头针加音乐联合康复治疗脑卒中后痉挛性偏瘫:随机对照研究

Spasmodic hemiplegia after stroke treated with scalp acupuncture, music therapy and rehabilitation: a randomized controlled trial

目的:评价头针加音乐联合康复治疗脑卒中后痉挛性偏瘫与单纯康复及音乐联合康复的临床疗效差异。方法:将76例脑卒中后痉挛性偏瘫患者随机分为康复组(25例)、音乐联合康复组(25例)和头针加音乐联合康复组(26例)。康复组予常规康复治疗,包括解除引起痉挛的各种诱因,正确的体位摆放和物理治疗;音乐联合康复组在康复组治疗基础上予音乐疗法,音乐治疗师用节奏听觉刺激、模式性感觉促进及治疗性器乐演奏3类技术为患者治疗;头针加音乐联合康复组在音乐联合康复治疗基础上,予头针疗法,取偏瘫肢体对侧顶颞前斜线、顶颞后斜线进行透刺并留针,留针期间每隔10 min捻针1次,每次2 min。以上治疗均每日1次,每周5次,连续治疗4周。观察患者治疗前后Fugl-Meyer运动功能评分(Fugl-Meyer assessment,FMA)、日常生活活动能力巴氏指数(Barthel index,BI)及静息状态下偏瘫侧肘、膝关节被动活动时的改良Ashworth痉挛分级(modified Ashworth scale,MAS)。结果:治疗前3组患者的FMA、BI、MAS这3项指标差异无统计学意义(均P>0.05),组间具有可比性。治疗后,3组患者的FMA和BI评分均较治疗前明显升高(均P<0.05),MAS分级均较本组治疗前明显降低(均P<0.05)。治疗后,头针加音乐联合康复组FMA、BI评分均高于音乐联合康复组及康复组(均P<0.05),音乐联合康复组FMA、BI评分均高于康复组(均P<0.05);头针加音乐联合康复组MAS分级低于音乐联合康复组及康复组(均P<0.05),音乐联合康复组MAS分级低于康复组(P<0.05)。结论:头针加音乐联合康复治疗脑卒中后痉挛性偏瘫与常规康复及音乐联合康复相比,临床疗效更优。

Objective To evaluate the differences in the clinical therapeutic effects on spasmodic hemiplegia after stroke among the alliance therapy of scalp acupuncture, music therapy combined with rehabilitation, the simple rehabilitation therapy and the combination of music therapy and rehabilitation. Methods A total of 76 patients of post-stroke spasmodic hemiplegia were randomized into a rehabilitation group （25 cases）, a combination group withmusic therapy and rehabilitation （25 cases） and an alliance therapy group with scalp acupuncture, music therapy and rehabilitation （26 cases）. In the rehabilitation group, the routine rehabilitation therapy was applied, including the removal of various incentives that cause spasm, the correction of body position and the physical therapy. In the combination group, the music therapy was added on the basis of the treatment as the rehabilitation group. The music physician used the rhythmic audito~ stimulation, the patterned sensory enhancement and the therapeutic instrumental music playing to set up the task in the treatment. In the alliance therapy group, scalp acupuncture was added on the basis of the treatment as the combination group. The anterior oblique line of vertex-tempora （MS 6） and the posterior oblique line of vertex-tempora （MS 7） on the eontralateral side were selected and stimulated with penetrating needling technique. The needles were retained. During the needling retaining, the needles were rotated once every I0 rain, for 2 rain each time. The treatment was given one session a day, totally for 5 sessions a week, continuously for 4 weeks. The Fugl-Meyer assessment （FMA）, Barthel index （BI） and the modified Ashworth scale （MAS） of the affected elbow and the passive knee movement at static conditionwere observed in the patients before and after treatment. Results The results of FMA, BI and MAS were not different before treatment in the patients among the three groups （all P〉 0.05）, indicating the comparability among groups. After treatment, FMA and BI scores were all increased apparently in the three groups as compared with those before treatment （all P〈 0.05）. MAS grade was reduced remarkably as compared with that before treatment （all P〈 0.05）. After treatment, FMA and BI scores in the alliance therapy group were higher than those in the combination group and the rehabilitation group （all P〈 0.05）. FMA and BI scores in the combination group were higher than those in the rehabilitation group （both P〈 0.05）. MAS grade in the alliance therapy group was lower than those in the combination group and the rehabilitation group （both P〈 0.05）. MAS grade in the combination group was lower than that in the rehabihtation group （P〈 0.05）. Conclusion The alliance therapy with scalp acupuncture, music therapy and rehabilitation achieve the remarkable clinical therapeutic effects on post-stroke spasmodic hemiplegia as compared with the routine rehabilitation and the combination of music therapy and rehabilitation.