生物反馈穴位刺激联合Rood技术对脑卒中康复期患者步行功能的影响

Biofeedback Acupoint Stimulation Combined with Rood Technique on Walking Function of Stroke Patients in Convalescent Period

目的:观察生物反馈穴位刺激联合Rood技术对脑卒中康复期患者步行功能的影响。方法:选择2020年1月—2021年1月在河北北方学院附属第一医院康复医学科治疗的脑卒中康复期患者120例,采用信封法随机分为对照组和观察组,每组60例。2组均接受改善脑循环、保护脑细胞、维持水及电解质稳定性等常规治疗,同时配合作业治疗、物理治疗及心理治疗等常规康复训练。对照组在常规治疗和常规康复训练基础上接受Rood技术治疗(感觉刺激诱发肌肉反应训练、感觉刺激抑制肌肉反应训练、依照个体发育规律促进运动控制能力训练),1次/d,40 min/次,5 d/周,共治疗4周。观察组在对照组基础上接受生物反馈穴位刺激,穴位选择足三里、阳陵泉、解溪、上巨虚穴,刺激频率保持50 Hz,持续4 s,每间隔12 s刺激1次,患者可耐受强度保持20~60 mA,按患者耐受水平调整,1次/d,15 min/次,5次/周,共治疗4周。于治疗前及治疗4周后分别采用10 m步行测试(10MWT)、六分钟步行试验(6MWT)、起立-行走计时测试(TUG)和功能性步行分级(FAC)量表评估患者步行功能;采用胫前肌表面肌电信号(iMEG、RMS)评估患者胫前肌状态。结果:与治疗前比较,2组治疗后TUG明显下降,10MWT、6MWT均明显升高,差异具有统计学意义(P<0.05)。与对照组比较,观察组TUG明显更低,10MWT、6MWT均明显更高,差异具有统计学意义(P<0.05)。与治疗前比较,2组治疗后FAC分级明显改善,差异具有统计学意义(P<0.05);与对照组比较,观察组FAC分级改善更明显,差异具有统计学意义(P<0.05)。与治疗前比较,2组治疗后胫前肌iEMG明显升高,RMS明显降低,差异具有统计学意义(P<0.05);与对照组比较,观察组胫前肌iEMG明显更高,RMS明显更低,差异具有统计学意义(P<0.05)。结论:生物反馈穴位刺激联合Rood技术可改善脑卒中康复期患者步行功能、胫前肌状态。

Objective:To observe the effect of biofeedback acupoint stimulation combined with Rood technique on walking function of stroke patients in convalescent period.Methods:A total of 120 stroke patients in convalescent period hospitalized in the Rehabilitation Medicine Department of the First Affiliated Hospital of Hebei North University from January 2020 to January 2021 were randomly divided into control group and observation group,with 60 cases in each group.Both groups received routine medical treatment on improving cerebral circulation,protecting brain cells,maintaining water and electrolyte balance,and also received routine rehabilitation training such as occupational therapy,physical therapy,and psychotherapy.The control group received Rood technique plus routine treatment and rehabilitation training.The Rood technique included sensory stimulation induced muscle response training,sensory stimulation inhibited muscle response training,the individual development principle guided motor control ability training,once a day,40 minutes a time,five days a week,lasting for four weeks.The observation group received biofeedback acupoint stimulation in addition to the treatment provided to the control group.Zusanli(ST 36),Yanglingquan(GB 34),Jiexi(ST 41)and Shangjuxu(ST 37)acupoints were selected,the stimulation frequency was set at 50 Hz,lasting for 4 seconds,and the stimulation interval was once every 12 seconds.The intensity was adjusted between 20~60 mA,according to the patients'tolerance level.The stimulation protocol was given once a day,15 minutes a time,five times a week for four weeks.Before treatment and four weeks after treatment,10-meter walking test(10MWT),6 minute walking test(6MWT),time up and go(TUG)and functional ambulation category(FAC)were used to evaluate patients'walking function;the surface electromyographic signals(iMEG,RMS)of the tibialis anterior muscle was used to evaluate the condition of the patients'tibialis anterior muscle.Results:Compared with that before treatment,TUG of both groups after treatment decreased significantly,10MWT and 6MWT increased significantly,and the differences were statistically significant(P<0.05).Compared with the control group,TUG in the observation group were significantly lower,10MWT and 6MWT were significantly higher,and the differences were statistically significant(P<0.05).Compared with that before treatment,the FAC of both groups after treatment significantly improved,and the differences were statistically significant(P<0.05);compared with the control group,the FAC of the observation group improved more significantly,and the difference was statistically significant(P<0.05).Compared with that before treatment,iEMG of tibialis anterior muscle was significantly higher and RMS was significantly lower in both groups after treatment,and the differences were statistically significant(P<0.05);compared with the control group,iEMG of tibialis anterior muscle was significantly higher and RMS was significantly lower in the observation group,and the differences were statistically significant(P<0.05).Conclusion:Biofeedback acupoint stimulation combined with Rood technique can improve walking function and tibialis anterior muscle function in stroke patients during convalescence.