互动式头针结合悬吊下数字作业疗法治疗脑卒中后上肢运动功能障碍:多中心随机对照试验

Interactive scalp acupuncture combined with suspension digital occupational therapy for upper limb motor dysfunction after stroke: a multi-center randomized controlled trial

目的:观察互动式头针对脑卒中后上肢运动功能障碍患者上肢运动和日常生活活动能力的影响。方法:将120例脑卒中后上肢运动功能障碍患者随机分为观察组(60例,脱落2例)和对照组(60例,脱落1例)。两组患者均接受常规药物和康复治疗,观察组给予互动式头针(穴取偏瘫对侧顶颞前斜线的中2/5、顶颞后斜线的中2/5、顶旁2线,每次30 min)结合悬吊下数字作业疗法(OT)治疗,对照组给予单纯悬吊下数字OT治疗,两组均每日1次,每周5次,共治疗4周。观察两组患者治疗前后Fugl-Meyer上肢运动功能评定量表(FMA-UE)、上肢动作研究量表(ARAT)、改良Barthel指数(MBI)评分及患侧肱二头肌、肱三头肌表面肌电信号(sEMG),并评定两组临床疗效。结果:治疗后,两组患者FMA-UE、ARAT、MBI评分较治疗前升高(P<0.05),且观察组升高幅度大于对照组(P<0.05);屈肘及伸肘时患侧肱二头肌、肱三头肌积分肌电值(iEMG)和均方根值(RMS)较治疗前升高(P<0.05),观察组升高幅度大于对照组(P<0.05)。观察组总有效率为94.8%(55/58),高于对照组的83.1%(49/59,P<0.05)。结论:互动式头针可改善脑卒中后上肢运动功能障碍患者上肢运动功能,提高日常生活活动能力。

Objective To observe the effects of interactive scalp acupuncture on upper limb motor function and activities of daily living in patients with upper limb motor dysfunction after stroke. Methods One hundred and twenty patients with upper limb motor dysfunction after stroke were randomly divided into an observation group(60 cases,2 cases dropped out)and a control group(60 cases,1 case dropped out). Both groups were treated with routine medication and rehabilitation. The observation group was treated with interactive scalp acupuncture combined with suspension digital occupational therapy,interactive scalp acupuncture was applied at middle 2/5 of the parietal and temporal anterior oblique line,middle 2/5 of the parietal and temporal posterior oblique line and second lateral line of parietal of the hemiparalysis contralateral side,30 min each time.The control group was treated with suspension digital occupational therapy alone. The treatment was given once a day, 5 times a week for 4 weeks in the two groups. The scores of Fugl-Meyer assessment scale of upper extremity(FMA-UE),action research arm test(ARAT), the modified Barthel index(MBI) and surface electromyography(sEMG)signal of the biceps and triceps on the affected side were observed before and after treatment in the two groups,and the clinical efficacy was evaluated.Results After treatment,the FMA-UE,ARAT and MBI scores were increased compared with those before treatment in both groups(P<0.05),the changes of the observation group were greater than those in the control group(P<0.05). After treatment, the integrated electromyography(iEMG)value and root mean square(RMS)value of the biceps and triceps on the affected side during elbow flexion and extension were increased compared with those before treatment in both groups(P<0.05),the changes of the observation group were greater than those in the control group(P<0.05). The total effective rate was 94.8%(55/58) in the observation group,which was higher than 83.1%(49/59) in the control group(P<0.05). Conclusion Interactive scalp acupuncture could improve upper limb motor function and activities of daily living in patients with upper limb motor dysfunction after stroke.