急性卒中后手法治疗对肩手综合征患者P300的影响

Effects of manipulation rehabilitation treatment on upper extremity function and P300 potential of patients with shoulder-hand syndrome after acute stroke

目的:探讨早期手法康复对脑卒中后肩手综合征患者上肢功能改善的影响,同时探讨康复治疗前后患者P300的影响,为脑卒中后改善认知功能的康复机制提供临床依据。方法:将42例脑卒中后肩痛患者随机分为两组:治疗组25例,治疗手法为对肩、肘、腕、手指诸关节行手法被动运动及定量运动;对照组17例,对患肢仅行良肢位摆放及无规则随意被动活动,两组治疗师选择采用盲法分组,治疗时间均为0.5h/次,2次/d。2个月后比较临床表现,采用Fugl-Meyer评定法评定康复治疗后偏瘫侧上肢的关节活动度和主动运动功能。对疼痛采用目测类比评分法(VAS)评定。对所有患者治疗前后进行事件相关单位(ERP)P300检查。结果:①对脑卒中患者予早期手法康复措施,在并发肩痛时,患侧上肢关节活动范围受限程度和疼痛程度均较非手法康复组轻。②经手法康复2个月后,脑卒中后肩痛患者患侧上肢的临床症状、关节活动度和运动功能均有改善(P<0.05),且手法康复组疗效显著优于非手法康复组。③治疗组手法康复2个月后,P300的潜伏期明显缩短,波幅明显增高(P<0.01)。结论:早期康复干预可以预防和减轻脑卒中患者肩痛的发生程度,可改善康复期患侧上肢运动,且手法康复更显著改善偏瘫上肢运动功能;同时手法康复可明显改善患者的认知功能。

Objective：To study the effects of early manipulation rehabilitation treatment on symptom,range of motion （ROM）,motor functions of upper extremity and P300 potential in patients with shoulder-hand syndrome（SHS） post stroke.Method：Forty-two patients with SHS post stroke were divided into two groups,manipulation treatment group （25 cases） and non-manipulation treatment group （17 cases）.Patients in manipulation group regularly received manual passive quantitative movement on shoulder,elbow,wrist and hand joints,while patients in non-manipulation group irregularly received passive movement or performed voluntary movement.The therapists were enrolled into the treatment for the two groups blindly.The passive ROM and motor function of affected limbs were assessed with Fugl-Meyer assessment.The pain was assessed with visual analogue scale （VAS）.The event-related potential（ERP） P300 potential was examined pretreatment and post two months treatment respectively.Result：The limiting of passive ROM and shoulder pain of affected limbs in manipulation treatment group were less than that in non-manipulation group.After 2 months treatment the clinical symptoms,ROM and motor function of upper extremities improved significantly in all patients （P〈0.05）.The manipulation treatment showed better effects than non-manipulation treatment.The latency of P300 was significantly shortened after 2 months manipulation treatment,and the amplitude of P300 wave was significantly heightened（P〈0.01）.Conclusion：The early manipulation treatment could improve the passive ROM and motor function of affected limbs and alleviate the shoulder pain in patients with SHS post stroke.Manipulation treatment could also improve patients cognitive function.