踝关节智能牵伸对脊髓损伤患者下肢痉挛效果的随机对照试验

doi:10.3969/j.issn.1006-9771.2024.10.009

《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (10): 1187-1192.doi: 10.3969/j.issn.1006-9771.2024.10.009

踝关节智能牵伸对脊髓损伤患者下肢痉挛效果的随机对照试验

高明明¹^,², 恽晓萍¹^,²(), 赵舒羽¹^,², 辛然¹^,², 宋桂芸¹^,², 赵阳¹^,²

1.首都医科大学康复医学院，北京市 100068
2.中国康复研究中心北京博爱医院康复评定科，北京市 100068

收稿日期:2024-07-12 修回日期:2024-09-11 出版日期:2024-10-25 发布日期:2024-11-08
通讯作者: 恽晓萍，E-mail： xiaoping_yun@163.com
作者简介:高明明(1982-)，女，汉族，河北承德市人，博士，副主任医师，主要研究方向：步态、平衡、肌张力、表面肌电、感觉、认知等功能障碍的评定与康复。
基金资助:
中国康复研究中心青年科研专项基金项目(2021zx-Q9)

Rehabilitation effect of intelligent ankle stretching on lower extremity spasm in patients with spinal cord injury: a randomized controlled trial

GAO Mingming¹^,², YUN Xiaoping¹^,²(), ZHAO Shuyu¹^,², XIN Ran¹^,², SONG Guiyun¹^,², ZHAO Yang¹^,²

1. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
2. Department of Rehabilitation Evaluation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China

Received:2024-07-12 Revised:2024-09-11 Published:2024-10-25 Online:2024-11-08
Contact: YUN Xiaoping，E-mail： xiaoping_yun@163.com
Supported by:
Special Funds for the Youth Research of China Rehabilitation Research Center(2021zx-Q9)

摘要/Abstract

摘要：

目的观察踝关节智能柔性牵伸在下肢痉挛脊髓损伤患者中的应用效果。

方法 2021年6月至2024年5月，北京博爱医院脊髓损伤患者28例，随机分为对照组和试验组，各14例。两组均接受常规康复治疗，在此基础上，对照组予以手法牵伸治疗，试验组给予踝关节智能牵伸系统训练，共8周。治疗前后分别采用改良Ashworth评定量表(MAS)、踝关节背屈角、临床痉挛指数、腓肠肌内侧头表面肌电最大均方根值和足大趾振动觉阈值(VPT)进行评定。

结果治疗后，试验组MAS分级(χ² = 10.378, P = 0.035)、踝关节背屈角(Z = -3.306, P < 0.001)、临床痉挛指数(t = 4.101, P = 0.001)和腓肠肌内侧头被动背屈时的最大均方根值(Z = -3.296, P < 0.001)均改善，试验组MAS分级(χ² = 11.418, P = 0.022)、踝关节背屈角(Z = -1.986, P = 0.047)、腓肠肌内侧头被动背屈时的最大均方根值(Z = -2.297, P = 0.021)均优于对照组。足大趾VPT虽有所改善，但组内和组间比较均无显著性差异(P > 0.05)。

结论踝关节智能柔性牵伸可改善脊髓损伤患者下肢肌痉挛，有改善足部本体感觉的趋势。

关键词: 脊髓损伤, 下肢康复机器人, 痉挛, 随机对照试验

Abstract:

Objective To observe the effect of intelligent flexible ankle stretching training on lower extremity spasm in patients with spinal cord injury.

Methods From June, 2021 to May, 2024, 28 patients with spinal cord injury were randomly divided into control group (n = 14) and experimental group (n = 14). Both groups received conventional rehabilitation treatment. On this basis, the control group received manual extension treatment, and the experimental group received intelligent flexible ankle stretching system training, for eight weeks. The modified Ashworth Scale (MAS), ankle dorsiflexion angle, Clinical Spasticity Index (CSI), max root mean square (RMS_max) of surface electromyography of gastrocnemius medial head and vibration perception threshold (VPT) of great toe were compared.

