头针联合下肢智能反馈训练治疗脑卒中后下肢运动功能障碍:随机对照研究

Scalp acupuncture combined with lower-limb intelligent feedback training for lower-limb motor dysfunction after stroke:a randomized controlled trial

目的:比较头针联合下肢智能反馈训练与单纯下肢智能反馈训练治疗脑卒中后下肢运动功能障碍的疗效。方法:将154例脑卒中后下肢运动功能障碍患者随机分为观察组(76例,脱落6例)和对照组(78例,脱落8例)。两组均予常规药物治疗及运动康复训练,观察组同时采用头针联合下肢智能反馈训练,穴取顶颞前斜线上1/5、顶颞后斜线上1/5,对照组仅予下肢智能反馈训练,均每天1次,每周治疗6 d,共治疗8周。于治疗前后评估两组患侧下肢Brunnstrom分期、患侧下肢改良Ashworth量表(MAS)分级、6分钟步行试验(6MWT)、Berg平衡量表(BBS)评分、改良Barthel指数(MBI)评分,采用步态功能评价系统进行足底压力检测。结果:治疗后,两组Brunnstrom分期均较治疗前提高(P<0.01),观察组MAS分级较治疗前改善(P<0.01),观察组Brunnstrom分期、MAS分级均优于对照组(P<0.01,P<0.05);治疗后,两组6MWT、BBS评分、MBI评分较治疗前升高(P<0.05),且观察组均高于对照组(P<0.05);治疗后,观察组患者健侧后足、患侧前后足、双侧全足触地面积较治疗前增加(P<0.05),且患侧前后足、全足触地面积大于对照组(P<0.05),观察组患者健侧前足、全足负重比较治疗前降低(P<0.05),患侧前足、后足、全足负重比较治疗前升高(P<0.05),且观察组健侧前足、全足负重比低于对照组(P<0.05),健侧后足、患侧前足、患侧全足负重比均高于对照组(P<0.05)。结论:头针联合下肢智能反馈训练能够降低脑卒中患者下肢肌张力,促进下肢分离运动模式出现,改善足底压力分布,提高患者平衡能力及步行能力,疗效优于单纯下肢智能反馈训练治疗。

Objective To compare the efficacy of scalp acupuncture combined with lower-limb intelligent feedback training and lower-limb intelligent feedback training alone for lower-limb motor dysfunction after stroke.Methods A total of 154 patients with lower-limb motor dysfunction after stroke were randomly divided into an observation group(76 cases,6 cases dropped off)and a control group(78 cases,8 cases dropped off).The patients in both groups were treated with conventional medication and exercise rehabilitation training.In addition,the patients in the observation group were treated with scalp acupuncture combined with lower-limb intelligent feedback training.The scalp acupuncture was given at upper 1/5 of the anterior oblique line of parietal temporal area and upper 1/5 of the posterior oblique line of parietal temporal area.The patients in the control group were treated with lower-limb intelligent feedback training alone.All the treatment was given once a day,6 days a week,totaling for 8 weeks.The affected-side lower-limb Brunnstrom stage and modified Ashworth scale(MAS)grade,6-minute walk test(6 MWT),Berg balance scale(BBS)score and modified Barthel index(MBI)score were evaluated before and after treatment in the two groups.The plantar pressure was measured by gait function evaluation system.Results Compared before treatment,the Brunnstrom stage in the two groups was improved after treatment(P<0.01);the MAS grade in the observation group was improved after treatment(P<0.01);the Brunnstrom stage and MAS grade in the observation group were superior to those in the control group(P<0.01,P<0.05).After treatment,the 6 MWT,BBS and MBI scores in the two groups were increased(P<0.05),and those in the observation group were higher than those in the control group(P<0.05).After treatment,the touchdown area of health-side hind foot,affected-side front-hind foot and bilateral full foot in the observation group was increased(P<0.05),and the touchdown area of affected-side front-hind foot and full foot in the observation group was larger than that in the control group(P<0.05).The weight-bearing ratio of health-side forefoot and full foot in the observation group was decreased after treatment(P<0.05),and the weight-bearing ratio of affected-side forefoot,hind foot and full foot was increased after treatment(P<0.05).The weight-bearing ratio of health-side forefoot and full foot in the observation group was lower than that in the control group(P<0.05),and the weight-bearing ratio of health-side hind foot,affected-side forefoot and affected-side full foot in the observation group was higher than that in the control group(P<0.05).Conclusion The scalp acupuncture combined with lower-limb intelligent feedback training could reduce the muscle tension of lower limbs,promote the separation movement mode of lower limbs,improve the plantar pressure distribution,and improve the balance ability and walking ability in stroke patients,and the curative effect is better than lower-limb intelligent feedback training alone.