results Compared with pre-treatment,the scores of FMA,BBS and TGA of lower limb in IE group and control group were significantly higher,and MWS in IE group and control group were significantly increased( P < 0. 05-0. 01). There was no statistical significance in scores of FMA,BBS and TGA of lower limb and MWS between IE group and control group before treatment( all P > 0. 05). Compared with control group,difference values between pre and post treatment of scores of lower limb FMA,TGA and MWS of IE group were significantly increased( t = 2. 28,P = 0. 04; t = 3. 85,P = 0. 00; Z = 2. 17,P = 0. 03),while difference values between pre and post treatment of score of BBS of IE group had no statistical significance( t =-0. 08,P = 0. 94). Conclusion Isometric exercises of muscle groups around pelvic and hip in three positions including supine,unaffected side-lying and prone position are effective to enhance affected lower limbs' motor function and walking ability of patients with stroke in sequelae period.
Objective To observe the effect of isometric exercise( IE) of muscle groups around pelvic and hip on walking function in patients with stroke in sequelae period. Methods According to different rehabilitation therapies,21 patients with stroke in sequelae period were divided into IE group( 11 cases) and control group( 10 cases). Both groups were accepted routine medication and rehabilitation therapies. IE group patients,based on treatments above-mentioned,were received isometric exercise of muscle groups around pelvic and hip in three positions including supine,unaffected side-lying and prone position at same time. Both groups were treated for 6 months. Before and after treatment, both groups were evaluated walking function by lower limb Fugl-Meyer assessment( FMA) scale,Berg balance scale( BBS),tinetti gait analysis( TGA) scale and 10 m maximum walking speed( MWS). Results Compared with pre-treatment,the scores of FMA,BBS and TGA of lower limb in IE group and control group were significantly higher,and MWS in IE group and control group were significantly increased( P < 0. 05-0. 01). There was no statistical significance in scores of FMA,BBS and TGA of lower limb and MWS between IE group and control group before treatment( all P > 0. 05). Compared with control group,difference values between pre and post treatment of scores of lower limb FMA,TGA and MWS of IE group were significantly increased( t = 2. 28,P = 0. 04; t = 3. 85,P = 0. 00; Z = 2. 17,P = 0. 03),while difference values between pre and post treatment of score of BBS of IE group had no statistical significance( t =-0. 08,P = 0. 94). Conclusion Isometric exercises of muscle groups around pelvic and hip in three positions including supine,unaffected side-lying and prone position are effective to enhance affected lower limbs' motor function and walking ability of patients with stroke in sequelae period.
引文
[1]陆晓,励建安.等长收缩运动在心血管康复中的应用基础研究概况[J].中华物理医学与康复杂志,1999,21:46.
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[3]陈伟伟,高润霖,刘力生,等.《中国心血管病报告2015》概要[J].中国循环杂志,2016,31:521.
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[6]张有超,李斌,范录平,等.早期介入运动想象疗法对急性脑卒中偏瘫患者下肢运动功能及日常生活活动能力的影响[J].临床神经病学杂志,2016,29:296.
[7]任惠明,袁海,王小同,等.脑的可塑性与卒中后运动功能康复相关研究的Meta分析[J].中国康复医学杂志,2011,26:182.
[8]李迎光,李志君,李小军.早期部分减重步行训练联合常规康复治疗对脑卒中偏瘫患者步行功能的影响[J].郑州大学学报:医学版,2011,46:160.
[9]Knarr BA,Kesar TM,Reisman DS,et al.Changes in the activation and function of the ankle plantar flexor muscles due to gait retraining in chronic stroke survivors[J].J Neuroeng Rehabil,2013,10:12.
[10]周斌.系统化思维(姿势控制理念)对偏瘫步行训练的意义[C]//第10届中日理学疗法国际学术大会论文集,南宁,2012:3.
[11]付奕,窦祖林,丘卫红,等.脑卒中患者姿势控制能力的量化评价[J].中国康复医学杂志,2010,25:947.
[12]戴红.运用促进技术对中枢性瘫痪进行训练的原理和处理原则[J].中国康复医学杂志,1994,9:273.
[13]牛岩,黄力平,曹龙军,等.静力牵伸与等长收缩对颈肩肌肉疼痛患者上斜方肌[J].中国康复医学杂志,2016,31:411.
[14]郑杨,王刚,徐进,等.大脑皮层-肌肉交互作用与注意力关系的实验研究[J].西安交通大学学报,2014,48:134.
[15]王文威,潘翠环,陈艳,等.步态中枢模式发生器对脑卒中偏瘫患者步行能力的影响[J].中国康复医学杂志,2011,26:529.
[16]黎涌明,于洪军,资薇,等.论核心力量及其在竞技体育中的训练--起源·问题·发展[J].体育科学,2008,28:19.
[2]中华神经科学会、中华神经外科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,6:379.
[3]陈伟伟,高润霖,刘力生,等.《中国心血管病报告2015》概要[J].中国循环杂志,2016,31:521.
[4]丁洋.《脑卒中综合防治工作方案》发布[N].中国中医药报,2016-12-14(001).
[5]中华医学会神经病学分会神经康复学组,中华医学会神经病学分会脑血管病学组,卫生部脑卒中筛查与防治工程委员会办公室,等.中国脑卒中康复治疗指南(2011完全版)[J].中国康复理论与实践,2012,18:301.
[6]张有超,李斌,范录平,等.早期介入运动想象疗法对急性脑卒中偏瘫患者下肢运动功能及日常生活活动能力的影响[J].临床神经病学杂志,2016,29:296.
[7]任惠明,袁海,王小同,等.脑的可塑性与卒中后运动功能康复相关研究的Meta分析[J].中国康复医学杂志,2011,26:182.
[8]李迎光,李志君,李小军.早期部分减重步行训练联合常规康复治疗对脑卒中偏瘫患者步行功能的影响[J].郑州大学学报:医学版,2011,46:160.
[9]Knarr BA,Kesar TM,Reisman DS,et al.Changes in the activation and function of the ankle plantar flexor muscles due to gait retraining in chronic stroke survivors[J].J Neuroeng Rehabil,2013,10:12.
[10]周斌.系统化思维(姿势控制理念)对偏瘫步行训练的意义[C]//第10届中日理学疗法国际学术大会论文集,南宁,2012:3.
[11]付奕,窦祖林,丘卫红,等.脑卒中患者姿势控制能力的量化评价[J].中国康复医学杂志,2010,25:947.
[12]戴红.运用促进技术对中枢性瘫痪进行训练的原理和处理原则[J].中国康复医学杂志,1994,9:273.
[13]牛岩,黄力平,曹龙军,等.静力牵伸与等长收缩对颈肩肌肉疼痛患者上斜方肌[J].中国康复医学杂志,2016,31:411.
[14]郑杨,王刚,徐进,等.大脑皮层-肌肉交互作用与注意力关系的实验研究[J].西安交通大学学报,2014,48:134.
[15]王文威,潘翠环,陈艳,等.步态中枢模式发生器对脑卒中偏瘫患者步行能力的影响[J].中国康复医学杂志,2011,26:529.
[16]黎涌明,于洪军,资薇,等.论核心力量及其在竞技体育中的训练--起源·问题·发展[J].体育科学,2008,28:19.