脑卒中后足下垂的康复评定与治疗新进展
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摘要
脑卒中后足下垂是一种影响脑卒中患者下肢运动功能的踝关节问题,主要表现为踝关节背屈困难,行走时足尖下垂,落地时足尖先触及地面,其原因系神经肌肉功能异常,改变正常生物力学机制。足下垂问题使得患者足触地的情况发生异常,站立及步行等功能活动中重心控制与转移不当,影响其日常生活活动能力。客观评定及针对治疗可改善脑卒中后足下垂患者的下肢功能性活动,对其整体康复具有重要意义。本文拟对脑卒中后足下垂的康复评定与治疗新进展进行综述,为相关治疗提供理论依据。
Foot drop after stroke, which is manifested as ankle dorsiflexion difficulty, drooping toes when walking and toes touch the ground first before landing, is a kind of ankle problem that affects patients' motor function of lower extremities and caused by abnormalities of neuromuscular functions have changed the biomechanical mechanism. Foot drop makes abnormal foot touchdown, and inappropriateness of gravity center control and transfer in functional activities like standing and walking, then finally affects patients' activities of daily living. Objective assessment and definitive treatment can improve the functional activities of lower extremities in patients with foot drop after stroke, which is of great significance to their overall rehabilitation. This article intends to review the latest development of rehabilitation assessment and treatment for foot drop after stroke, to provide theoretical basis for related treatments.
Foot drop after stroke, which is manifested as ankle dorsiflexion difficulty, drooping toes when walking and toes touch the ground first before landing, is a kind of ankle problem that affects patients' motor function of lower extremities and caused by abnormalities of neuromuscular functions have changed the biomechanical mechanism. Foot drop makes abnormal foot touchdown, and inappropriateness of gravity center control and transfer in functional activities like standing and walking, then finally affects patients' activities of daily living. Objective assessment and definitive treatment can improve the functional activities of lower extremities in patients with foot drop after stroke, which is of great significance to their overall rehabilitation. This article intends to review the latest development of rehabilitation assessment and treatment for foot drop after stroke, to provide theoretical basis for related treatments.
引文
[1]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(4):301-318.
[2]王陇德.中国脑卒中防治报告[M].北京:中国协和医科大学出版社,2015.
[3]商敏,王玉凤,杨凤梅,等.系统康复治疗对脑卒中恢复期患者认知功能、运动功能及生活质量的影响[J].中国老年学杂志,2014,(23):6551-6553.
[4]陈艳,陈建军,艾炳蔚.脑卒中后偏瘫患者踝关节功能障碍治疗研究进展[J].中国实用神经疾病杂志,2009,12(10):47-50.
[5]Mcwain J,Bonarrigo KC,Randall K.Foot Drop:Simple Terms,Complex Problem[J].Rehab Management Interdisc Rehabil,2012,25(9):26.
[6]刘刚,吕长生,袁立霞.脑卒中足下垂及足内翻的足底生物力学特征研究[J].中华中医药学刊,2010,8(7):1444-1446.
[7]刘丹,徐海艳.电针结合艾灸涌泉穴治疗脑卒中后足下垂的临床观察[J].针灸临床杂志,2014,30(3):8-9.
[8]张千生.针刺治疗脑卒中后足下垂的临床观察[J].中国康复医学杂志,2007,22(5):461-462.
[9]张文通,孟殿怀,许光旭,等.计时起立行走与最大步行速度评估脑卒中步行功能的对比分析[J].中华物理医学与康复杂志,2016,38(4):246-249.
[10]Chang HY,Huang CH,Wei SH.Test-retest reliability and validity of 3D ultrasound based motion analysis system:comparison of the goniometer and zebris system[J].J Biomechanics,2007,40(2):S722.
[11]荣积峰,吴毅,顾玲,等.脑卒中患者足下垂和足内翻康复研究进展[J].中国康复,2015,30(1):45-48.
[12]Kaji R,Osako Y,Suyama K,et al.Botulinum toxin type A in poststroke lower limb spasticity:a multicenter,double-blind,placebocontrolled trial[J].J Neurol,2010,257(8):1330-1337.
[13]邢健莉.针灸联合康复训练治疗脑中风后遗症的临床研究[J].按摩与康复医学,2016,7(15):24-25.
[14]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(6):1660-1669.
[15]Carda S,Invernizzi M,Baricich A,et al.Casting,taping or stretching after botulinum toxin type A for spastic equines foot:a singleblind randomized trial on adult stroke patients[J].Clin Rehabil,2011,25(12):1119-1127.
[16]Hesse S,Krajnik J,Lueke D,et al.Ankle muscle aetivating before and after botulinum toxin therapy for lower limb extensor spasticity in chronic hemiparetic patients[J].Stroke,1996,27(3):445-460.
[17]林恒凯,洪峰.中医综合康复治疗气虚血瘀型缺血性中风恢复期的疗效观察[J].按摩与康复医学,2015,6(24):67-68.
