《中国康复理论与实践》

中国康复理论与实践 >

2020 , Vol. 26 >Issue 5: 597 - 602

DOI: https://doi.org/10.3969/j.issn.1006-9771.2020.05.021

临床研究

BTE系统对颈脊髓损伤后上肢肌力强化训练的效果

  • 冯晓娟 ,
  • 李建军
展开
  • 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作业疗法科,北京市 100068
冯晓娟(1987-),女,汉族,湖北随州市人,硕士研究生,主管治疗师,主要研究方向：神经及肌肉骨骼系统等疾病的康复治疗。

收稿日期: 2020-04-02

  修回日期: 2020-04-20

  网络出版日期: 2020-05-29

收起

Effects of BTE System Intensive Training on Upper Limbs after Cervical Spinal Cord Injury

  • Xiao-juan FENG ,
  • Jian-jun LI
Expand
  • 1. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
    2. Department of Occupational Therapy, Beijing Bo’ai Hospital, China Rehabilitation Research Center, Beijing 100068, China

Received date: 2020-04-02

  Revised date: 2020-04-20

  Online published: 2020-05-29

Fold

摘要

目的 研究BTE系统对不同病程颈脊髓损伤患者进行上肢肌力强化训练的有效性。方法 2019年6月至2020年1月,创伤性完全性C6-7脊髓损伤住院患者60例按病程分为亚急性期组(术后1~2个月,n = 15)和恢复期组(术后3~6个月,n = 15),术后6个月以上者分为稳定期组和对照组,各15例。对照组行常规综合康复,其余三组每天采用BTE系统行上肢肌力强化训练,共4周。治疗前后,采用上肢运动评分(UEMS)和功能独立性测量(FIM)进行评定,并测量双侧伸肘肌群等长峰值力矩(IPT)和等张极限肌耐力(IEE)。结果 治疗后,每组各项评分均明显提高(t > 3.500, P < 0.01);各组间均有非常高度显著性差异( F > 9.257, P < 0.001),其中亚急性期组UEMS、IPT最高,恢复期组IEE、FIM最高,稳定期组较差。 结论 采用BTE系统对颈脊髓损伤患者进行上肢肌力强化训练疗效明显,亚急性期患者上肢运动功能、爆发力恢复更快,恢复期患者耐力和日常生活活动能力进步更快;稳定期患者各项功能也有不同程度提高。

关键词： 脊髓损伤; 上肢; 肌力; BTE系统; 等长峰值力矩; 等张极限肌耐力

本文引用格式

冯晓娟 , 李建军 . BTE系统对颈脊髓损伤后上肢肌力强化训练的效果[J]. 中国康复理论与实践, 2020 , 26(5) : 597 -602 . DOI: 10.3969/j.issn.1006-9771.2020.05.021

Abstract

Objective To investigate the effect of BTE system intensive training on upper limbs for cervical spinal cord injured patients in various courses.Methods From June, 2019 to January, 2020, 60 inpatients with traumatic C6-7 spinal cord injury were selected into sub-acute group (one to two months after surgery, n = 15), recovery group (three to six months after surgery, n = 15), stable group (over six months after surgery, n = 15) according to the course of disease, and control group (over six months after surgery, n = 15). The control group received comprehensive rehabilitation, while the other groups received upper limbs intensive training on BTE system in addition, for four weeks. They were assessed with Upper Extremity Motor Score (UEMS) and Functional Independence Measure (FIM), meassured isometric peak torque (IPT) and isotonic extreme muscle endurance (IEE) of bilateral elbow extensors before and after treatment.Results All the indexes improved after treatment (t > 3.500, P < 0.01), and they were significantly different among the groups ( F > 9.257, P < 0.001), in which, it was the most of UEMS and IPT in the sub-acute group, and IEE and FIM in the recovery group. Conclusion BTE system intensive training is effective on upper limbs after cervical spinal cord injury. Sub-acute patients may improve more in motor function and explosive power, while patients at recovery stage do better in endurance and activities of daily living. Even stable patients can benefit from it somehow.

