便携式上肢功能性电刺激设备对脑卒中患者功能的即刻影响

The instant effect of upper extremity functional electrical stimulation on stroke patients

目的研究脑卒中患者佩带便携式上肢功能性电刺激（FES）设备对其手部功能性动作即刻功能变化的影响。方法选取脑卒中患者20例，全部佩带便携式上肢FES设备接受治疗，开始刺激前，将8块电极片分别按第1、第2、第3和第4通道四个刺激通道位置粘贴，刺激频率为40Hz，脉冲宽度为患者能够完成动作的最小宽度，刺激时间为患者能够完成动作的最短时间。电刺激顺序为：第1通道、第2／3通道、第1通道、第4通道。每个通道电刺激的刺激间隔为2000～3000ms，用支具将腕关节固定于功能位，通过15min的康复练习，协助患者能较熟练地在FES的辅助下完成抓、握和对捏动作，记录刺激参数。分别于患者佩带便携式上肢FES设备前（佩戴前）和戴后FES产生手部功能性动作即刻（佩戴后），对患者进行各项功能指标评定，评定内容包括Fugl-Meyer运动功能评分（FMA）、上肢功能试验（UEFT）、目测类比法（VAS）和改良的Barthel指数（MBI）评分，并进行统计学分析比较。结果佩戴便携式上肢FES设备前，20例脑卒中患者的FMA、UEFT和MBI评分分别为（19．4±7．1）、（3．6±3．7）和（53．8±26．2）分，佩戴便携式上肢FES设备后，患者的FMA评分[（30．4±9．6）分]、UEFT评分[（26．9±5．9）分]和MBI评分[（65．8±17．7）分]均较佩戴前明显提高，且差异有统计学意义（P〈0．05）。佩戴后患者的VAS评分[（1．3±0．7）分]较佩戴前[（1．4±0．4）分]有所下降，但差异并无统计学意义（P〉0．05）。结论脑卒中患者佩戴便携式上肢FES设备可即刻改善患者的上肢功能和患者日常生活活动能力，但对患者疼痛程度改善不明显。

Objective To study the immediate effect of applying a portable functional electrical stimulation device （PUEFESD） to the upper extremities of stroke patients. Methods Twenty stroke survivors were selected. Pairs of electrodes of the PUEFESD were applied on the dorsal and palm sides of the affected forearm and thenar to stimulate the extensors and flexors as well as the thenar muscles sequentially according to a programmed protocol. Functional evaluation was conducted before and immediately after the stimulation. All participants were assessed with regard to their motor function and performance in the activities of daily living using an upper extremity function test （UEFT） , the upper extremity motor function portion of the Fugal-Meyer assessment （FMA） , and rating with the modified Barthel index （MBI）, A visual analogue scale （VAS） was used to evaluate pain in the affected upper ex- tremity. Results The patients＇ average FMA score was 19.4± 7. 1 before the stimulation and 30.4 ＋ 9.6 after. The corresponding UEFT scores were 3.6 ±3.7 and 26.9 ± 5.9, and the average MBI scores were 53.8 ± 26.2 and 65.8± 17.7. All of these increases were statistically significant. The average VAS score, however, did not change significantly. Conclusions Functional electric stimulation can quickly improve upper extremity function and the ADL ability of stroke patients, but pain is not relieved significantly.