Results After treatment, MAS (χ² = 10.378, P = 0.035), ankle dorsiflexion angle (Z = -3.306, P < 0.001), CSI (t = 4.101, P = 0.001) and RMS_max of gastrocnemius medial head (Z = -3.296, P < 0.001) improved in the experimental group, while MAS (χ² = 11.418, P = 0.022), ankle dorsiflexion angle (Z = -1.986, P = 0.047) and RMS_max of gastrocnemius medial head (Z = -2.297, P = 0.021) were better in the experimental group than in the control group. Although VPT was improved after treatment, no significant difference was found within and beteen groups (P > 0.05).

Conclusion The intelligent flexible ankle stretching training could improve the lower limb muscle spasticity in patients with spinal cord injury, and may be benefit for foot proprioception.

Key words: spinal cord injury, lower limb rehabilitation robot, spasm, randomized controlled trial

中图分类号:

R651.2

高明明, 恽晓萍, 赵舒羽, 辛然, 宋桂芸, 赵阳. 踝关节智能牵伸对脊髓损伤患者下肢痉挛效果的随机对照试验[J]. 《中国康复理论与实践》, 2024, 30(10): 1187-1192.

GAO Mingming, YUN Xiaoping, ZHAO Shuyu, XIN Ran, SONG Guiyun, ZHAO Yang. Rehabilitation effect of intelligent ankle stretching on lower extremity spasm in patients with spinal cord injury: a randomized controlled trial[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(10): 1187-1192.

图/表 6

表1

表2

表3

表4

两组治疗前后CSI评分比较"

组别	n	测试	$x - ± s$	t值	P值
对照组	14	前测	12.86±2.28	1.665	0.120
		后测	12.29±2.46
试验组	14	前测	12.86±1.83	4.101	0.001
		后测	11.21±2.94
治疗前两组均值差			0.00±2.25	0.000	1.000
治疗后两组均值差			-1.07±3.81	-1.045	0.306

