深层电动肌肉振动仪联合手指康复训练机器人在脑卒中合并手运动功能障碍患者康复治疗中的应用效果

Application effect of deep electric muscle vibration instrument combined with finger rehabilitation training robot in rehabilitation treatment of stroke patients with hand movement dysfunction

目的探讨深层电动肌肉振动仪联合手指康复训练机器人在脑卒中合并手运动功能障碍患者康复治疗中的效果。方法回顾性选取2022年2月至2023年2月于首都医科大学附属北京康复医院就诊的脑卒中合并手功能障碍患者106例作为研究对象,按照康复训练方式的不同将患者分为对照组(采用手指康复训练机器人进行干预)50例和观察组(采用深层电动肌肉振动仪联合手指康复训练机器人进行干预)56例。干预8周后对比两组临床疗效、手运动功能、手指总活动情况、脑电图[脑电波δ/α值(DAR)、脑对称指数(BSI)]和血清学指标[神经肽(NPY)和基质金属蛋白酶-9(MMP-9)]、神经功能缺损情况[美国国立卫生研究院的卒中量表(NIHSS)评分]和日常生活活动能力[日常生活能力评定量表(ADL)评分]。结果观察组临床总疗效率明显高于对照组(80.36%vs.60.00%),差异有统计学意义(P<0.05)。干预8周后,观察组最大握力[(43.17±5.96)N]和最大捏力[(12.03±3.43)N]、手屈曲伸肌肌电值[(25.11±3.66)μV]、手屈曲屈指浅肌肌电值[(14.56±3.27)μV]及手背伸屈指浅肌肌电值[(9.02±1.77)μV]和手背伸伸指肌肌电值[(20.13±3.25)μV]高于对照组[(38.99±5.56)N、(9.87±3.55)N、(21.99±3.83)μV、(12.69±2.32)μV、(7.89±1.55)μV、(17.85±3.21)μV],差异均有统计学意义(P<0.05)。观察组手指活动优良率为85.71%,明显高于对照组的66.00%,差异有统计学意义(P<0.05)。干预8周后,观察组的DAR(2.73±0.75)、BSI(0.25±0.08)及血清NPY[(110.63±5.33)μg/L]和MMP-9[(80.23±4.55)μg/L]水平低于对照组[3.11±0.88、0.33±0.05、(120.55±6.61)μg/L、(83.53±5.39)μg/L],差异均有统计学意义(P<0.05)。干预8周后,观察组NIHSS评分[(8.89±2.28)分]低于对照组[(10.02±2.33)分],ADL评分[(44.25±3.41)分]高于对照组[(40.88±4.66)分],差异均有统计学意义(P<0.05)。结论深层电动肌肉振动仪联合手指康复训练机器人对脑卒中合并手运动功能障碍患效果明显,能够提高手运动功能,改善神经因子水平,有助于促进神经功能缺损恢复和提高日常生活能力。

Objective To investigate the application effect of deep electric muscle vibration instrument combined with finger rehabilitation training robot in rehabilitation treatment of stroke patients with hand movement dysfunction.Methods A retrospective study was conducted on 106 stroke patients,who visited Beijing Rehabilitation Hospital Affiliated to Capital Medical University from February 2022 to February 2023.According to different rehabilitation training methods,they were divided into 50 cases of control group(intervened by finger rehabilitation training robot)and 56 cases of observation group(intervened by deep electric muscle vibrator+finger rehabilitation training machine).After 8 weeks of intervention,hand motor function,total finger activity,clinical efficacy,electroencephalography[brain waveδ/αvalue(DAR),brain symmetry index(BSI)]and serological indicators[natriuretic peptide(NPY)and matrix metalloproteinase-9(MMP-9)],neurological impairment[National Institutes of Health Stroke Scale(NIHSS)]and daily living activities[Activities of Daily Living Assessment(ADL)]were compared between the two groups.Results The total clinical efficacy rate of the observation group was significantly higher than that of the control group(80.36%vs.60.00%),and the difference was statistically significant(P<0.05).After 8 weeks of intervention,the maximum grip strength[(43.17±5.96)N]and maximum pinch strength[(12.03±3.43)N],electromyographic value of hand flexor-extensor muscle[(25.11±3.66)μV],electromyographic value of hand flexor-flexor-superflexor muscle[(14.56±3.27)μV],electromyographic value of dorsal flexor-flexor-superflexor muscle[(9.02±1.77)μV]and electromyographic value of hand back extensor fingers[(20.13±3.25)μV]were higher than those of the control group[(38.99±5.56)N,(9.87±3.55)N,(21.99±3.83)μV,(12.69±2.32)μV,(7.89±1.55)μV,(17.85±3.21)μV],and the differences were statistically significant(P<0.05).The excellent rate of finger activity in the observation group was 85.71%,which was significantly higher than 66.00%in the control group,and the difference was statistically significant(P<0.05).After 8 weeks of intervention,the DAR(2.73±0.75),BSI(0.25±0.08)and serum NPY[(110.63±5.33)μg/L]and MMP-9[(80.23±4.55)μg/L]levels in the observation group were lower than those in the control group[3.11±0.88,0.33±0.05,(120.55±6.61)μg/L,(83.53±5.39)μg/L],and the differences were statistically significant(P<0.05).After 8 weeks of intervention,the NIHSS score[(8.89±2.28)points]in the observation group was lower than that of the control group[(10.02±2.33)points],and the ADL score[(44.25±3.41)points]was higher than that of the control group[(40.88±4.66)points],and the differences were all statistically significant(P<0.05).Conclusion The combination of deep electric muscle vibration instrument and finger rehabilitation training robot has a significant effect on stroke patients with hand movement dysfunction,which can improve hand motor function and neurofactors levels,and help to promote the recovery of neurological deficits and daily living abilities.