穴位肌电生物反馈改善脑卒中后偏瘫患者步行功能的临床研究

Clinical study of electromyographic biofeedback at acupoint on improving walking function of the post-stroke patients with hemiplegia

目的:探讨穴位肌电生物反馈(electromyographic biofeedback, EMGBF)在治疗脑卒中后偏瘫患者步行功能中的临床效果。方法:选取80例脑卒中后步行功能障碍患者为受试对象,按照入院顺序随机分为观察组与对照组各40例。对照组给予胫前肌EMGBF治疗,观察组则选取足三里、阳陵泉、解溪、上巨虚给予穴位EMGBF治疗。比较两组患者治疗前及治疗4周、8周后踝关节主动活动度(AROM)、下肢运动功能[Fugl-Meyer下肢运动功能评测量表(FMA-LE)]、患侧最大自主背屈状态胫前肌表面肌电参数肌电积分值(iEMG)、协同收缩率(CR)、情绪状态[汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)]、日常生活活动能力[改良Barthel指数(MBI)]等指标变化。结果:治疗4周、8周后,两组踝关节AROM、FMA-LE、胫前肌iEMG、MBI较治疗前均有显著改善,且观察组优于同期对照组(P均<0.05);两组CR水平及HAMA、HAMD评分均较治疗前有显著下降,且观察组低于同期对照组(P均<0.05)。结论:穴位EMGBF治疗能更有效的改善脑卒中步行功能障碍患者的踝关节主动活动度,提高下肢运动功能及日常生活活动能力。

Objective:To explore the clinical effects of electromyographic biofeedback(EMGBF) at acupoint on walking function of the post-stroke patients with hemiplegia.Method:Eighty post-stroke patients with walking dysfunction were chosen as subjects. According to the order of admission, the patients were randomly divided into observation group and control group with forty cases in each group.The patients in control group were treated with EMGBF at tibialis anterior muscle, while the patients in observation group were treated with EMGBF at acupoints(Zusanli, Yanglingquan, Jiexi and Shangjuxu).The strength of the active range of motion for the ankle(AROM), the motor function of the lower limb [FuglMeyer assessment for lower limb(FMA-LE)], surface electromyographic parameters including the maximal voluntary of the tibialis anterior muscle at dorsiflexion state [integrated electromyography(iEMG)] and the co-contraction ratio(CR), the emotional states [Hamilton Anxiety Scale(HAMA), Hamilton Depression Scale(HAMD)] and the activity of daily living [Modified Barthel Index(MBI)] were compared between the two groups before and after four weeks and eight weeks treatment.Result:After four or eight weeks treatment, the Lovett grading of ankle dorsiflexion,AROM,FMA-LE,the iEMG of tibialis anterior muscle,MBI in two groups were significantly improved compared with those before treatment. Furthermore, those indices in the observation group were significantly higher than those in control group at the same time point(P<0.05). The CR level and the scores of HAMA and HAMD were significantly lower than those before treatment, while those in observation group were significantly lower than those in control group at the same time point(P<0.05).Conclusion:EMGBF at acupoint can more effectively improve the active range of motion for the ankle, the walking function and the ability of daily living in post-stroke patients with walking dysfunction.