表4

表5

表6

参考文献 25

[1]	恽晓平. 脑性瘫痪儿童康复评定[M]. 北京: 北京出版社, 2018: 111.
[2]	SKOOG B, JAKOBSSON K E. Prevalence of spasticity and below-level neuropathic pain related to spinal cord injury level and damage to the lower spinal segments[J]. J Rehabil Med Clin Commun, 2020, 3: 1000039.
[3]	BILLINGTON Z J, HENKE A M, GATER D R J. Spasticity management after spinal cord injury: the here and now[J]. J Pers Med, 2022, 12(5): 808.
[4]	卢利萍, 桑德春, 季淑凤. 下肢康复机器人LR2训练对偏瘫患者下肢肌痉挛和ADL能力改善的疗效观察[J]. 中国康复医学杂志, 2018, 33(1): 45-49.
	LU L P, SANG D C, JI S F. A study on the antispasticity effect and ADL of leg rehabilitation robot (LR2) in the hemiplegia patients[J]. Chin J Rehabil Med, 2018, 33(1): 45-49.
[5]	FRANCISCO G E, WISSEL J, PLATZ T, et al. Post-stroke spasticity[M]// PLATZ T. Clinical pathways in stroke rehabilitation. Evidence-based clinical practice recommendations, Cham, Switzerland: WFNR-Springer, 2021.
[6]	GUNNARSSON S, LEMMING D, ALEHAGEN S, et al. Dosing patterns in treatment of disabling spasticity with intrathecal Baclofen[J]. Rehabil Nurs, 2021, 46(6): 315-322.
[7]	SKOOG B, HEDMAN B. Intrathecal Baclofen dosage for long-term treatment of patients with spasticity due to traumatic spinal cord injuries or multiple sclerosis[J]. Ann Rehabil Med, 2019, 43(5): 555-561. doi: 10.5535/arm.2019.43.5.555 pmid: 31693845
[8]	PALAZÓN-GARCÍA R, ALCOBENDAS-MAESTRO M, ESCLARIN-DE R A, et al. Treatment of spasticity in spinal cord injury with Botulinum toxin[J]. J Spinal Cord Med, 2019, 42(3): 281-287.
[9]	FELIX B D, QUAN X S. Effectiveness of intelligent control strategies in robot-assisted rehabilitation: a systematic review[J]. IEEE Trans Neural Syst Rehabil Eng, 2024, 32: 1828-1840.
[10]	杨绯, 潘钰, 吴琼, 等. 踝扭伤后关节生物力学和本体感觉变化特征及相关性[J]. 中国康复理论与实践, 2019, 25(12): 1365-1369.
	YANG F, PAN Y, WU Q, et al. Biomechanics characteristics and its correlation with proprioception of ankle post sprain[J]. Chin J Rehabil Theory Pract, 2019, 25(12): 1365‐1369.
[11]	REN Y, WU Y N, YANG C Y, et al. Developing a wearable ankle rehabilitation robotic device for in-bed acute stroke rehabilitation[J]. IEEE Trans Neural Syst Rehabil Eng, 2017, 25(6): 589-596.
[12]	ZHAI X X, WU Q, LI X, et al. Effects of robot-aided rehabilitation on the ankle joint properties and balance function in stroke survivors: a randomized controlled trial[J]. Front Neurol, 2021, 12: 719305.
[13]	翟晓雪, 潘钰, 吴琼, 等. 踝关节智能牵伸训练对偏瘫患者踝关节生物力学特性及其运动功能和日常生活活动能力的影响[J]. 中华物理医学与康复杂志, 2021, 43(1): 25-29.
	ZHAI X X, PAN Y, WU Q, et al. Ankle stretching can improve stroke survivors′ ankle biomechanics, balance, walking and ability in the activities of daily living[J]. Chin J Phys Med Rehabil, 2021, 43(1): 25-29.
[14]	LIN P J, ZHAI X, LI W, et al. A transferable deep learning prognosis model for predicting stroke patients' recovery in different rehabilitation trainings[J]. IEEE J Biomed Health Inform, 2022, 26(12): 6003-6011.
[15]	KIRSHBLUM S C, BURNS S P, BIERING-SORENSEN F, et al. International Standards for Neurological Classification of Spinal Cord Injury (revised 2011)[J]. J Spinal Cord Med, 2011, 34(6): 535-546. doi: 10.1179/204577211X13207446293695 pmid: 22330108
[16]	恽晓平. 康复疗法评定学[M]. 2版. 北京: 华夏出版社, 2014: 205.
[17]	GAO M M, YUN X P, ZHANG T. VSA-3000: A quantitative vibration sensation testing device for patients with central nervous system injury[J]. Front Neurol, 2020, 11: 936. doi: 10.3389/fneur.2020.00936 pmid: 33013633
[18]	夏晓昧, 蒋孝翠, 赵秦, 等. 序贯应用全身振动训练和下肢康复机器人训练对不完全性脊髓损伤患者下肢功能的影响[J]. 江苏医药, 2022, 48(8): 801-804.
	XIA X M, JIANG X C, ZHAO Q, et al. Effect of sequential application of whole-body vibration training and lower limb rehabilitation robot training on function of lower limbs in patients with incomplete spinal cord injury[J]. Jiangsu Med J, 2022, 48(8): 801-804.
[19]	CALABRÒ R S, BILLERI L, CIAPPINA F, et al. Toward improving functional recovery in spinal cord injury using robotics: a pilot study focusing on ankle rehabilitation[J]. Expert Rev Med Devices, 2022, 19(1): 83-95.
[20]	SHAKTI D, DAS R, KUMAR N, et al. Development of robotic rehabilitation device for spasticity treatment of acute spinal cord injury patients[J]. IETE J Res, 2021, 69(8): 5044-5051.
[21]	PILKAR R, MOMENI K, RAMAMNUJAM A, et al. Use of surface EMG in clinical rehabilitation of individuals with SCI: barriers and future considerations[J]. Front Neurol, 2020, 11: 578559.
[22]	LI J, SU K, MEI J, et al. Using surface electromyography to evaluate the efficacy of governor vessel electroacupuncture in poststroke lower limb spasticity: study protocol for a randomized controlled parallel trial[J]. Evid Based Complement Alternat Med, 2021, 2021: 5511031.
[23]	LI S, LUO X, ZHANG S, et al. Evaluation of multilevel surgeries in children with spastic cerebral palsy based on surface electromyography[J]. Front Neurosci, 2021, 15: 680645.
[24]	BALBINOT G, JONER W M, LI G, et al. The use of surface EMG in neurorehabilitation following traumatic spinal cord injury: a scoping review[J]. Clin Neurophysiol, 2022, 138: 61-73. doi: 10.1016/j.clinph.2022.02.028 pmid: 35364465
[25]	LEE Y, CHEN K, REN Y, et al. Robot-guided ankle sensorimotor rehabilitation of patients with multiple sclerosis[J]. Mult Scler Relat Disord, 2017, 11: 65-70.

