基于双侧训练理论的对侧控制功能性电刺激治疗对偏瘫肩功能的影响

Effects of contralaterally controlled functional electrical stimulation based on bilateral training theory on hemiplegic shoulder function

目的:探讨基于双侧训练理论的对侧控制功能性电刺激治疗对偏瘫肩功能的影响。方法:将44例脑卒中偏瘫患者随机分为神经肌肉电刺激(NMES)组和对侧控制功能性电刺激(CCFES)组,每组各22例。所有患者均接受常规康复治疗,NMES组在此基础上接受常规的神经肌肉电刺激治疗,CCFES组患者在常规治疗基础上接受基于双侧训练理论的对侧控制功能性电刺激治疗,均每次20min,每天1次,每周治疗5d,连续治疗4周。于治疗前及治疗4周后,统计肩关节疼痛及半脱位发生率,采用表面肌电图(sEMG)、肩关节主动活动角度(AROM)、Fugl-Meyer量表上肢运动功能评估量表(U-FMA)对患者肩关节功能进行评定。结果:治疗后,CCFES组患者肩关节疼痛及半脱位例数比治疗前减少(P<0.05);2组AEMG值、肩关节AROM、U-FMA评分均比治疗前有明显提高(P<0.05),且CCFES组各指标改善程度优于NMES组(P<0.05)。结论:基于双侧训练理论的对侧控制功能性电刺激治疗可用于防治脑卒中患者肩关节疼痛及半脱位,改善患者肩部及上肢的功能,且优于常规的神经肌肉电刺激。

Objective:To investigate the effects of contralaterally controlled functional electrical stimulation(CCFES)based on bilateral training theory on hemiplegic shoulder function.Methods:From June 2018 to December 2019,44 patients with hemiplegia after stroke were divided into neuromuscular electrical stimulation(NMES)group(22 cases)and CCFES group(22 cases)according to the random number table.Patients in both groups all received conventional neurological treatment and rehabilitation treatment.The NMES group received conventional NMES therapy,while patients in the CCFES group received CCFES based on bilateral training theory.Before and after 4 weeks of the treatment,sEMG,shoulder active range of motion(AROM)and upper extremities motor function test of Fugl-Meyer movement assessment(U-FMA)were used to evaluate the shoulder function of patients.Results:After treatment,the number of shoulder pain and subluxation in CCFES group significantly decreased as compared with that before treatment(P<0.05).AEMG,shoulder AROM and U-FMA scores in both groups were significantly higher than those before treatment(P<0.05),and those in the CCFES group was superior to the NMES group(P<0.05).Conclusion:CCFES based on bilateral training theory can be used to prevent and treat hemiplegic shoulder joint pain and subluxation after stroke,improve the function of shoulder and upper limb,and is superior to conventional NMES.