[18]Zhang Y,Liu H,Fu C,et al.The biomechanical effect of acupuncture for post stroke cavovarus foot:study protocol for a randomized controlled pilot trial[J].Trials,2016,17(1):146.
[19]Harvey LA,Katalinic OM,Herbert RD,et al.Stretch for the treatment and prevention of contracture:an abridged republication of a Cochrane Systematic Review[J].J Physiother,2017,63(2):67-75.
[20]纵亚,崔立军,鲍勇,等.反复促通技术对脑卒中足下垂患者疗效的积分肌电图研究[J].内科理论与实践,2012,7(2):119-120.
[21]谢羽婕,张驰,胥方元,等.核心稳定性训练结合神经发育疗法对脑卒中患者下肢运动功能的影响[J].中国康复医学杂志,2014,29(8):773-775.
[22]朱玉连.改良强制性运动疗法对脑卒中偏瘫患者步行能力及步态生物力学的影响[D].上海体育学院,2016.
[23]Kottink AI,Hermens HJ,Nene AV,et al.A randomized controlled trial of an implantable 2-channel peroneal nerve stimulator on walking speed and activity in post stroke hemiplegia[J].Arch Phys Med,2007,88(8):971-978.
[24]Cheng JS,Yang YR,Cheng SJ,et al.Effects of combining gelectric stimulation with active ankle dorsiflexion while standing on a rocker board:a pilot study for subjects with spastic foot after stroke[J].Arch Phys Med,2009,91(4):505-512.
[25]Bakhtiary AH,Fatemy E.Does electrical stimulation reduce spasticity after stroke?A randomized controlled study[J].Clin Rehabil,2008,22(5):418-425.
[26]Sabut SK,Kumar R,Mahadevappa M.Design of a programmable multi-pattern FES system for restoring foot drop in stroke rehabilitation[J].J Med EngTechnol,2010,34(3):217-223.
[27]Sabut SK,Sikdar C,Mondal R.Restoration of gait and motor recovery by functional electrical stimulation therapy in persons with stroke[J].Disabil Rehabil,2010,32(19):1594-1603.
[28]翟宏伟,巩尊科,陈伟,等.肌电生物反馈训练对脑卒中偏瘫患者上肢运动功能的影响[J].中华物理医学与康复杂志,2010,32(7):535-536.
[29]Millee J.Orthotics and Prosthetics in Rehabilitation[M].Elsevier Health Sciences,2012:237-238.
[30]Aguilar-Ferrándiz ME,Castro-Sánchez AM,Matarán-Pe?arrocha GA,et al.A randomized controlled trial of a mixed Kinesio taping-compression technique on venous symptoms,pain,peripheral venous flow,clinical severity and overall health status in postmenopausal women with chronic venous insufficiency[J].Clin Rehabil,2014,28(1):69-81.
[31]余波,陈文华,王人卫.肌内效贴改善运动功能的临床研究现状与思考[J].中国运动医学杂志,2014,33(3):275-280.
[32]Karadag-Saygi E,Cubukcu-Aydoseli K,Kablan N,et al.The role of kinesio taping combined with botulinum toxin to reduce plantar flexors spasticity after stroke[J].Top Stroke Rehabil,2010,17(4):318-322.
[33]Bae YH,Kim HG,Min KS,et al.Effects of lower-leg kinesiology taping on balance ability in stroke patients with foot drop[J].Evid Based Complement Alternat Med,2015,2015:125629.
[2]王陇德.中国脑卒中防治报告[M].北京:中国协和医科大学出版社,2015.
[3]商敏,王玉凤,杨凤梅,等.系统康复治疗对脑卒中恢复期患者认知功能、运动功能及生活质量的影响[J].中国老年学杂志,2014,(23):6551-6553.
[4]陈艳,陈建军,艾炳蔚.脑卒中后偏瘫患者踝关节功能障碍治疗研究进展[J].中国实用神经疾病杂志,2009,12(10):47-50.
[5]Mcwain J,Bonarrigo KC,Randall K.Foot Drop:Simple Terms,Complex Problem[J].Rehab Management Interdisc Rehabil,2012,25(9):26.
[6]刘刚,吕长生,袁立霞.脑卒中足下垂及足内翻的足底生物力学特征研究[J].中华中医药学刊,2010,8(7):1444-1446.
[7]刘丹,徐海艳.电针结合艾灸涌泉穴治疗脑卒中后足下垂的临床观察[J].针灸临床杂志,2014,30(3):8-9.
[8]张千生.针刺治疗脑卒中后足下垂的临床观察[J].中国康复医学杂志,2007,22(5):461-462.
[9]张文通,孟殿怀,许光旭,等.计时起立行走与最大步行速度评估脑卒中步行功能的对比分析[J].中华物理医学与康复杂志,2016,38(4):246-249.