组别	n	性别 (男/女)/n	损伤类型 (完全性/不完全性)/n	损伤节段 (颈段/胸段/腰段)/n	年龄/岁	病程/月
对照组	14	12/2	2/12	10/4/0	34.36±11.47	5.25 (3.88, 7.63)
试验组	14	9/5	3/11	5/8/1	39.07±16.02	7.50 (3.00, 27.38)
χ²/t/Z值		1.714	0.243	4.000	0.895	-0.690
P值		0.190	0.622	0.135	0.379	0.490

组别	n	测试	M(Q_L, Q_U)	Z值	P值
对照组	14	前测	17.90(7.18, 87.33)	-0.594	0.552
		后测	17.45(8.40, 39.05)
试验组	14	前测	19.30(10.00, 54.93)	-1.334	0.182
		后测	12.15(9.10, 130.00)
治疗前两组差值			0.00 (-8.48, 8.85)	-0.300	0.769
治疗后两组差值			-0.25 (-14.43, 27.80)	-0.416	0.701

踝关节智能牵伸对脊髓损伤患者下肢痉挛效果的随机对照试验

Rehabilitation effect of intelligent ankle stretching on lower extremity spasm in patients with spinal cord injury: a randomized controlled trial

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 6

参考文献 25

相关文章 15

Metrics

本文评价

推荐阅读 0

组别	n	测试	0级	1级	1⁺级	2级	3级	χ²值	P值
对照组	14	前测	0	3	9	0	2	0.202	0.904
		后测	0	4	8	0	2
试验组	14	前测	0	3	7	1	3	10.378	0.035
		后测	2	7	2	3	0
治疗前两组差值			0	0	2	1	1	1.450	0.694
治疗后两组差值			2	3	6	3	2	11.418	0.022

组别	n	测试	M(Q_L, Q_U)	Z值	P值
对照组	14	前测	95.00 (90.00, 103.50)	-0.118	0.906
		后测	94.00 (90.75, 100.75)
试验组	14	前测	104.50 (94.50, 111.25)	-3.306	< 0.001
		后测	90.00 (80.00, 95.50)
治疗前两组差值			2.50 (-0.75, 12.75)	-0.799	0.424
治疗后两组差值			-6.50 (-16.00, 0.50)	-1.986	0.047

组别	n	测试	M(Q_L, Q_U)	Z值	P值
对照组	14	前测	54.20 (36.63, 72.60)	-1.476	0.140
		后测	59.65 (45.00, 73.38)
试验组	14	前测	82.40 (32.45, 107.50)	-3.296	< 0.001
		后测	25.40 (14.48, 63.18)
治疗前两组差值			11.50 (-16.18, 50.60)	-1.011	0.329
治疗后两组差值			-29.80 (-53.38, -8.13)	-2.297	0.021

