肌电生物反馈疗法对脑卒中患者手功能的影响

发布时间：2018-02-26 20:25

本文关键词： 肌电值生物反馈脑卒中手功能　出处：《泸州医学院》2014年硕士论文　论文类型：学位论文

【摘要】：目的脑卒中（stroke）的发病率在国内外呈现逐年上升的趋势，随着现代医学诊疗水平的提高，脑卒中后病死率降低，但致残率却大大增加。根据神经发育原理，脑卒中后肢体功能恢复过程呈现下肢恢复比上肢快，并由近端向远端恢复的特点，所以手功能恢复时间较上肢恢复时间长。然而，手的功能在日常生活中却具有重要的作用，所以近年来对脑卒中后手功能恢复的研究逐渐成为热点。其中，肌电生物反馈疗法(Electro-myographic biofeedback therapy)是研究较多的一种康复治疗方法。它作为肌电反馈治疗的一种，近年来越来越多地应用于脑卒中患者肢体功能障碍，并取得了较好的疗效。本研究旨在探讨一种有效的方法治疗脑卒中后手功能障碍，以减少脑卒中患者因手活动受限而对日常生活造成的影响,同时也对手功能的评定方法作进一步探讨。通过研究肌电生物反馈对脑卒中患者偏瘫侧手功能的影响，寻找有效的改善偏瘫患者手功能的方法。方法1、预实验：选择同1w内在我科住院的2例性别、年龄、病程、病变性质均相同或相似的患者进行预实验，从入选时到肌电生物反馈疗法治疗11w内，每周观察两名患者桡侧腕伸肌主动收缩时的最大肌电值,腕关节背伸主动活动度(active range of motion, AROM)，食指和拇指2min内对捏与松开的次数，Fugl-Meyer评定量表（Fugl-Meyer assessment，FMA）上肢腕手功能评分：包括腕背伸、屈曲、环转运动、手指共同屈曲、手指共同背伸、钩状抓握、侧捏等，总分24分。采集预实验中各项实验数据，参照实验结果，根据所选研究对象的疾病情况进行正式实验的设计。2、正式实验：将符合条件的脑卒中患者80例按入院先后顺序编号后按照SPSS21产生的随机序列号随机分为试验组和对照组，每组40例。两组均常规予以运动疗法，包括：感觉刺激、肌力训练、平衡训练、关节活动度训练、牵伸训练、易化与抑制技术等。40min/次，5次/w。试验组在相同运动疗法基础上加用肌电生物反馈治疗，刺激时间为10s，间歇时间为10s。20min/次，5次/w。将两组结果进行比较，分别观察入选时、治疗后3w、治疗后6w、治疗后9w患者各项评定指标的变化情况。结果治疗前，两组患者的桡侧腕伸肌主动收缩时的最大肌电值，腕关节背伸AROM，食指和拇指2min内对捏与松开的次数，简化FMA上肢腕手功能评分均没有明显差异(P0.05)；经过治疗后对照组各项评分均有提高(P 0.001)，与对照组比较，试验组各项评分均有显著提高(P 0.05)，差异有统计学意义(P 0.05)。结论1、采用桡侧腕伸肌主动收缩时的最大肌电值，腕关节背伸AROM，，食指和拇指2min内对捏与松开的次数，简化FMA上肢腕手功能评分对判断脑卒中后手功能恢复有指导意义。2、肌电生物反馈治疗配合运动疗法可有效改善脑卒中后患者偏瘫侧手功能障碍，疗效优于单用运动疗法。
[Abstract]:Objective the incidence of stroke stroke is increasing year by year at home and abroad. With the improvement of modern medical diagnosis and treatment, the fatality rate of stroke decreases, but the disability rate increases greatly. The recovery process of limb function after stroke is faster than that of upper limb, and the recovery time of hand function is longer than that of upper limb, so the recovery time of hand function is longer than that of upper limb. However, hand function plays an important role in daily life. So in recent years, the research on hand function recovery after stroke has gradually become a hot topic. Among them, electromyographic biofeedback therapy (EMG) is a kind of rehabilitation therapy, which is a kind of electromyography feedback therapy. In recent years, more and more applications have been applied to the limb dysfunction of stroke patients, and good results have been obtained. This study aims to explore an effective method for the treatment of hand dysfunction after stroke. In order to reduce the influence of hand movement limitation on daily life in stroke patients and to further explore the evaluation method of hand function, the effects of myoelectric biofeedback on hemiplegic hand function in stroke patients were studied. Methods (1) Pre-experiment: two patients with the same sex, age, course of disease and pathological changes were selected to carry on the pre-experiment, which had the same sex, age, course of disease and pathological changes. From the time of selection to the electromyoelectric biofeedback therapy for 11 weeks, the maximal myoelectric values of two patients with active contraction of extensor Carpi radialis were observed weekly. Active range of wrist extension active range of motion, AROMN, forefinger and thumb within 2 minutes of kneading and loosening the Fugl-Meyer Assessment FMA-Fugl-Meyer Assessment FMAs of upper limb wrist and hand function score: wrist extension, flexion, circumflex movement, joint flexion of finger, joint extension of finger, joint extension of finger, and so on. Hook grip, side pinch, total score of 24 points. Collect the experimental data in the preliminary experiment, refer to the experimental results, According to the disease condition of the selected subjects, the design of the formal experiment. 2. The formal experiment: 80 patients with stroke who met the criteria were randomly divided into the experimental group and the control group according to the random serial number produced by SPSS21 after the number of patients were numbered according to the order of admission. 40 cases in each group were treated with routine exercise therapy, including sensory stimulation, muscle strength training, balance training, joint motion training, and drafting training. The experiment group was treated with EMG biofeedback on the basis of the same exercise therapy. The stimulation time was 10s, the interval time was 10s. The results of the two groups were compared. Results before treatment, the maximal myoelectric value of radial extensor carpal muscle, the times of wrist dorsal extension of AROM, the number of kneading and loosening of forefinger and thumb within 2 minutes after treatment were measured. There was no significant difference in the score of wrist and hand function in simplified FMA. After treatment, all scores in the control group were improved (P 0.001), compared with that in the control group. All the scores in the test group were significantly improved (P 0.05), and the difference was statistically significant (P 0.05). Conclusion 1. The maximum myoelectric value of radial extensor carpal muscle and the times of pinch and release of wrist dorsal extension AROM, forefinger and thumb within 2 minutes were used. The simplified FMA score of wrist-hand function of upper limb is of guiding significance in judging the recovery of hand function after stroke. EMG biofeedback therapy combined with motor therapy can effectively improve hemiplegic hand dysfunction after stroke, and the curative effect is better than that of motor therapy alone.
【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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