矫正偏瘫下肢异常运动模式的方法及临床效果观察

Research on the effectiveness of the training method and device for lower limb motor pattern remodeling

目的研究矫正偏瘫下肢异常运动模式的方法并观察临床效果。方法选择30例经传统方法训练后下肢运动模式仍异常的患者，对其进行运动模式重塑训练60次，训练前后自身对照研究，分别进行功能评定，数据采用SPSS12．0统计软件进行分析。结果功能性步行分级，下肢Fugl—Meyer，屈髋肌徒手肌力，屈髋肌、伸膝和足背屈表面肌电信号的强度和比例，屈髋、伸膝和足背屈自主关节活动度，日常生活能力评估指标，训练前后均有明显改善（3．7±1．4比0．3±0．9；30±9比15±25；3．6±1．3比1．4±0．9；111±18比58±35；161±4比111±13；15±7比4±6；79±12比56±25），差异均有统计学意义（均P〈0．01）。结论下肢运动模式重塑训练方式及其装置能够有效限制下肢运动中不需要的关节活动，能有效重塑下肢正常运动模式。

Objective To make a device that can valid inhibit the unwanted joint motion in the movement of the lower extremity, in order to ensure the patient walking in normal gait. After the training using this method and device, the normal gait can be remodeled. Another purpose of this research is to observe its effectiveness. Methods The lower extremity motor pattern remodeling device was made, according to the figure of the lower trunk and the lower limb of the patient, by using the parts as follows ： （1）the artificial aluminium-alloy joint hip, knee and ankle, which was the initial flexion angle of the joint that could be adjusted. The motion angle of those artificial joint could be adjusted. （2）The aluminium-alloy aid raddle and the waistline made of lukewarm thermoplast board; Also those artificial joint could only be allowed to act on the direction of frontal axis moving forward and backward, in order to ensure the patient walking in normal gait. The clinical trail of the lower limb gait motor pattern remodeling was done by own control study in 30 hemiplegie patients who had gait training using commonly used method and who still had abnormal gait motor pattern. The data was analyzed by t test using SPSS 12.0 statistical software. Results The functional evaluation items were done before and after the training, including the functional ambulation category （ FAC）, Fugl-Meyer of the lower limb motor function, sEMG that was the intensity and proportion of the motor pro- gram, the joint active range of motion （ROM） including hip extension, knee extension, foot dorsiflexion and foot e- version, activity of daily living （ADL）. There were extremely siguificances before and after the training （3.7 ± 1.4 vs 0.3 ±0.9; 30 ±9 vs 15 ±25; 3.6± 1.3 vs 1.4 ±0.9; 111±18 vs 58 ±35; 161 ±4 vs 111 ±13; 15 ±7 vs4± 6 ; 79 ± 12 vs 56 ± 25, P 〈 0.01 ）. Conclusions The lower limb motor pattern remodeling method and device can confine the unwanted joint motion when the lower limb is in activity. Using this device, the normal gait motor pattern of the lower limb can be remodeled, based on the training of neurological potency development and motor program reconstruction.