[1]	罗红, 徐丽. 重复经颅磁刺激联合重复外周磁刺激对脑出血患者上肢运动功能的效果：基于静息态功能磁共振成像的随机对照试验[J]. 《中国康复理论与实践》, 2024, 30(9): 1060-1068.
[2]	王敏, 方篮天, 黄晨燚. 改良分级运动表象训练对脑卒中患者上肢运动功能效果的随机对照试验[J]. 《中国康复理论与实践》, 2024, 30(9): 1069-1073.
[3]	李冬, 张皓, 刘楠, 王昕悦, 徐淼. 认知-运动双任务训练对脑卒中恢复期患者平衡功能和步态效果的随机对照试验[J]. 《中国康复理论与实践》, 2024, 30(9): 1082-1091.
[4]	赵建斌, 姚英策, 吴菁, 薛博士, 杨晓巍, 周志鹏, 郑亮亮. 肌肉能量技术对非特异性腰痛患者动态姿势控制和腰神经肌肉功能效果的随机对照试验[J]. 《中国康复理论与实践》, 2024, 30(9): 1092-1098.
[5]	朱博文, 赵素红, 李苗秀, 张帅攀, 姚重界, 朱清广, 房敏. 基于表面肌电图的手法治疗对老年人膝骨关节炎效果的随机对照试验[J]. 《中国康复理论与实践》, 2024, 30(9): 1099-1106.
[6]	吕倩倩, 王萌萌, 吴易凌, 杨晓真, 马玲玲, 赵亚萍, 肖瑶, 桑杲. 早期介入丹佛模式基础上联合神经反馈训练对孤独症谱系障碍儿童效果的随机对照试验[J]. 《中国康复理论与实践》, 2024, 30(8): 914-921.
[7]	牛茂林, 赵潭, 刘晓丽, 郭峰. 在线和离线高精度经颅直流电刺激对健康成年人手指运动技能学习效果的随机对照试验[J]. 《中国康复理论与实践》, 2024, 30(8): 957-964.
[8]	于婷婷, 蔡福良, 缪桂华, 顾晨, 彭媛. 基于个性优势的结构化治疗与教育对缺血性脑卒中康复效果的随机对照试验[J]. 《中国康复理论与实践》, 2024, 30(8): 965-971.
[9]	梁天佳, 龙耀斌, 陆丽燕, 周金英, 黄福才, 黄林鹏, 邬映超, 龙耀翔, 韦小翠, 柳忠. 绳带辅助本体感觉神经肌肉促进技术训练联合绳带辅助脑机接口训练对脑卒中偏瘫上肢康复效果的随机对照试验[J]. 《中国康复理论与实践》, 2024, 30(8): 972-978.
[10]	何爱群, 黎景波, 何茂莉, 叶思媚, 宋秋爽, 刘海鸥, 谢有书. 作业技能再学习策略对脑卒中偏瘫上肢功能效果的随机对照试验[J]. 《中国康复理论与实践》, 2024, 30(7): 823-830.
[11]	陈晨, 孟兆祥, 杨康, 张敏杰, 左亚南, 王奎, 张熙斌, 全逸峰, 金星. 智能镜像手套任务导向性训练联合低频重复经颅磁刺激对脑卒中患者手功能效果的随机对照试验[J]. 《中国康复理论与实践》, 2024, 30(7): 831-838.
[12]	丹禹钦, 苏佳宁, 丁懿, 王雪妍, 许铛瀚, 王菁华, 吴雨静, 张梦圆, 尹萌, 鹿海峰, 于功昌, 李丽. 悬吊推拿运动技术对老年腰椎间盘突出症患者恐动症效果的随机对照试验：基于脑-骨轴理论[J]. 《中国康复理论与实践》, 2024, 30(7): 861-868.
[13]	袁媛, 周红俊, 卫波, 丛欣莹, 刘根林, 郑樱, 郝春霞, 张缨, 王一吉, 康海琼, 逯晓蕾, 蒙倩茹. 创伤性颈脊髓损伤患者华勒氏变性的磁共振成像研究[J]. 《中国康复理论与实践》, 2024, 30(4): 487-492.
[14]	吴亮, 许秀, 罗亮. 运动康复和适应性身体活动对痉挛性脑性瘫痪儿童青少年心理运动功能、运动功能和动作发展的效益：基于ICF的循证研究[J]. 《中国康复理论与实践》, 2024, 30(2): 148-156.
[15]	蔡丝妍, 范颖洁, 田慧芳, 夏春亚, 张娟, 苏敏. 音乐治疗基础上联合经颅直流电刺激对失眠效果的随机对照试验[J]. 《中国康复理论与实践》, 2024, 30(10): 1193-1202.