全身振动训练对亚急性期脑卒中患者上肢运动功能的影响

Effects of whole body vibration training on upper limb motor function in hemiplegic patients with subacute stroke

目的:观察并探讨全身振动训练对亚急性期脑卒中偏瘫患者上肢运动功能的影响。方法:选取2018年8月—2019年1月北京大学第三医院康复医学科住院治疗的亚急性期脑卒中偏瘫患者28例,随机分为试验组(n=14)和对照组(n=14)。试验组接受常规康复训练与全身振动训练,方案为常规康复训练每次45min,每日2次,全身振动训练每次30min,每日1次,每周5天,治疗周期为3周。对照组仅接受常规康复训练,每次60min,每日2次,每周5天,治疗周期为3周。治疗开始前采集所有患者的一般情况。治疗前,治疗3周后分别采用Fugl-Meyer评定量表上肢部分(FMA-UE),Wolf运动功能测试(WMFT),以及表面肌电图(sEMG)测定的肘关节屈、伸最大等长收缩(MIVC)时肱二头肌、肱三头肌积分肌电值(IEMG)及由此计算的协同收缩率(CR)来评定患者偏瘫侧上肢运动功能。结果:治疗前,试验组与对照组患者在一般情况、FMA-UE评分、WMFT评分及肘关节屈、伸MIVC时,肱二头肌、肱三头肌CR均无显著差异(P>0.05)。治疗3周后,试验组和对照组患者上肢FMA、WMFT评分较治疗前均显著提高(P<0.05),肘关节屈、伸MIVC时肱二头肌、肱三头肌CR均较治疗前下降(P<0.05)。治疗3周后,试验组患者FMA和WMFT评分明显高于对照组患者(P<0.05),试验组患者肘伸展MIVC时肱三头肌CR显著低于对照组患者,试验组与对照组患者肘屈曲MIVC时肱二头肌CR无明显差异(P>0.05)。结论:全身振动训练在提高亚急性期脑卒中患者上肢运动功能方面具有潜在优势。

Objective:To investigate the effect of whole body vibration on upper limb motor function in hemiplegic patients with subacute stroke.Method:Twenty-eight hemiplegia patients with subactue stroke who were hospitalized in the department of rehabilitation medicine,Peking University Third Hospital from August 2018 to January 2019 were selected and randomly divided into the control group(n=14)and the experimental group(n=14).The subjects in the control group received 1 hour conventional rehabilitation therapy twice a day,5 days per week,for 3 weeks.The subjects in the experimental group received 45 minutes conventional rehabilitation therapy twice a day and 30 minutes whole body vibration training once a day,5 days per week,for 3 weeks.General information of all patients was collected before the start of treatment.All patients were assessed before and 3 weeks after treatment with Fugl-meyer assessment scale of upper limb(FMA-UE),Wolf motor function test(WMFT).Surface electromyography was used to measure the integrated EMG(IEMG)of the biceps and triceps during maximum isometric voluntary contraction(MIVC)of the affected elbow flexion and then extension and the co-contraction rate(CR)was calculated.Result:Before treatment,there was no significant difference in general information,FMA-UE,WMFT,CR of the biceps flexion and CR of the triceps extension of the affected elbow between the two groups(P>0.05).After 3 weeks treatment,FMA and WMFT in the experimental group and the control group were significantly increased compared with that before treatment(P<0.05),and the CR of the triceps and the CR of the biceps were significantly decreased compared with that before treatment(P<0.05).After 3 weeks treatment,compared with control group,experimental group had significantly greater improvements on FMA-UE and WMFT(P<0.05).The CR of the triceps in the experimental group was significantly lower than that in the control group(P<0.05).There was no significant difference in CR of biceps between the experimental group and the control group(P>0.05).Conclusion:Whole body vibration training has potential advantages in improving upper limb motor function in patients with subacute stroke.