四肢联动训练增进脑卒中偏瘫患者下肢肌肉激活及协调性

A Study on Improvement of Hemiplegic Stroke Patients' Lower Limb Muscle Activation and Coordination by Training of Limbs Linkage

目的:探讨四肢联动康复训练对脑卒中偏瘫患者运动功能、平衡与协调能力及下肢表面肌电的影响。方法:选取我院脑卒中偏瘫患者60例,采用随机数字法分为对照组和实验组,每组30例。对照组采用常规康复训练+患者家属自行辅助康复训练,实验组采用常规康复训练+四肢联动康复训练。比较实验前后及实验后组间的改良Barthel指数(MBI)、Fugl-Meyer评分(FMA)、Berg评分(BBS)以及下肢表面肌电指标变化。结果:实验组与对照组训练后MBI、FMA和BBS评分均较训练前显著提高(P<0.05)。训练后实验组MBI、FMA和BBS评分均显著高于对照组(P<0.05)。训练后,实验组患者踝背屈时胫前肌、踝跖屈时腓肠肌、伸膝时股直肌积分肌电值(iEMG)显著高于对照组(P<0.05);实验组患者踝背屈及伸膝协同收缩率较训练前显著下降,且显著低于对照组训练后(P<0.05)。结论:四肢联动训练通过增进偏瘫患者伸膝及踝背屈动作肌肉激活与动作的协调性,改善其运动功能,平衡协调功能,提升日常生活活动能力。

Objective To investigate the effects of limbs linkage training on motor function,balance and surface electromyography of lower limbs of hemiplegic stroke survivors.Methods Sixty stroke survivors with hemiplegia were randomly divided into a control group(n=30)and an experimental group(n=30),according to a random number table.In addition to the conventional rehabilitation training,the control group performed assisted rehabilitation training by themselves,while the experimental group underwent the limbs linkage training.The modified Barthel index(MBI),Fugl-Meyer assessment(FMA)score,Berg balance scale(BBS)score and surface electromyography indicators were compared between the two groups before and after the intervention.Results Compared with before training,all measurements improved significantly for both groups(P<0.05),with the improvement in the average MBI,FMA and BBS scores of the experimental group significantly higher than the control group.After the training,the average iEMG of the tibialis anterior at the ankle dorsiflexion,the gastrocnemius at the plantar flexion and the rectus femoris at the extension of the knee of the experimental group were significantly higher than the control group(P<0.05).Moreover,the co-contraction ratio of ankle dorsiflexion and knee extension of the experimental group reduced significantly(P<0.05)compared with before the training and that of the control group after the training.Conclusion Limbs linkage training can improve the muscular activation and coordination during the knee extending and ankle dorsiflexion,which can better the motor function,balance and coordination function,as well as the activities of daily living of stoke survivors with hemiplegia.