指部徒手感觉刺激前后脑卒中偏瘫患者手指屈、伸肌张力及超声剪切波弹性成像的变化

doi:10.3969/j.issn.1006-9771.2022.02.011

Abstract

Abstract:

Objective To demonstrate the changes in flexor digitorum and extensor digitorum tension in the affected hands with shear-wave elastography (SWE) before and after manual digitorum sensory stimulation (MDSS) in hemiplegic patients with stroke. Methods A total of 51 hemiplegic post-stroke inpatients in the Department of Rehabilitation Medicine in Second Hospital of Anhui Medical University from April to June, 2020, underwent MDSS completed by a researcher who used a bare thumb and index finger to squeeze each nail bed as well as the sides of each fingertip in the affected hand. The stimulation intensity was the minimum that could cause finger extension without obvious pain, and the interval between two stimulations was five to ten seconds. Muscular tension of the flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus and extensor digitorum were assessed with modified Ashworth Scale (MAS) and shear-wave velocity (SWV) of SWE on the affected side before and immediately after MDSS. MAS score was -1 as low muscular tension. Results The MAS scores of all the muscles significantly reduced after MDSS (|Z| > 2.843, P < 0.001); while the changes of SWV were not significantly in all the muscles with initially MAS score of 0 or -1 (t < 1.052, P > 0.05), and it reduced in those muscles with initial MAS scores of one to three (t > 2.672, P < 0.05). The SWV were positively correlated with the MAS scores both before and after MDSS (r > 0.334, P < 0.05). Conclusion MDSS can effectively, immediately, and safely relieves muscle spasms of the flexor digitorum and facilitate active finger extension in the affected hand for hemiplegic patients with stroke. SWE is useful for quantitatively and objectively evaluating muscular tension in the affected hand for hemiplegic patients with stroke.

Key words: stroke, spasticity, manual digitorum sensory stimulation, shear-wave elastography, modified Ashworth Scale

CLC Number:

R743.3

HE Ziyan,TANG Xiaoxiao,TIAN Yaxing,JIANG Fan,KAN Xiuli,SHEN Xianshan,MAO Jing,XU Jun,LIU Xue,WU Jianxian,WU Tingting,HONG Yongfeng. Features in digitorum muscular tension and shear-wave elastography in hemiplegic patients with stroke before and after manual digitorum sensory stimulation[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(2): 204-211.

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References 40

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肌张力	评级	指浅屈肌		指深屈肌		拇长屈肌		指伸肌
肌张力	评级	MDSS前	MDSS后	MDSS前	MDSS后	MDSS前	MDSS后	MDSS前	MDSS后
低张力	-1	2.218±0.288	2.133±0263^a	2.385±0.431	2.373±0.185^b	2.365±0.191	2.390±0.042^c	2.623±0.489	2.550±0.785^d
MAS	0	2.761±0.560	2.562±0.210^e	2.521±0.483	2.420±0.565^f	2.585±0.417	2.515±0.476^g	2.742±0.549	2.645±0.463^h
	1	3.587±0.348	2.609±0.597ⁱ	3.499±1.051	2.484±0.488^j	3.708±0.570	2.671±0.621^k	3.934±0.738	2.808±0.543^l
	1⁺	4.285±1.034	2.713±0.283^m	4.021±0.417	2.467±0.605ⁿ	-	-	4.845±0.530	2.850±0.679^o
	2	4.497±1.155	2.947±0.760^p	3.631±0.965	2.704±0.708^q	4.278±0.774	2.903±0.889^r	5.396±0.714	3.451±0.702^s
	3	4.929±1.030	3.256±0.731^t	3.731±1.089	2.895±0.832^u	5.530±0.636	3.340±0.438^v	5.295±0.615	3.920±0.679^w
	4	-	-	-	-	-	-	-	-
F值		11.329	-	3.765	-	26.385	-	20.962	-
P值		< 0.001	-	0.006	-	< 0.001	-	< 0.001	-

项目	MDSS前		MDSS后
项目	r值	P值	r值	P值
指浅屈肌	0.780	< 0.001	0.552	< 0.001
指深屈肌	0.494	< 0.001	0.334	0.017
拇长屈肌	0.829	< 0.001	0.493	< 0.001
指伸肌	0.847	< 0.001	0.371	0.007

Features in digitorum muscular tension and shear-wave elastography in hemiplegic patients with stroke before and after manual digitorum sensory stimulation

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