对侧控制功能性电刺激镜像反馈治疗偏瘫手功能疗效观察

Effect of Mirror Feedback Therapy of Contralaterally Controlled Functional Electrical Stimulation on Hand Function of Apoplectic Hemiplegic Patients

目的:探讨对侧控制功能性电刺激镜像反馈治疗对脑卒中偏瘫患者手功能疗效影响。方法:选取符合本研究标准的60例脑卒中偏瘫患者,随机分为A组、B组和C组,每组20例。在常规康复治疗的基础上,A组患者接受镜像治疗,B组患者接受对侧控制功能性电刺激治疗,C组患者接受对侧控制功能性电刺激镜像反馈治疗,3组治疗均每次20 min,每天1次,每周治疗5 d,连续治疗4周。于治疗前及治疗4周后,采用表面肌电图(sEMG)、Fugl-Meyer量表上肢运动功能测试部分(U-FMA)、组块测试(BBT)、腕关节主动活动角度(AROM)对患者手功能进行评定,并进行统计学分析。结果:治疗前,3组时域指标——平均肌电值(AEMG)、频域指标——中位频率值(MF)、U-FMA评分、BBT评分以及腕关节AROM比较,差异均无统计学意义(P>0.05)。治疗4周后,3组AEMG值、MF值、U-FMA评分、BBT评分以及腕关节AROM均比治疗前有明显提高(P<0.05);组间比较,C组AEMG值、MF值、BBT评分以及腕关节AROM分别为(73.17±29.12)μV、(95.67±26.54)Hz、(9.50±3.28)分、(41.75±17.19)°优于A组(57.33±18.47)μV、(77.62±31.10)Hz、(7.15±3.13)分、(26.75±14.53)°和B组(55.61±20.17)μV、(74.45±23.22)Hz、(6.50±3.78)分、(31.50±16.47)°,差异均具有统计学意义(P<0.05);3组U-FMA评分分别为A组(25.85±8.38)分、B组(25.40±9.25)分、C组(27.20±9.21)分,差异无统计学意义(P>0.05)。结论:对侧控制功能性电刺激镜像反馈治疗可改善脑卒中偏瘫患者的手功能,且优于单一的对侧控制功能性电刺激以及镜像治疗。

Objective: To investigate the effects of mirror feedback therapy of contralaterally controlled functional electrical stimulation on hand function of apoplectic hemiplegic patients. Methods: A total of 60 apoplectic hemiplegic patients were randomly divided into group A, group B and group C, with 20 cases in each group. All three groups received treatment for 20 minutes each time, once a day, for 5 days a week, and for 4 weeks. On the basis of conventional rehabilitation treatment, patients in group A received mirror therapy (MT), patients in group B received contralaterally controlled functional electrical stimulation (CCFES), and patients in group C received mirror feedback therapy of CCFES. Surface electromyography (sEMG), upper extremities motor function test of Fugl-Meyer movement assessment (U-FMA), box and block test (BBT) and wrist active range of motion (AROM) were used to evaluate hand function of patients before and after treatment. Results: Before treatment, average EMG (AEMG) value, median frequency (MF) value, U-FMA scores, BBT scores and wrist AROM of all three groups showed no significant differences (P>0.05). After 4 weeks of treatment, the AEMG value, MF value, U-FMA scores, BBT scores and wrist AROM improved significantly in all three groups (P<0.05). The AEMG value, MF value, BBT scores and wrist AROM for group C were: (73.17±29.12), (95.67±26.54), (9.50±3.28), (41.75±17.19), which were better than group A: (57.33±18.47), (77.62±31.10), (7.15±3.13), (26.75±14.53), and Group B (55.61±20.17), (74.45±23.22), (6.50±3.78), (31.50±16.47). The differences were statistically significant (P<0.05). The U-FMA scores of the three groups were (25.85±8.38) in group A, (25.40±9.25) in group B and (27.20±9.21) in group C. There were no significant statistical differences in U-FMA scores in the three groups (P>0.05). Conclusion: Mirror feedback therapy of contralaterally controlled functional electrical stimulation can improve hand function of apoplectic hemiplegic patients, and is superior to the single CCFES or MT.