对侧触发功能性电刺激促进早期脑卒中患者伸腕的随机对照研究

Effects of early-phase contralaterally controlled functional electrical stimulation on wrist dorsiflexion in patients with stroke: A randomized controlled trial

目的:探讨对侧触发功能性电刺激对早期脑卒中患者伸腕及上肢功能恢复的影响。方法:将本院神经内科早期脑卒中患者随机分为两组。试验组患者接受常规康复训练及伸腕肌群对侧触发功能性电刺激治疗;对照组患者接受常规康复训练及伸腕肌群神经肌肉电刺激治疗。电刺激治疗均为每日1次,每次20min,疗程2周,治疗过程中记录首次出现主动伸腕动作的时间。治疗前后,两组患者均接受以下评估:上肢FuglMeyer简易运动功能评估、伸腕肌群肌力评估、主动伸腕关节活动度评估、日常生活活动能力评定量表评估(ADL)、Jebsen手功能评估、国际功能、残疾和健康分类(ICF)通用组合评估。结果:试验终点时,试验组共21例患者,对照组共20例患者。治疗组中有19例(90.48%)患者在治疗期间出现了主动伸腕动作;对照组中有12例(60.00%)患者出现了主动伸腕动作,治疗组患者平均主动伸腕动作出现时间(18.33±7.01)天,显著早于对照组(40.95±20.02)天。两组患者各项参数治疗前后对比均存在组内显著性差异(P<0.05)。两组患者治疗前各数据组间无显著性差异(P>0.05),治疗后两组上肢Fugl-Meyer简易运动功能评分、伸腕肌群肌力、主动伸腕关节活动度、ADL得分和ICF得分的差值具有组间显著性差异(P<0.05)。治疗后两组的Jebsen手功能得分并无显著性差异。两组患者治疗后功能相关参数的得分均显著高于治疗前的得分(P<0.05)。结论:与神经肌肉电刺激相比,对侧触发功能性电刺激治疗可使早期脑卒中患者主动伸腕动作出现的时间显著提前,并能有效促进其功能恢复。

Objective： To investigate the effectiveness of contralaterally controlled functional electrical stimulation （CCFES） on upper limbs in patients with early-phase stroke. Method： Eligible patients were randomly assigned into two study groups. Patients in the CCFES group were treated with routine rehabilitation combined with CCFES while those in the neuromuscular electrical stimulation （NMES） group were treated with routine rehabilitation combined with NMES. Electrical stimulation was performed once a day for two weeks and the duration was 20min for each episode. The first-sight of active wrist dorsiflexion was recorded once detected during the treatment period. Evaluation of physical function of upper limb, active range of motion for wrist dorsiflexion, strength of extensor carpi, activities in daily living, hand function and ICF generic set were performed before and after treatment. Result： Twenty-one patients in CCFES group and 20 patients in NMES group participated in this trial. Nineteen patients （90.48%） in CCFES group and 12 patients （60.00%） in NMES group were observed to obtain the active wrist dorsiflexion during the treatment period. The first-sight of active wrist dorsiflexion was significantly earlier in CCFES group （18.33±7.01 days） as compared to that in NMES group （40.95±20.02 days）. In terms of the results, the baseline data was similar in both groups, while significant differences were detected between baseline and endpoint. Differences in the outcome of upper limb Fugl-Meyer Assessment, strength of extensor carpi, active range of motion （AROM） for wrist dorsiflexion, ADL and ICF generic set between baseline and endpoint were significant across groups （P〈0.05）. No significant difference was found in the Jebson hand function score between groups at the endpoint. The value of each parameter evaluated at baseline was statistically higher in both groups as compared to which was obtained at endpoint. Conclusion： As compared to the NMES, CCFES can advance the onset of the active wrist dorsiflexion in patients with stroke and in turn improve its corresponding function.