镜像疗法配合肌电生物反馈对老年偏瘫患者步行功能的影响

Effect of mirror therapy combined with EMG biofeedback on walking function of hemiplegic patients

目的探究镜像疗法配合肌电生物反馈对改善老年脑卒中偏瘫患者步行功能的效果。方法选择97例老年脑卒中偏瘫患者,其中男性49例,女性48例;年龄65~81岁,平均69.63岁;身体质量指数23.05~29.71 kg/m^(2),平均身体质量指数25.84 kg/m^(2);脑卒中类型:脑梗死59例,脑出血38例;偏瘫下肢左侧62例,右侧35例。随机分观察组(49例)和对照组(48例)。对照组给予单一肌电生物反馈治疗,观察组给予镜像疗法配合肌电生物反馈治疗。治疗1个月后,比较2组患者步行功能、日常生活能力、下肢关节活动度、脑电波、独立单次步行距离及单次步行距离测定中失衡发生率。结果治疗1个月后,2组患者步行功能等级分布均未至Ⅳ~Ⅴ级;两组患者步行功能等级分布比较,差异有统计学意义(P<0.05);治疗后,两组患者的Fugl-Meyer运动功能评价量表(FMAS)及日常生活能力Barthel指数(BI)评分均高于治疗前[FMAS:观察组(17.69±1.54)分vs(10.63±2.74)分,对照组(14.16±1.38)分vs(10.71±2.86)分;BI:观察组(50.02±6.39)分vs(37.62±7.13)分,对照组(43.67±6.15)分vs(36.94±7.25)分。P<0.05],且观察组FMAS及BI评分均高于对照组(P<0.05);治疗后两组患者的肌电积分值及下肢踝关节活动度均高于治疗前[肌电积分值:观察组(46.13±4.27)μV vs(18.79±3.29)μV,对照组(40.06±4.22)μV vs(18.91±3.64)μV;下肢踝关节活动度:观察组(6.29±1.03)°vs(1.32±0.69)°,对照组(3.87±0.96)°vs(1.29±0.73)°。P<0.05],且观察组均高于对照组(P<0.05);观察组和对照组治疗后β波值分别为(8.34±0.75 vs 7.81±0.74),两组治疗后β波值均高于治疗前,观察组高于对照组(P<0.01)。观察组独立单次步行距离长于对照组[观察组(6.34±0.61)m vs对照组(4.07±0.53)m。P<0.05];两组失衡率比较,差异无统计学意义(P>0.05)。结论镜像疗法配合肌电生物反馈治疗老年脑卒中偏瘫患者有助于改善患者的步行功能,提高患者的日常活动能力,调节大脑肌电信号。

Objective To explore the effect of mirror therapy combined with electromyographic(EMG)biofeedback on improving walking function of elderly stroke patients with hemiplegia.Methods A total of 97 elderly stroke patients with hemiplegia were enrolled,which included 49 males and 48 females,aged 65-81 years old with mean age of 69.63 years old;body mass index(BMI)was 23.05-29.71 kg/m^(2) with BMI of 25.84 kg/m^(2);Stroke type:59 cases of cerebral infarction and 38 of cerebral hemorrhage;62 cases were left lower limb and 35 of right lower limb.All of them were randomly divided into observation group(n=49)and control group(n=48).The control group performed single EMG biofeedback,and observation group performed mirror image therapy combined with EMG biofeedback.One-month post treatment,the walking function,daily living ability,lower limb joint range of motion,electroencephalogram(EEG),independent single walk distance and incidence of imbalance in measurement of single walk distance were compared between 2 groups.Results One-month post treatment,the distribution of walking function in 2 groups did not reachedⅣ-Ⅴ.There was statistically significant difference in distribution of walking function grades between 2 groups(P<0.05).After treatment,the scores of Fugl-Meyer motor function assessment scale(FMAS)and Barthel index(BI)of 2 groups were higher than those before treatment[FMAS,observation group(17.69±1.54)scores vs(10.63±2.74)scores,control group(14.16±1.38)scores vs(10.71±2.86)scores;BI,observation group(50.02±6.39)scores vs(37.62±7.13)scores,control group(43.67±6.15)scores vs(36.94±7.25)scores.P<0.05],and FMAS and BI scores of observation group were significantly higher than those of control group(P<0.05).After treatment,the EMG integral value and ankle joint range of lower limb motion of 2 groups were significantly higher than those before treatment[EMG integral value,observation group(46.13±4.27)μV vs(18.79±3.29)μV,control group(40.06±4.22)μV vs(18.91±3.64)μV;ankle joint range of lower limb motion,observation group(6.29±1.03)°vs(1.32±0.69)°,control group(3.87±0.96)°vs(1.29±0.73)°.P<0.05],and the EMG integral value and ankle joint range of observation group were significantly higher than that of control group(P<0.05).After treatment,theβwave value of 2 groups were significantly higher than those before treatment,and the value of observation group was higher than that of control group(8.34±0.75 vs 7.81±0.74.P<0.01).The distance of independent single walk in observation group was significantly longer than that in control group[(6.34±0.61)meters vs(4.07±0.53)meters.P<0.05].There was no significant difference in imbalance rate between 2 groups(P>0.05).Conclusion It is demonstrated that mirror therapy combined with EMG biofeedback in treatment of elderly stroke patients with hemiplegia is helpful to improve walking function and daily activities ability,and regulate brain EMG signals.