临床研究

重复局部肌肉振动疗法对脑卒中偏瘫早期患者上肢功能恢复的效果

  • 袁小敏 ,
  • 琚红艳
展开
  • 1.珠海市第二人民医院康复科,广东珠海市 519002;
    2.中山市疾病预防控制中心,广东中山市 528400
袁小敏(1975-),男,汉族,湖北襄阳市人,副主任医师,主要研究方向:神经康复和骨科康复。

收稿日期: 2018-06-26

  修回日期: 2018-07-23

  网络出版日期: 2018-08-20

Effect of Repetitive Focal Muscle Stimulation on Upper Limb Function Recovery after Stroke

  • YUAN Xiao-min ,
  • QU Hong-yan
Expand
  • 1. Rehabilitation Department, Zhuhai City Second People's Hospital, Zhuhai, Guangdong 519002, China;
    2. Center for Disease Control and Prevention of Zhongshan City, Zhongshan, Guangdong 528400, China

Received date: 2018-06-26

  Revised date: 2018-07-23

  Online published: 2018-08-20

摘要

目的 观察重复局部肌肉振动疗法对脑卒中偏瘫早期患者上肢功能恢复的影响。方法 2016年10月至2018年2月,选择在本院住院的脑卒中偏瘫早期患者46例分为对照组(n=23) 和观察组(n=23)。两组均接受常规康复治疗。观察组在此基础上,进行重复局部肌肉振动,分别作用于患者的掌心、前臂桡侧腕伸肌腱、肱二头肌及肩胛周围肌肉;对照组接受相同时长的安慰刺激。每天1次,每周5 d,共4周。分别于治疗前、治疗后采用Fugl-Meyer评定量表上肢部分(FMA-UE)、运动力指数上肢部分(MI-UE)、偏瘫上肢功能测试(香港版)(FTHUE-HK)对上肢功能进行评定。结果 治疗后,两组FMA-UE、MI-UE及FTHUE-HK评分均较治疗前提高(F>2.577, P<0.05),且观察组各评分均高于对照组(t>2.153, P<0.05)。结论 重复局部肌肉振动疗法有助于提高偏瘫早期患者上肢功能的恢复。

本文引用格式

袁小敏 , 琚红艳 . 重复局部肌肉振动疗法对脑卒中偏瘫早期患者上肢功能恢复的效果[J]. 中国康复理论与实践, 2018 , 24(8) : 938 -941 . DOI: 10.3969/j.issn.1006-9771.2018.08.013

Abstract

Objective To observe the effect of repetitive focal muscle stimulation on recovery of upper limb function after stroke.Methods From October, 2016 to February, 2018, 46 stroke patients at early stage were recruited and divided into control group (n=23) and observation group (n=23). Both groups received basic rehabilitation training. The observation group accepted additional repetitive focal muscle stimulation on palms, forearm extensor carpi radialis, biceps brachii and muscles around scapula. The control group received sound stimulation as placebo treatment. The treatment was implemented once a day, five days a week for four weeks totally. The scores of Fugl-Meyer Assessment -Upper Extremities (FMA-UE), the Motricity Index of Upper Extremities (MI-UE) and the Hong Kong version of Functional Test for the Hemiplegic Upper Extremity (FTHUE-HK) were compared before and four weeks after treatment. Results After treatment, the scores of FMA-UE, MI-UE and FTHUE-HK improved in both groups (F>2.577, P<0.05), and were higher in the observation group than in the control group (t>2.153, P<0.05).Conclusion Repetitive focal muscle stimulation could facilitate to recover the function of upper limb in early-stage stroke patients.

