基于表面肌电探讨模拟现实步态训练对卒中后步行痉挛型老人行走及跌倒恐惧的影响

Effect of simulated real gait training based on surface electromyography on walking and fear of falling in the elderly patients with walking spasm after stroke

目的基于表面肌电探讨模拟现实步态训练对卒中后步行痉挛型老人的影响。方法采用方便抽样法选择59例卒中后步行痉挛型老人,随机分为干预组(n=29)和对照组(n=30),对照组采用常规康复护理,干预组在此基础上采用模拟现实步态训练,2组在干预前和干预4周后采用表面肌电分析胫骨前肌和腓肠肌在最大等长收缩状态下的积分肌电值(iEMG),采用改良Ashworth量表(MAS)评估肌痉挛,采用Fugl-Meyer运动功能评分(FMA)评估下肢步行能力,并且以修订版跌倒效能量表(modified falls efficacy scale,MFES)对老人跌倒恐惧进行分析。结果干预4周后,2组胫骨前肌和腓肠肌最大等长收缩状态下iEMG和FMA评分均较干预前增高(P<0.05),且干预组高于对照组,差异有统计学意义(P<0.05);2组MAS评分均较干预前降低(P<0.05),且干预组低于对照组,差异有统计学意义(P<0.05);干预组MFES评分明显较干预前升高,且显著高于对照组,差异有统计学意义(P<0.05)。结论模拟现实步态训练可以有效缓解卒中后步行痉挛型老人的肌痉挛,提高其步行能力,改善跌倒恐惧的状况。

Objective To explore the effect of simulated real gait training based on surface electromyography(SEMG)in the elderly patients with walking spasm after stroke.Methods A total of 59 elderly patients with walking spasm after stroke were randomly divided into intervention group(n=29)and control group(n=30).The control group was given the routine rehabilitation nursing,and the intervention group was given simulated real gait training on the basis of rehabilitation of the control group.SEMG was used to analyze the integrated electromyography(iEMG)of tibialis anterior and gastrocnemius muscles in the state of maximum isometric contraction before and four weeks after intervention.Modified Ashworth Scale(MAS)was used to evaluate muscle spasm,and Fugl Meyer motor function score(FMA)was used to evaluate the walking ability of lower limbs.The fear of falling in the elderly was analyzed by the modified falls efficacy scale(MFES).Results Four weeks after intervention,the level of iEMG under the condition of maximum isometric contraction of tibialis anterior muscle and gastrocnemius muscle and the score of FMA in the two groups were significantly higher and the score of MAS was significantly lower than that before intervention(P<0.05),especially in the intervention group(P<0.05).The score of MFES in the intervention group was significantly higher than that before intervention and that in the control group after four weeks of intervention(P<0.05).Conclusions Simulated real gait training can effectively alleviate the muscle spasm in the elderly patients with walking spasm after stroke,and improve the walking ability and fear of falling.