基于正常行走模式的功能性电刺激对脑梗死早期患者下肢功能的影响

Functional electrical stimulation based on a normal walking pattern for improving lower extremity function early after cerebral infarction

目的观察基于正常行走模式的功能性电刺激（FES）对脑梗死早期患者偏瘫下肢功能的影响。方法采用随机数字表法将20例脑梗死早期患者分为电刺激组和安慰组。2组患者均给予常规药物治疗及基本康复训练，电刺激组同时辅以基于正常行走模式的FES治疗；安慰组电极放置与电刺激组相同，但治疗期间无电流输出。2组患者均每天治疗1次，每周治疗5d。于治疗前、治疗3周后分别采用简化Fugl-Meyer运动功能量表（FMA）下肢部分、脑卒中患者姿势评定量表（PASS）、Berg平衡量表（BBS）、步行功能分级（FAC）、改良Barthel指数（MBI）对2组患者进行评定。结果经3周治疗后，发现电刺激组FMA、PASS、BBS、MBI评分分别由治疗前（13．0±1．9）分、（19．5±2．4）分、（14．1±4．0）分和（43．2±5．2）分提高至（23．4±1．8）分、（30．1±1．0）分、（35．7±4．9）分和（83．4±3．8）分；安慰组上述指标则分别由治疗前（10．3±2．6）分、（16．4±3．5）分、（12．7±5．2）分和（40．4±7．2）分提高至（16．2±2．6）分、（24．3±2．8）分、（24．2±6．9）分和（66。8±7．0）分；并且电刺激组上述各指标的改善幅度均显著优于安慰组（均P〈0．05）。治疗后2组患者步行FAC分级也有明显改善，但组间差异无统计学意义（P〉0．05）。通过相关性分析发现，人选患者FMA、PASS、BBS评分与MBI评分均具有显著相关性（r值分别为0．890、0．644和0．917，均P〈0．05）。结论基于正常行走模式的FES治疗可显著改善脑梗死早期患者偏瘫下肢运动功能及平衡能力，对提高其日常生活活动能力具有重要意义。

Objective To observe the effects of functional electrical stimulation （FES） based on a normal walking pattern on the lower extremity function of subjects early after cerebral infarction. Methods Twenty patients with cerebral infarction aged （59. 7 ± 10. 1 ） years （ range 45-80） who were hospitalized and within 3 months （31.1 ± 19.3 days） after the onset were randomly assigned to an FES group （n = 11 ） or a placebo stimulation group （n =9）. All subjects in both groups received standard medical and rehabilitation treatment. In addition, the FES group received FES and the placebo group received sham-FES without current output. The daily stimulation and sham-stimulation sessions lasted for 30 min, 5 d/week for 3 weeks. All of the subjects in the two groups were assessed using the Fugl-Meyer assessment （FMA）, postural assessment for stroke patients （ PASS）, the Berg balance scale （BBS） , functional ambulation categories （FACs） and the modified Barthel index （MBI）. Results After 3 weeks of treatment, FMA, PASS, BBS and MBI scores had all improved significantly compared with before treatment in both groups, but the FES group showed significantly better improvement. After treatment the average FAC results of both groups had improved, and there was no significant difference between the two groups. At the same time, the research revealed the expected significant correlations among the FMA, PASS, BBS and MBI results. Conclusion FES based on a normal walking pattern can improve lower extremity motor function early after cerebral infarction, improve balance, and improve ability in the activities of daily living.