下肢单侧负重训练对痉挛型偏瘫脑瘫患儿步态参数的影响

发布时间：2018-05-07 22:07

本文选题：偏瘫痉挛型脑瘫 + 步态　；参考：《天津体育学院》2017年硕士论文

【摘要】：痉挛型偏瘫脑瘫是最常见的脑瘫类型之一。这一类型脑瘫患者因一侧肢体受累而呈偏瘫代偿步态,这一步态具有步行期间运动神经协调性差,存在步幅短,步频高,稳定性差的特点。同时有健侧支撑相过长,摆动相较短的问题。台湾治疗师叶苍甫老师在Bobath疗法基础上提出了健侧负重方法以干预偏瘫脑瘫儿童的病理步态。单侧负重是一种非正常的负重干预手段。目前国内有关单侧负重步行可能对人体步行模式的影响研究仍是空白,而国外有关研究有很多,且有相关研究支持单侧负重对脑卒中代偿步态有治疗意义。脑瘫代偿步态和脑卒中代偿步态有高度相似性。因此本实验拟测定偏瘫痉挛脑瘫儿童健侧下肢踝关节处负重干预对步行周期中双侧下肢运动学参数的影响,以及下肢主要肌肉表面肌电(sEMG)的变化。以期了解健侧负重干预后步行能力的变化。探讨运动控制系统在负重步行中的调控作用。对进一步了解健侧负重对偏瘫脑瘫患儿的影响,探究健侧负重治疗方法的有效性。研究对象和方法:选取12名偏瘫痉挛型脑瘫患儿,受试者在实验过程中在健侧下肢踝关节处佩戴负重用的沙袋之后进行20分钟的沙袋负重步行训练干预。在干预前、干预即刻和干预后分别采集受试者双侧下肢的运动学、sEMG指标。并对这些数据进行统计学处理分析。研究结果:1.干预即刻健侧和患侧支撑期时长和干预前相比均有显著缩小(P0.05),干预后健侧下肢支撑期时长相比干预即刻显著增大(P0.05)。2.患侧步长均在干预即刻和干预后均呈增大趋势,无显著性。3.干预即刻和干预后患侧膝踝关节活动范围无显著性变化。4.健侧胫骨前肌、股二头肌、腓肠肌在干预即刻的支撑期摆动期平均振幅与干预前相比均显著增大(P0.05)。健侧胫骨前肌、患侧胫骨前肌摆动期平均振幅干预后与干预即刻相比显著缩小(P0.05)。健侧胫骨前肌摆动期平均振幅干预即刻与干预前相比显著增大(P0.05)。6.健侧腓肠肌支撑期平均振幅干预即刻与干预前相比显著增大(P0.05)。健侧腓肠肌支撑期平均振幅干预后与干预即刻相比显著缩小(P0.05)。健侧腓肠肌摆动期平均振幅干预后与干预即刻相比显著缩小(P0.05)。健侧腓肠肌支撑期平均振幅干预即刻与干预前相比显著增大(P0.05)。7.患侧股二头肌摆动期平均振幅干预即刻与干预前相比显著增大(P0.05)。患侧股二头肌支撑期、摆动期平均振幅干预后与干预即刻比显著缩小(P0.05)。健侧股二头肌支撑期、摆动期平均振幅干预即刻与干预前比显著增大(P0.05)。8.患侧股直肌摆动期平均振幅干预后与干预即刻相比显著增大(P0.05)。患侧股直肌支撑期平均振幅干预即刻与干预前相比显著增大(P0.05)。健侧股直肌摆动期平均振幅干预即刻与干预前相比显著增大(P0.05)。健侧股直肌支撑期平均振幅干预后与干预前相比显著缩小(P0.05)。研究结论:1.健侧负重干预即刻双下肢的摆动期支撑期均有显著性增大,干预后二者均有减小趋势,其中健侧支撑期减小更大,患侧相对维持增长不变,提示干预后患侧步行稳定性提高。双下肢步行周期中摆动期时间占比在干预即刻均有增长,提示步态能力得到提高。干预即刻干预后患侧跨步长、步长均有增加趋势,步态参数得到改善。2.单侧负重该干预对于患侧膝踝关节活动范围改善意义不大。健侧负重干预在干预即刻打破了原有的的步态模式,但在干预后已经重新建立起步态模式。3.下肢各肌肉表面肌电数据表明下肢单侧负重会增加除健侧股直肌外其他七块肌肉的激活程度,但在干预后迅速恢复干预前水平。而健侧股直肌扔保持低激活水平,提示患侧股直肌肌肉激活相对提高,提高提示健侧负重干预会增大下肢主要肌群的激活水平,使得步态稳定性提高。下肢肌肉的协同性分析表明健侧负重干预对于步态具有改善作用。
[Abstract]:Spastic hemiplegic cerebral palsy is one of the most common types of cerebral palsy. This type of cerebral palsy suffers from hemiplegia compensatory gait. This gait has the characteristics of poor coordination of motor nerve during walking, short stride, high step frequency and poor stability. At the same time, it has the problem of long stride support and short swing. Taiwan therapist On the basis of Bobath therapy, Mr. Ye Cangfu proposed a healthy side weight method to interfere with the pathological gait of children with hemiplegic cerebral palsy. Unilateral weight-bearing is an abnormal weight bearing intervention. At present, the study on the effect of single load walking on human walking pattern is still blank, but there are many foreign related research and related research. The effect of the compensatory gait of cerebral palsy and the compensatory gait of cerebral apoplexy is highly similar. Therefore, this experiment is to determine the effect of weight intervention on the kinematic parameters of bilateral lower limbs in the walking cycle and the surface electromyography of the main muscles of the lower limbs (s EMG) changes. In order to understand the changes in walking ability after the healthy side weight loss. Explore the control function of the exercise control system in the load walking. To further understand the effect of the healthy side weight on the hemiplegia cerebral palsy children, explore the effectiveness of the method of the side weight treatment. Research object and method: 12 children with hemiplegic spastic cerebral palsy were selected. In the course of the experiment, a sandbag loaded walking training intervention was carried out for 20 minutes after wearing a sand bag in the ankle joint of the healthy side of the lower extremities. Before intervention, the kinematics of the lower limbs of the lower limbs of the subjects were collected and the sEMG indexes were collected. The data were analyzed statistically. The results were: 1. intervention on the immediate side of the healthy side. There was a significant reduction in the length of the patient's support period and before the intervention (P0.05). After intervention, the phase ratio of the healthy side of the lower limb was significantly increased (P0.05) and the lateral step of.2. was increased in both immediate and post intervention. No significant.3. intervention had no significant changes in the range of the knee and ankle joint activity after the intervention of.4.. The average amplitude of the lateral tibial anterior muscle, the two