[10]Chang HY,Huang CH,Wei SH.Test-retest reliability and validity of 3D ultrasound based motion analysis system:comparison of the goniometer and zebris system[J].J Biomechanics,2007,40(2):S722.
[11]荣积峰,吴毅,顾玲,等.脑卒中患者足下垂和足内翻康复研究进展[J].中国康复,2015,30(1):45-48.
[12]Kaji R,Osako Y,Suyama K,et al.Botulinum toxin type A in poststroke lower limb spasticity:a multicenter,double-blind,placebocontrolled trial[J].J Neurol,2010,257(8):1330-1337.
[13]邢健莉.针灸联合康复训练治疗脑中风后遗症的临床研究[J].按摩与康复医学,2016,7(15):24-25.
[14]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(6):1660-1669.
[15]Carda S,Invernizzi M,Baricich A,et al.Casting,taping or stretching after botulinum toxin type A for spastic equines foot:a singleblind randomized trial on adult stroke patients[J].Clin Rehabil,2011,25(12):1119-1127.
[16]Hesse S,Krajnik J,Lueke D,et al.Ankle muscle aetivating before and after botulinum toxin therapy for lower limb extensor spasticity in chronic hemiparetic patients[J].Stroke,1996,27(3):445-460.
[17]林恒凯,洪峰.中医综合康复治疗气虚血瘀型缺血性中风恢复期的疗效观察[J].按摩与康复医学,2015,6(24):67-68.
[18]Zhang Y,Liu H,Fu C,et al.The biomechanical effect of acupuncture for post stroke cavovarus foot:study protocol for a randomized controlled pilot trial[J].Trials,2016,17(1):146.
[19]Harvey LA,Katalinic OM,Herbert RD,et al.Stretch for the treatment and prevention of contracture:an abridged republication of a Cochrane Systematic Review[J].J Physiother,2017,63(2):67-75.
[20]纵亚,崔立军,鲍勇,等.反复促通技术对脑卒中足下垂患者疗效的积分肌电图研究[J].内科理论与实践,2012,7(2):119-120.
[21]谢羽婕,张驰,胥方元,等.核心稳定性训练结合神经发育疗法对脑卒中患者下肢运动功能的影响[J].中国康复医学杂志,2014,29(8):773-775.
[22]朱玉连.改良强制性运动疗法对脑卒中偏瘫患者步行能力及步态生物力学的影响[D].上海体育学院,2016.
[23]Kottink AI,Hermens HJ,Nene AV,et al.A randomized controlled trial of an implantable 2-channel peroneal nerve stimulator on walking speed and activity in post stroke hemiplegia[J].Arch Phys Med,2007,88(8):971-978.
[24]Cheng JS,Yang YR,Cheng SJ,et al.Effects of combining gelectric stimulation with active ankle dorsiflexion while standing on a rocker board:a pilot study for subjects with spastic foot after stroke[J].Arch Phys Med,2009,91(4):505-512.
[25]Bakhtiary AH,Fatemy E.Does electrical stimulation reduce spasticity after stroke?A randomized controlled study[J].Clin Rehabil,2008,22(5):418-425.
[26]Sabut SK,Kumar R,Mahadevappa M.Design of a programmable multi-pattern FES system for restoring foot drop in stroke rehabilitation[J].J Med EngTechnol,2010,34(3):217-223.
[27]Sabut SK,Sikdar C,Mondal R.Restoration of gait and motor recovery by functional electrical stimulation therapy in persons with stroke[J].Disabil Rehabil,2010,32(19):1594-1603.
[28]翟宏伟,巩尊科,陈伟,等.肌电生物反馈训练对脑卒中偏瘫患者上肢运动功能的影响[J].中华物理医学与康复杂志,2010,32(7):535-536.
[29]Millee J.Orthotics and Prosthetics in Rehabilitation[M].Elsevier Health Sciences,2012:237-238.
[30]Aguilar-Ferrándiz ME,Castro-Sánchez AM,Matarán-Pe?arrocha GA,et al.A randomized controlled trial of a mixed Kinesio taping-compression technique on venous symptoms,pain,peripheral venous flow,clinical severity and overall health status in postmenopausal women with chronic venous insufficiency[J].Clin Rehabil,2014,28(1):69-81.
[31]余波,陈文华,王人卫.肌内效贴改善运动功能的临床研究现状与思考[J].中国运动医学杂志,2014,33(3):275-280.
[32]Karadag-Saygi E,Cubukcu-Aydoseli K,Kablan N,et al.The role of kinesio taping combined with botulinum toxin to reduce plantar flexors spasticity after stroke[J].Top Stroke Rehabil,2010,17(4):318-322.
[33]Bae YH,Kim HG,Min KS,et al.Effects of lower-leg kinesiology taping on balance ability in stroke patients with foot drop[J].Evid Based Complement Alternat Med,2015,2015:125629.