偏瘫患者膝伸肌群等速离心收缩训练的效果

Effects of isokinetic eccentric training in patients with hemiparetic knee

目的 :探讨等速离心收缩训练对偏瘫患者膝伸肌群力量及步速的改善情况 ,了解其是否加重偏瘫膝伸肌群痉挛程度并产生肌肉损害。方法 :应用Kin Com等速装置对 16例伴有膝伸肌群痉挛的偏瘫患者进行 3次 /周共 4周的等速离心收缩训练 ,训练前、后分别用等速被动测试方法以 30°/s、6 0°/s、12 0°/s角速度测定被动阻力力矩 (痉挛量化指标 ) ,以及受累侧膝伸不同角速度时的向心收缩、离心收缩力矩 ;同时用表面电极EMG记录股四头肌、绳肌的肌电信号 ;测定训练前及训练停止 3周后的自我习惯步态的 10m步速。训练停止 3周后 ,再次测定受累侧膝伸向心收缩力矩、离心收缩力矩。训练前和第 1次训练后 72h测定血中C反应蛋白和血肌酸激酶水平。结果 :训练后 ,受累侧膝伸向心收缩、离心收缩力矩显著增加 (P <0 0 5 ) ;痉挛程度保持稳定 (P <0 0 5 ) ;原动肌 (股四头肌 )平均EMG活动显著增加 (P <0 0 5 ) ,拮抗肌 (绳肌 )抑制活动变化较小 (P <0 0 5 ) ;步速增加 (P <0 0 5 )。停止训练后 3周时 ,受累侧膝伸肌力改善的百分比有所降低 ,但步速的改善基本保持 (P >0 0 5 )。第 1次训练后 72h血C反应蛋白和血肌酸激酶均未高于正常值。结论 :短期的等速离心收缩训练可显著地改善偏瘫患者肌力与步速 ,且不增加痉?

Objective:To determine whether isokinetic eccentric training can improve the strength of the hemiparetic knee extension,gait speed,to evaluate its effect on spasticity in long term stroke survivors and to its side effect on musclar damage. Method: Sixteen subjects with spastic hemiparesis trained three sessions per week for 4 weeks with a Kin Com isokinetic dynamomter. The effects were evaluated from the following tests before and after the training period. The averaged resistance torque of affected knee extensors at 30°/s, 60°/s,120°/s were collected. The average concentric and eccentric torques of the affected knee extensor together with surface electromyography at constant velocities of 30°/s,60°/s,120°/s. The self selected walking speed was measured. The average concentric and eccentric torques of the affected knee extenor and the self selected walking speed were also recorded at 3 weeks after training cessation.Result: After training,the affected knee extensor strength had significantly incresed in both eccentric and concentric actions( P <0 05), while tone remined consistent( P >0 05).The averaged agonist EMG activity had significantly increased( P <0 05) but the restraint of the antagonistic muscles had not increased( P >0.05). The walking speed had significantly increased( P <0 05).At follow up, the improvement of affected knee extensor strength was a slight decline but the improvement of walking speed was continued. At 72 hours after the first time of exercise, the blood levels of C reactive protein and creative kinase had not hingher compared with their normal values. Conclusion:The short term isokinetic eccentric knee extensor training was able to significantly improve chronic stroke survivors′ strength and gait speed without concomitant increases in tone.