Key words： spinal cord injury; upper limbs; muscle strength; BTE system; isometric peak torque; isotonic extreme muscle endurance

参考文献

[1] Krisa L, Runyen M, Detloff R. Translational challenges of rat models of upper extremity dysfunction after spinal cord injury[J]. Top Spinal Cord Inj Rehabil, 2018, 24(3):195-205.
[2] 陈星月, 陈栋, 陈春慧, 等. 中国创伤性脊髓损伤流行病学和疾病经济负担的系统评价[J]. 中国循证医学杂志, 2018, 18(2):143-150.
[3] 孙天胜. 颈脊髓损伤的临床评估[J]. 中国骨伤, 2015, 28(8):683-685.
[4] 王方永, 李建军. 脊髓损伤神经学分类国际标准2011版最新修订及标准解读[J]. 中国康复理论与实践, 2012, 18(8):797-800.
[5] Kirshblum S, Waring W. Updates for the International Standards for Neurological Classification of Spinal Cord Injury[J]. Phys Med Rehabil Clin N Am, 2014, 25(3):505-517.
[6] 王一吉, 周红俊, 李建军, 等. 脊髓损伤神经学分类国际标准检查表最新修订及解读[J]. 中国康复理论与实践, 2015, 21(8):879-882.
[7] 康海琼, 周红俊, 刘根林, 等. 脊髓损伤神经学分类国际标准检查表2019版最新修订及解读[J]. 中国康复理论与实践, 2019, 25(8):983-985.
[8] Khalifeh J M, Dibble C F, van Voorhis A, et al. Nerve transfers in the upper extremity following cervical spinal cord injury. Part 1: systematic review of the literature[J]. J Neurosurg Spine, 2019, 2019:1-12.
[9] Snoek G J, Ijzerman M J, Hermens H J, et al. Survey of the needs of patients with spinal cord injury: impact and priority for improvement in hand function in tetraplegics[J]. Spinal Cord, 2004, 42(9):526-532.
[10] Galea M, Dunlop S, Geraghty T, et al. Intensive exercise program after spinal cord injury (SCIPA full-on): a randomized controlled trial[J]. Trials, 2018, 61(5):42-45.
[11] 贺智昌, 石玉霞. 脊髓损伤致不全瘫患者实施强化康复训练对其神经功能及生活能力的影响[J]. 心理医生, 2017, 23(11):88-89.
[12] 张永立, 唐春阳, 何泉源, 等. 强化康复训练对脊髓损伤患者神经运动功能恢复的影响[J]. 中国实用医药, 2012, 7(17):235-236.
[13] Hicks A L, Martin A, Ditor S, et al. Long-term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well-being[J]. Spinal Cord, 2003, 41(1):34-43.
[14] 张春水. BTE康复训练和评估系统功能简介[J]. 医疗装备, 2006(9):1-3.
[15] 董新春, 何星飞, 梁成盼, 等. BTE Primus~(RS)训练联合Maitland手法治疗踝关节创伤性关节炎的疗效[J]. 实用医学杂志, 2016, 32(7):1202-1203.
[16] 蔡仁祥, 周礼荣. BTE Primus康复评估仪在正常人手功能强度评定中的应用[J]. 中国康复医学杂志, 2000, 15(5):274-276.
[17] 卢讯文, 廖麟荣, 徐艳文, 等. BTE Primus工作模拟训练系统对手外伤患者重返工作的影响[J]. 中国康复医学杂志, 2015, 30(8):811-814.
[18] 徐建红, 施加加, 顾斌, 等. 运用BTE Primus RS系统康复治疗慢性期肩周炎患者疗效观察[J]. 中国医药导刊, 2015, 17(11):1100-1101.
[19] 黄鹏. BTE训练系统对排球运动员挥臂动作上肢肌力影响特征分析[C]. 桂林:第十六届全国运动生物力学学术交流大会, 2013.
[20] Martin S. Natural Course of Disease of Spinal Cord Injury [M]. New York: Springer International Publishing, 2017: 77-105.
[21] 蒋娜娜, 王文学, 郑伟, 等. 创伤性脊髓损伤康复治疗最佳介入时间窗观察[J]. 医学信息, 2018, 31(7):85-88.
[22] Loy K, Bareyre M. Rehabilitation following spinal cord injury: how animal models can help our understanding of exercise-induced neuroplasticity[J]. Neural Regen Res, 2019, 14(3):405-412.
[23] Zholdeva L V, Qiang L, Marchenko V, et al. The neuroplastic and therapeutic potential of spinal interneurons in the injured spinal cord[J]. Trends Neurosci, 2018, 41(9):625-639.
[24] 刘晓艳, 成慧慧, 陈燕颜. 系统康复治疗对完全性颈6脊髓损伤患者预后的影响[J]. 中国康复, 2012, 27(6):453-454.
[25] 解姗姗. 康复治疗对脊髓损伤患者功能恢复的影响分析[J]. 实用中西医结合临床, 2018, 18(1):145-146.
[26] 宣磊, 吴建贤, 潘家武. 等速技术在康复医学领域中的研究进展[J]. 中国康复理论与实践, 2019, 25(7):788-792.
[27] 史冀鹏, 徐红旗, 张欣, 等. 运用BTE Primus RS系统测定人体下肢单关节肌群极限功率与肌耐力的方法学研究[J]. 天津体育学院学报, 2012, 27(2):162-167.
