运动想象疗法联合西药、康复训练对脑卒中偏瘫患者平衡功能、表面肌电图的影响

Effects of motor imagery therapy combined with western medicine and rehabilitation training on balance function and surface electromyography in stroke patients with hemiplegia

目的探讨运动想象疗法联合西药、康复训练对脑卒中偏瘫患者平衡功能、表面肌电图(sEMG)的影响。方法选取2016年5~12月浙江中医药大学附属温州中医院收治的脑卒中偏瘫患者70例,并随机分为治疗组和对照组,每组各35例。对照组给予西药、常规康复训练,治疗组在对照组治疗基础上加用运动想象疗法,均治疗3个月。以简化Fugl-Meyer运动量表(FMA)(下肢部分)、Berg平衡量表(BBS)评估其下肢运动功能、平衡功能,应用sEMG测定两组治疗前后股四头肌、胫骨前肌与腓肠肌的肌电积分值(iEMG)和均方根振幅(RMS),并记录三维步态时空与时相参数[步速、步频、跨步长比率(患肢/健肢)],同时观察不良事件。结果两组治疗后FMA评分、BBS评分均高于治疗前(P<0.05),且治疗后治疗组FMA评分、BBS评分高于对照组(P<0.05);两组治疗后股四头肌、胫骨前肌与腓肠肌的iEMG较治疗前增加,RMS较治疗前降低(P<0.05),治疗后治疗组四头肌、胫骨前肌与腓肠肌的iEMG高于对照组,RMS低于对照组(P<0.05);两组治疗后步速、步频、跨步长比率(患肢/健肢)均高于治疗前(P<0.05),且治疗后治疗组步速、步频、跨步长比率(患肢/健肢)高于对照组(P<0.05);治疗组不良事件发生率低于对照组(P<0.05)。结论运动想象疗法联合西药、康复训练可明显改善脑卒中偏瘫患者运动功能、平衡功能,促进其股四头肌、胫骨前肌与腓肠肌功能恢复,且不良事件少,值得在临床推广应用。

Objective To explore the effects of exercise imagery therapy combined with western medicine and rehabili- tation training on balance function and surface electromyography （sEMG） in stroke patients with hemiplegia. Methods From May to December 2016, 70 cases of stroke patients with hemiplegia treated in Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Chinese Medicine were selected, and randomly divided into treatment group and the control group, with 35 cases in each group. The control group was treated by western medicine and routine rehabilitation training, and the control group was treated by the motor imagery therapy on the basis of the control group, and they were treated for 3 months. The simplified Fugl-Meyer assessment （FMA） （lower limb） and Berg balance scale （BBS） were used to evaluate the motor function and balance function of lower limbs, and the sEMG was used to measure the integrated electromyograph （iEMG） score and the root mean square amplitude （RMS） of quadriceps femoris, tibialis anterior muscle and gastrocnemius muscle of the two groups before and after treatment, and the time and phase parameters of three-dimensional gait [leg speed, stride frequency, stride length ratio （affected limb/healthy limbs）] was recorded, and the adverse events was observed at the same time. Results The scores of FMA and BBS after treatment in the two groups were all higher than before treatment （P 〈 0.05）, and after treatment, the scores of FMA and BBS in the treatment group were higher than those of the control group （P 〈 0.05）. The iEMG levels of qnadriceps femoris, tibialis anterior muscle and gastrocnemius muscle after treatment in the two groups were all increased more than before treatment, while the RMS level was lower than before treatment （P 〈 0.05）, and after treatment, the iEMG levels of quadriceps femoris, tibialis anterior muscle and gastrocnemius muscle in the treatment group were higher than those in the control group, while the RMS level was lower than that in the control group （P 〈 0.05）. The leg speed, stride frequency, stride length ratio （affected limb/healthy limbs） after treatment in the two groups were all higher than before treatment （P 〈 0.05）, and after treatment, the leg speed, stride frequency, stride length ratio （affected limb/healthy limbs） in the treatment group were higher than those of in the control group （P 〈 0.05）. The incidence rate of adverse events in the treatment group was lower than that in the control group （P 〈 0.05）. Conclusion Motor imagery therapy combined with western medicine and rehabilitation training can improve the motor function and balance function, and promote the recovery of quadriceps femoris and tibialis anterior and gastrocnemius muscle function with low adverse events, therefore it is worthy of clinical promotion and application.