头针联合上肢智能反馈训练对卒中后上肢肌痉挛的影响

Effects of Scalp Acupuncture Combined with Intelligent Upper-limb Feedback Training for Post-stroke Upper-limb Spasticity

目的观察头针联合上肢智能反馈训练对卒中后上肢肌张力及功能的影响。方法将160例卒中后上肢肌痉挛患者随机分为治疗组(78例)和对照组(84例)。两组均予常规药物和运动康复训练,治疗组予头针联合上肢智能反馈训练,对照组仅进行与治疗组相同的上肢智能反馈训练。治疗前、治疗1个月后、治疗后、随访时,比较两组患侧上肢肌张力[上肢改良Ashworth量表(MAS)评分]、肘关节痉挛角度、腕关节痉挛角度、上肢Fugl-Meyer量表(FMA)评分、上肢和手Brunnstrom分期、改良Barthel指数(MBI)评分。结果两组治疗前、治疗1个月后,肘腕关节MAS评分、肘关节痉挛角度、腕关节痉挛角度、上肢FMA评分比较,差异均无统计学意义(P>0.05)。治疗后、随访时,两组肘腕关节MAS评分、肘关节痉挛角度、腕关节痉挛角度比较,差异均具有统计学意义(P<0.05,P<0.01)。两组治疗前、治疗1个月后、治疗后FMA评分及MBI评分比较,差异均无统计学意义(P>0.05)。两组随访时FMA评分、MBI评分比较,差异均具有统计学意义(P<0.05);肘腕关节MAS评分、肘关节痉挛角度、腕关节痉挛角度、FMA评分、MBI评分治疗前后差值及治疗前与随访时差值比较,差异均具有统计学意义(P<0.05)。两组治疗前Brunnstrom分期比较,差异无统计学意义(P>0.05);两组治疗后Brunnstrom分期比较,差异具有统计学意义(P<0.01)。结论在常规药物和运动康复训练基础上,头针联合上肢智能反馈训练能有效降低卒中患者上肢肌痉挛,改善上肢肘关节、腕关节活动度,提高卒中患者上肢运动功能及生活自理能力,疗效优于单纯上肢智能反馈训练。

Objective To observe the effects of scalp acupuncture plus intelligent upper-limb feedback training on the upper-limb muscle tension and function after stroke.Method A total of 160 patients with post-stroke upper-limb spasticity were randomized into a treatment group of 78 cases and a control group of 84 cases.Conventional medication and rehabilitation training were given to both groups.In addition,the treatment group was given scalp acupuncture plus intelligent upper-limb feedback training,while the control group only received the same intelligent upper-limb feedback training.The upper-limb muscle tension[modified Ashworth scale(MAS)score of the upper limb],spasticity angle of the elbow and wrist joints,Fugl-Meyer assessment(FMA)score of the upper limb,Bruunstrom stage of the upper extremity and hand,and the modified Barthel index(MBI)score were compared before treatment,at 1-month treatment,after treatment and at follow-up.Result Before treatment and at 1-month treatment,there were no significant differences in the MAS scores of the elbow and wrist joints,spasticity angle of the elbow and wrist joints,and the upper-limb FMA score between the two groups(P>0.05).After treatment and at follow-up,the differences in the elbow and wrist MAS scores,spasticity angle of the elbow and wrist joints were statistically significant between the two groups(P<0.05,P<0.01).Before treatment,at 1-month treatment and after treatment,there were no significant differences in the FMA and MBI scores between the two groups(P>0.05).At follow-up,the differences in the FMA and MBI scores were statistically significant between the two groups(P<0.05).The changes between before and after treatment and between before treatment and follow-up in the MAS scores of the elbow and wrist joints,spasticity angles of the elbow and wrist joints,and the FMA and MBI scores were significantly different between the two groups(P<0.05).There was no significant between-group difference in the Brunnstrom staging result before treatment(P>0.05);after treatment,the difference in the Brunnstrom staging result was statistically significant between the two groups(P<0.01).Conclusion Based on conventional medication and rehabilitation training,scalp acupuncture plus intelligent upper-limb feedback training can effectively reduce the upper-limb spasticity,improve the range of motion of the elbow and wrist joints,and enhance the upper-limb motor function and activities of daily living in patients after stroke,which is better than intelligent upper-limb feedback training alone.