[28] Francisco G E, Yozbstiran N, Berliner J. Robot-assisted training of arm and hand movement shows functional improvements for incomplete cervical spinal cord injury[J]. Am J Phys Med Rehabil, 2017, 96(10):S171-S177.
[29] Lewinson R T, Ganesh A, Yeung M. The biomechanics of manual muscle testing in the neuromuscular exam[J]. Can J Neurol Sci, 2018, 45(5):518-521.
[30] Baschung P, Bruin E D, Sterkele I, et al. Manual muscle testing and hand-held dynamometry in people with inflammatory myopathy: an intra- and interrater reliability and validity study[J]. PLoS One, 2018, 13(3):194-199.
[31] Mikhail S, Janne L, Petteri J, et al. Pre- and postintervention factor structure of Functional Independence Measure in patients with spinal cord injury[J]. Rehabil Res Pract, 2017, 2017(1):693-698.
[32] Birgit P, Prodinger B, Gerold S, et al. Establishing score equivalence of the Functional Independence Measure motor scale and the Barthel Index, utilizing the International Classification of Functioning, Disability and Health and Rasch measurement theory[J]. J Rehabil Med, 2017, 49(5):416-422.
[33] 傅青雯, 卫哲. 功能独立性评定在脊髓损伤患者中的临床应用[J]. 中华临床实验室管理电子杂志, 2019, 7(2):92-95.
[34] Kalsi-Ryan S, Beaton D, Curt A, et al. Defining the role of sensation, strength, and prehension for upper limb function in cervical spinal cord injury[J]. Neurorehabil Neural Repair, 2014, 28(1):66-74.
[35] Ybzbatiran N, Francisco G E. Robot-assisted therapy for the upper limb after cervical spinal cord injury[J]. Phys Med Rehabil Clin N Am, 2019, 30(2):367-384.
[36] Fisher J A, Mcnelis M A, Gorgey A S, et al. Does upper extremity training influence body composition after spinal cord injury[J]. Aging Dis, 2015, 6(4):271-281.
[37] Solstrand D L, Becerra L, Borsook D, et al. Brain changes after spinal cord injury, a quantitative meta-analysis and review[J]. Neurosci Biobehav Rev, 2018, 90(1):272-293.
[38] 王彤. 运动对脊髓损伤功能改善作用机制的探讨[C]. 上海:中国康复医学会运动疗法分会第十一届全国康复学术大会学术会议, 2011.
[39] Afshari T, Choi D, Russo A. Controversies regarding mobilization and rehabilitation following acute spinal cord injury[J]. Br J Neurosurg, 2019, 17(8):1-4.
[40] 任习. 脊髓损伤患者早期综合康复治疗的疗效分析[J]. 东方食疗与保健, 2015(9):71-72.
[41] Usuda N, Shirakawa K, Hatano K, et al. Coherence between oscillations in the cardiorespiratory system and tissue oxygen index in muscle recovering from intensive exercise in humans[J]. Physiol Int, 2019, 106(3):261-271.
[42] 李庆玲, 孙立宁, 杜志江. 上肢康复机器人发展现状的分析与研究[J]. 机械设计, 2008(9):1-3.
[43] Fry A, Delgado A D, Mekki M, et al. Robotic rehabilitation and spinal cord injury: a narrative review[J]. Neurotherapeutics, 2018, 15(3):604-617.
[44] Boland R A, Lin C S, Engel S, et al. Adaptation of motor function after spinal cord injury: novel insights into spinal shock[J]. Brain, 2011, 134(2):495-505.
[45] Matsuda Y, Kubo T, Fujino Y, et al. Relationship between depressive state and treatment characteristics of acute cervical spinal cord injury in Japan[J]. J Epidemiol, 2016, 26(1):30-35.
[46] Wilson J R, Arnold P M, Singh A, et al. Clinical prediction model for acute inpatient complications after traumatic cervical spinal cord injury: a subanalysis from the Surgical Timing in Acute Spinal Cord Injury Study[J]. J Neurosurg Spine, 2012, 17(1):46-51.
[47] 姜财. 基于整体观探讨脊髓损伤康复期患者生存质量状况及其影响因素研究[D]. 福州:福建中医药大学, 2018.
[48] 罗静文. 基于希望心理干预在脊髓损伤康复期患者主要照顾者中的应用研究[D]. 衡阳:南华大学, 2017.
Options
文章导航

/

〈 〉