head of the femoris and the gastrocnemius muscle during the intervention period was significantly higher than that before the intervention (P0.05). The average amplitude of the lateral tibial anterior muscle in the healthy side, the average amplitude of the lateral tibial muscle in the affected side of the tibial muscle was significantly reduced (P0.05). The mean amplitude of the wobble period of the anterior tibial muscle in the healthy side was immediately and before the intervention. The average amplitude intervention of the gastrocnemius muscle support phase in the healthy side of the healthy side was significantly increased compared with that before the intervention (P0.05). The average amplitude of the amplitude of the prop in the healthy side of the gastrocnemius muscle was significantly smaller than that of the intervention (P0.05). The mean amplitude of the sway gastrocnemius muscle in the healthy side was significantly smaller than that of the intervention (P0.05) after intervention (P0.05). The healthy side of the gastrocnemius was significantly reduced (P0.05). The mean amplitude intervention of the muscle support period was significantly higher than before the intervention (P0.05) the mean amplitude intervention of the two head muscles in the.7. affected side of the affected side was significantly higher than before the intervention (P0.05). The average amplitude of the amplitude of the swinging stage was significantly reduced (P0.05) at the stage of the swinging stage and the intervention of the two heads of the healthy side, and the swing period of the wobble period. The mean amplitude intervention was significantly higher than that before intervention (P0.05) the average amplitude of the amplitude of the lateral femoral rectus muscle in.8. affected side was significantly increased (P0.05). The mean amplitude intervention of the lateral femoral rectus muscle in the affected side was significantly higher than before the intervention (P0.05). The intervention of the mean amplitude of the lateral femoral rectus muscle in the healthy side was compared with that before the intervention. A significant increase (P0.05). The average amplitude of the amplitude of the lateral femoral rectus muscle in the healthy side was significantly reduced compared with that before the intervention (P0.05). Conclusion: 1. a significant increase in the support period of the wobble period of the immediate double lower limbs was significantly increased by the intervention of the healthy side of the healthy side, and the two all decreased after the intervention, in which the support period of the healthy side decreased more, and the relative maintenance of the affected side remained unchanged. The stability of the patient's walking was increased after the intervention. The time period of the wobble period was increased at the moment of intervention in the walking cycle of the lower extremities, suggesting that the gait ability was improved. The step length of the affected side after intervention was increased, and the gait parameters improved the significance of the.2. unilateral load to improve the range of the knee and ankle joint activities. The intervention of healthy side weight intervention broke the original gait pattern immediately after intervention, but the data of the muscle surface electromyography of the lower extremities of.3. had been reestablished after the intervention. The activation degree of the other seven muscles except the lateral femoral rectus muscles in the lower extremities was increased, but the level of the other muscles before intervention was quickly restored after intervention. The lower activation level of the rectus femoris is maintained, which suggests that the muscle activation of the rectus femoris is relatively improved. It suggests that the intervention of the healthy side will increase the activation level of the main muscles of the lower extremities and improve the stability of the gait. The synergistic analysis of the lower limb muscles indicates that the intervention of the healthy side weight is improved in the gait.

【学位授予单位】：天津体育学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：G804.6

【参考文献】