参考文献

[1] Kwakkel G, Kollen BJ, Krebs HI.Effects of robot-assisted therapy on upper limb recovery after stroke: a systematic review[J]. Neurorehabil Neural Repair, 2008, 22(2): 111-121.
[2] 易金花,张颖,官龙,等. 脑卒中患者上肢康复训练系统研究进展[J]. 中国康复, 2013, 28(4): 249-251.
[3] Rasmussen RS, Østergaard A, Kjær P, et al.Stroke rehabilitation at home before and after discharge reduced disability and improved quality of life: a randomised controlled trial[J]. Clin Rehabil, 2016, 30(3): 225-236.
[4] Forner-Cordero A, Steyvers M, Levin O, et al.Changes in corticomotor excitability following prolonged muscle tendon vibration[J]. Behav Brain Res, 2008, 190(1): 41-49.
[5] 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, 29(6): 379-380.
[6] Caliandro P, Celletti C, Padua L, et al.Focal muscle vibration in the treatment of upper limb spasticity: a pilot randomized controlled trial in patients with chronic stroke[J]. Arch Phys Med Rehabil, 2012, 93(9): 1656-1661.
[7] Filippi GM, Brunetti O, Botti FM, et al.Improvement of stance control and muscle performance induced by focal muscle vibration in young-elderly women: a randomized controlled trial[J]. Arch Phys Med Rehabil, 2009, 90(12): 2019-2025.
[8] Gladstone DJ, Danells CJ, Black SE.The Fugl-Meyer assessment of motor recovery after stroke: a critical review of its measurement properties[J]. Neurorehabil Neural Repair, 2002, 16(3): 232-240.
[9] Kong KH, Chua KS, Lee J.Recovery of upper limb dexterity in patients more than 1 year after stroke: frequency, clinical correlates and predictors[J]. NeuroRehabilitation, 2011, 28(2): 105-111.
[10] Fong K, Ng B, Chan D, et al.Development of the Hong Kong version of the functional test for the hemiplegic upper extremity (FTHUE-HK)[J]. Hong Kong J Occup Ther, 2004, 14(1): 21-29.
[11] Cardinale M, Pope MH.The effects of whole body vibration on humans: dangerous or advantageous?[J]. Acta Physiol Hung, 2003, 90(3): 195-206.
[12] Costantino C, Galuppo L, Romiti D.Short-term effect of local muscle vibration treatment versus sham therapy on upper limb in chronic post-stroke patients: a randomized controlled trial[J]. Eur J Phys Rehabil Med, 2017, 53(1): 32-40.
[13] Casale R, Ring H, Rainoldi A.High frequency vibration conditioning stimulation centrally reduces myoelectrical manifestation of fatigue in healthy subjects[J]. J Electromyogr Kinesiol, 2009, 9(5): 998-1004.
[14] Collins DF, Refshauge K, Todd G, et al.Cutaneous receptors contribute to kinesthesia at the index finger, elbow, and knee[J]. J Neurophysiol, 2005, 94(3): 1699-1706.
[15] Langhorne PF, Coupar F, Pollock A.Motor recovery after stroke: a systematic review[J]. Lancet Neurol, 2009, 8(8): 741-754.
[16] O'Dell MW, Lin CD, Harrison V. Stroke rehabilitation: strategies to enhance motor recovery[J]. Annu Rev Med, 2009, 60: 55-68.
[17] Di Pino G, Pellegrino G, Assenza G, et al.Modulation of brain plasticity in stroke: a novel model for neurorehabilitation[J]. Nat Rev Neurol, 2014, 10(10): 597-608.
[18] Kim SS, Gomez Ramirez M, Thakur PH, et al.Multimodal interactions between proprioceptive and cutaneous signals in primary somatosensory cortex[J]. Neuron, 2015, 86(2): 555-566.
[19] Marconi B, Filippi GM, Koch G, et al.Long-term effects on motor cortical excitability induced by repeated muscle vibration during contraction in healthy subjects[J]. J Neurol Sci, 2008, 275(1-2): 51-59.
[20] Paoloni M, Mangone M, Scettri P, et al.Segmental muscle vibration improves walking in chronic stroke patients with foot drop: a randomized controlled trial[J]. Neurorehabil Neural Repair, 2010, 24(3): 254-262.
[21] Winters C, van Wegen EH, Daffertshofer A, et al. Generalizability of the proportional recovery model for the upper extremity after an ischemic stroke[J]. Neurorehabil Neural Repair, 29(7): 614-622.
[22] 李哲,赵玉敏,郭钢花,等. 全身振动训练对脑卒中患者躯干肌痉挛的影响[J]. 中国康复医学杂志, 2015, 30(8): 798-800.
[23] Aprile I, Di Sipio E, Germanotta M, et al.Muscle focal vibration in healthy subjects: evaluation of the effects on upper limb motor performance measured using a robotic device[J]. Eur J Appl Physiol, 2016, 116(4): 729-737.
[24] Paoloni M, Tavernese E, Fini M, et al.Segmental muscle vibration modifies muscle activation during reaching in chronic stroke: a pilot study[J]. NeuroRehabilitation, 2014, 35(3): 405-414.
[25] Pietrangelo T, Mancinelli R, Toniolo L, et al.Effects of local vibrations on skeletal muscle trophism in elderly people: mechanical, cellular, and molecular events[J]. Int J Mol Med, 2009, 24(4): 503-512.
文章导航

/