肌电生物反馈疗法结合镜像疗法对脑卒中患者下肢运动和平衡功能的影响

Effects of electromyographic biofeedback therapy combined with mirror therapy on lower limb motor and balance function in stroke patients

目的:探究肌电生物反馈疗法(EMGBFT)结合镜像疗法(MT)对脑卒中患者下肢运动和平衡功能的影响。方法:选取60例脑卒中后偏瘫患者,随机分为肌电反馈组与镜像肌电组,每组30例。在常规康复基础上,肌电反馈组患者接受假MT刺激结合EMGBFT,镜像肌电组患者接受MT结合EMGBFT。于治疗前后,选用Fugl-Meyer运动功能评定量表下肢部分(FMA-LE)、表面肌电图-膝屈曲及踝背伸下的积分肌电值(iEMG)、协同收缩率(CR)评价患者下肢运动功能;睁眼及闭眼状态下,足底压力-双足平均压力和接触面积的对称指数(SI)、身体重心椭圆面积、身体重心前后向(AP)和内外向(ML)位移距离评价患者负重与平衡功能。结果:治疗后,两组患者的FMA-LE,股二头肌和股直肌、胫骨前肌和腓肠肌内侧头的CR和i EMG均明显改善(P<0.01)。治疗后,睁眼状态下,两组患者双足平均压力和接触面积SI、身体重心椭圆面积、身体重心AP及ML位移距离均明显改善(P<0.05,P<0.01),闭眼状态下,两组患者双足平均压力和接触面积SI、身体重心ML位移距离均明显改善(P<0.05,P<0.01)。与肌电反馈组治疗后比较,镜像肌电组FMA-LE、股二头肌和胫骨前肌i EMG、睁眼时身体重心椭圆面积和身体重心AP及ML位移距离、闭眼时双足接触面积SI变化幅度更加显著(P<0.05,P<0.01)。结论:肌电生物反馈疗法结合镜像疗法可提高脑卒中患者下肢运动和平衡功能,其潜在机制可能是激活了下肢薄弱肌群运动单位,缓解了下肢痉挛,改善了站立位静态平衡能力。

Objective:To study the influence of electromyographic biofeedback therapy(EMGBFT)combined with mirror therapy(MT)on lower limb motor and balance function in stroke patients.Method:Sixty patients with hemiplegia after stroke were randomly divided into two groups:MT based EMGBFT group and EMGBFT group,30 patients in each group.On the basis of conventional rehabilitation,the patients in the EMGBFT group received sham MT stimulation combined with EMGBFT,and the patients in the MT based EMGBFT group received MT combined with EMGBFT.Before and after treatment,the lower limb motor function of the patients was evaluated using Fugl-Meyer assessment scale-lower extremity(FMALE)and surface electromyography-integrated electromyography(i EMG)of knee flexion and ankle dorsiflexion,co-contraction ratio(CR).Plantar pressure-symmetry index(SI)of mean pressure and contact area of both feet,elliptical area of body center of gravity,anteroposterior(AP)and mediolateral(ML)displacement distance of body center of gravity under eye-opening and eye-closed states were calculated to evaluate patients'weight-bearing and balance function.Result:After treatment,FMA-LE,CR and iEMG of biceps femoris and rectus femoris under knee flexion,tibialis anterior and medial gastrocnemius under ankle dorsiflexion were markedly ameliorated in the two groups(P<0.01).After treatment,in the eye-opening state,the SI of mean pressure and contact area of both feet,elliptical area of body center of gravity,AP and ML displacement distances of body center of gravity were greatly enhanced in the two groups(P<0.05,P<0.01),in the eye-closed state,the SI of mean pressure and contact area of both feet,ML displacement distances of body center of gravity were observably ameliorated in the two groups(P<0.05,P<0.01).Compared with the EMGBFT group,the FMA-LE,iEMG of biceps femoris and tibialis anterior muscles,elliptical area of body center of gravity,AP and ML displacement distance of body center of gravity with eyes open,SI of contact area of both feet with eyes closed had more significant changes in the MT based EMGBFT group after treatment(P<0.05,P<0.01).Conclusion:Electromyographic biofeedback therapy combined with mirror therapy can improve lower limb motor and balance function in stroke patients,the underlying mechanism of which may be the activation of lower limb weak muscle motor units,the relief of lower limb spasm,and the improvement of standing static balance ability.