对侧控制型功能性电刺激对亚急性期脑卒中患者上肢运动功能恢复的影响

Contralateral controlled functional electrical stimulation improves the recovery of upper limb motor function after a stroke

目的观察对侧控制型功能性电刺激(CCFES)常规治疗及强化治疗对亚急性脑卒中患者上肢运动功能恢复的影响。方法选取病程1-3个月的脑卒中患者43例,按照随机数字表法将其分为CCFES组(14例)、CCFES强化组(14例)和神经肌肉电刺激(NMES)组(15例)。3组患者均接受常规康复训练,CCFES组给予CCFES常规剂量治疗,CCFES强化组给予CCFES强化剂量治疗,NMES组给予NMES常规剂量治疗。3组均给予每次20 min相应电刺激治疗,CCFES强化组每日给予2次,余两组每日1次,每周5 d,连续3周。分别于治疗前、治疗3周后(治疗后),采用上肢Fugl-Meyer评分法、改良Barthel指数、表面肌电图(sEMG)以及腕关节背伸主动关节活动度对患者进行上肢功能评估。结果治疗前,3组患者上肢FMA、MBI、RMS比值、关节活动度比较,差异无统计学意义(P>0.05)。与组内治疗前比较,3组患者治疗后上述指标均有所改善(P<0.05)。与NMES组治疗后比较,CCFES组和强化CCFES组各项评估指标均较为优异(P<0.05)。与CCFES组比较,强化CCFES组治疗后RMS比值(0.22±0.05)、关节活动度[(22.79±6.74)°]较为优异。结论CCFES及CCFES强化训练较NMES在促进患者上肢功能恢复方面均有显著优势,CCFES强化训练在改善患侧肢体肌力及关节活动度方面较为优异。

Objective To observe the effect of contralateral controlled functional electrical stimulation(CCFES)on the recovery of upper limb motor function after a stroke.Methods Stroke survivors 1 to 6 months after onset were randomly divided into a CCFES group(14 cases,group A),a CCFES intensive group(14 cases,group B)and a neuromuscular electrical stimulation group(15 cases,group C).In addition to routine rehabilitation training,groups A and B received contralateral controlled functional electrical stimulation,while Group C received routine neuromuscular electrical stimulation.Group B was treated twice daily,while the other two groups were given 1 session each day,5 times a week for 3 weeks.Each session lasted 20 minutes.The Fugl-Meyer assessment(FMA),the Modified Barthel Index(MBI),surface electromyography and the active range of motion for wrist dorsiflexion were used to evaluate the subjects′upper limb function before and after the treatment.Results There was no significant difference in any of the measurements among the three groups before the treatment.After the treatment,all of them had improved significantly,with the improvements in groups A and B significantly greater than in group C,on average.Conclusions Both normal and intensive contralateral controlled functional electrical stimulation have significant advantages over neuromuscular electrical stimulation in promoting functional recovery of the upper limbs.Intensive CCFES training is superior to routine training in improving muscle strength and range of motion.