肌电触发电刺激联合减重步行训练对脑卒中偏瘫患者下肢肌张力的影响

Effect of EMG -triggered stimulation combined with BWSTT on muscle tonus in patients with stroke

目的 探讨肌电触发电刺激联合减重步行训练（BWSTT）对脑卒中偏瘫患者下肢肌张力的影响.方法 72例脑卒中患者采用析因设计方法随机分为4组（每组n=18）.常规治疗组（常规组）采用常规治疗;BWSTT组、肌电触发电刺激组（触发组）、肌电触发电刺激联合BWSTT组（联合组）在常规治疗基础上给予相应治疗.并于治疗前后分别进行Fugl-Meyer评分、临床痉挛指数（CSI）评分及积分肌电值（iEMG）评定.统计学处理采用析因设计的多因素方差分析.结果 治疗前各组Fugl-Meyer评分、CSI评分及iEMG差异均无统计学意义（P＞0.05）;治疗后,BWSTT组和触发组脑卒中患者下肢Fugl-Meyer评分均提高（P＜0.01）,CSI评分及腓肠肌iEMG数值均降低（P＜0.05）;使用肌电触发电刺激、BWSTT对Fugl-Meyer评分、CSI评分及iEMG数值存在交互作用（P＜0.05）,提示肌电触发电刺激与BWSTT联合干预对促进脑卒中患者的康复效果更佳.各组iEMG结果与Fugl-Meyer评分和CSI评分一致.结论 肌电触发电刺激和BWSTT均可减低脑卒中患者肌张力,缓解肌痉挛,二者联合可以发挥协同作用,提高疗效.iEMG在脑卒中肌张力评价中有潜在的应用价值.

Objective To investigate the effect of electromyography （EMG） - triggered stimulation combined with body weight support treadmill training＇（BWSTT） on muscle tonus of the lower limbs. Methods 72 hemiplegie patients were randomized by factorial design method into 4 groups （n = 18 each）. The routine treatment group （routine group） underwent routine treatment ; BWSJT group, EMG - triggered stimulation group （ triggered group） and EMG - triggered stimulation combined with BWSTT group （ combination group） underwent corresponding treatments on the basis of routine treatment. Patients in each group were assessed by Fugl -Meyer scale, clinical spasm index （CS1） and integrated elec- tromyography （iEMG） values before and after the treatment. Multifactor ANOVA by Factorial design was conducted in the statistical analysis. Results Before the treatment, there were no statistical significance in Fugl - Meyer scores, CSI scores and iEMG values in the 4 groups （ P 〉 0.05 ）. At the end of the treatment, the Fugl - Meyer scores were elevated, and both CSI and iEMG values of the gastrocnemius muscle decreased （ P 〈 0.05 ） in BWSTT group and triggered group. The application of BWSTT and EMG - triggered stimulation had interactions with Fugl - Meyer scores, CSI scores and iEMG values （P 〈 0.05 ）, which suggested that combined intervention with EMG - triggered stimulation and BWSqT had better effect on the improved rehabilitation of patients with stroke. The iEMG values in each group was consistent with the Fugl - Meyer scores and CSI scores. Conclusion Both EMG - triggered stimulation and BWSTF can reduce the muscle tonus and relieve muscular spasm in stroke patients. Their combination has synergistic effect and can increase curative efficacy, iEMG has potential application value in the evaluation of muscle tonus in stroke patients.