低频穴位电刺激结合强制性运动促进中风后手抓握研究
发布时间：2018-07-14 16:11
【摘要】：目的：针对中风后上肢运动功能障碍难以恢复的问题,改进现有的治疗方法,采用表面肌电客观评价低频穴位电刺激结合强制性运动疗法与电针对手抓握功能的影响,旨在为临床寻求一种更有效的治疗方法提供根据并验证临床疗效。 方法：选择符合标准的脑卒中患者60例,随机分为两组,在常规康复的基础上,对照组给予电针治疗,波形为2Hz连续波,刺激强度以肉眼可见肌肉收缩为度,每次治疗30分钟；治疗组先采用低频穴位电刺激,给予50Hz断续比为1：1的断续波,刺激强度以出现拇指内收四指屈曲、拇指外展四指伸展两组动作交替为度,每次治疗30分钟,然后采用强制性运动疗法,限制健侧肢体使用,强迫患者患肢作握杯子、握笔、拾物以及和日常生活相关的穿衣、刷牙、系扣等训练,每个动作重复10～15次,每次治疗30分钟,两组都选取手三里、外关、鱼际、大陵、内关、灵道穴。采集患者患肢的疗前、疗后手做拇指内收四指屈曲、拇指外展四指伸展动作时的伸、屈肌群的sEMG信号,提取最大值(MAX)、均方根值(RMS),采用MAX、RMS、手关节活动度(ROM).Fugl-Meyer量表(上肢).BarthelADL指数、并根据神经功能缺损评分(上肢)计算有效率作为疗效判定指标 结果： 1.低频穴位电刺激结合强制性运动组与电针组患者患侧疗后伸、屈肌群的MAX.RMS较治疗前均有显著性差异(p0.01),且治疗组患侧MAX、RMS的差值较对照组有显著性差异(p0.01),治疗组优于对照组。 2.低频穴位电刺激结合强制性运动组与电针组患者疗后Fugl-Meyer量表,Barthel ADL指数与治疗前比较均有显著性差异(p0.01),且治疗组患侧Fugl-Meyer量表、Barthel ADL指数评分的差值较对照组有显著性差异(p0.01),治疗组优于对照组。 3.低频穴位电刺激结合强制性运动组与电针组患者疗后手关节活动度(ROM)评分比未治疗前存在明显差异(p0.01),结果显示治疗组优于对照组。 4.低频穴位电刺激结合强制性运动组与电针组患者治疗后神经功能缺损评分较疗前有显著性差异(p0.01),治疗组优于对照组。 结论： 1.低频穴位电刺激结合强制性运动疗法与电针疗法可提高手部及上肢伸、屈肌群收缩功能和单位时间内的做功能力,从而提高患侧伸、屈肌肌力,改善上肢运动功能。 2.低频穴位电刺激结合强制性运动疗法与电针疗法均可改善上肢日常生活能力,对恢复手抓握功能疗效肯定,但低频穴位电刺激结合强制性运动疗法要优于电针疗法。
[Abstract]:Objective: to improve the existing treatment methods and to evaluate the effects of low frequency acupoint electric stimulation combined with compulsory motor therapy and electroacupuncture on grip function of the upper limb motor dysfunction after apoplexy. The aim is to find a more effective treatment for the clinical basis and verify the clinical efficacy. Methods: sixty stroke patients who met the standard were randomly divided into two groups. On the basis of routine rehabilitation, the control group was treated with electroacupuncture, the waveform was 2Hz continuous wave, and the intensity of stimulation was as follows: muscle contraction was visible to the naked eye for 30 minutes each time. In the treatment group, the low frequency acupoint electrical stimulation was first used, and the intermittent wave of 50 Hz was given to 1:1. The intensity of the stimulation was to show the flexion of the thumb with four fingers flexion, and the extension of the four fingers of the thumb was alternately divided into two groups, for 30 minutes each time. Then we used compulsory exercise therapy to restrict the use of healthy limbs, and forced the patients to hold cups, pens, pick up objects and clothing, brush their teeth, fasten their buckles, and so on. Each exercise was repeated 1015 times. Each treatment for 30 minutes, the two groups are selected hand Sanli, Ouguan, thenar, Daling, Neiguan, Lingdao acupoints. The SEMG signals of the flexor and flexor muscles were collected before and after the treatment. The maximum (Max) and root mean square (RMS) were extracted. The index of hand joint motion (ROM). Fugl-Meyer scale (upper limb). Barthel ADL index was used to extract the maximum value (Max), root mean square (RMS), mean square value (RMS), and the index of hand joint motion (ROM), Fugl-Meyer scale (upper limb). According to the nerve function defect score (upper limb), the effective rate was calculated as the index of curative effect: 1. Low frequency acupoint electrical stimulation combined with compulsory exercise group and electroacupuncture group patients with side extension after treatment, There were significant differences in MAX.RMS of flexor group compared with those before treatment (p0.01), and the difference of MAX-RMS in the treatment group was significantly higher than that in the control group (p0.01), and the difference between the treatment group and the control group was better than that in the control group (p0.01). There were significant differences between the low frequency acupoint electric stimulation and compulsory exercise group and electroacupuncture group after treatment with the Fugl-Meyer scale Barthel ADL index (p0.01), and the difference in the score of Barthel ADL index between the treatment group and the control group was significant compared with that of the control group. The difference (p0.01), the treatment group was better than the control group. The range of motion (ROM) of hand joint in the low frequency acupoint electric stimulation combined with compulsory exercise group and electroacupuncture group was significantly different from that before treatment (p0.01). The results showed that the treatment group was better than the control group. 4. There was significant difference in the scores of nerve function defect between the low frequency acupoint electric stimulation group and the electroacupuncture group after treatment (p0.01), and the treatment group was superior to the control group. Conclusion: 1. Low frequency acupoint electrical stimulation combined with forced exercise therapy and electroacupuncture therapy can improve the contractile function of hand and upper limb, flexor group and the ability to do work per unit time, thus increasing the muscle strength of the affected side and flexor muscle. Improved upper limb motor function. 2. Low frequency acupoint electric stimulation combined with compulsory exercise therapy and electroacupuncture therapy can improve the daily life ability of upper limb and have a positive effect on the recovery of hand grip function, but low frequency acupoint electric stimulation combined with compulsory exercise therapy is better than electroacupuncture therapy.
【学位授予单位】：黑龙江中医药大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R245.97
本文编号：2122202
[Abstract]:Objective: to improve the existing treatment methods and to evaluate the effects of low frequency acupoint electric stimulation combined with compulsory motor therapy and electroacupuncture on grip function of the upper limb motor dysfunction after apoplexy. The aim is to find a more effective treatment for the clinical basis and verify the clinical efficacy. Methods: sixty stroke patients who met the standard were randomly divided into two groups. On the basis of routine rehabilitation, the control group was treated with electroacupuncture, the waveform was 2Hz continuous wave, and the intensity of stimulation was as follows: muscle contraction was visible to the naked eye for 30 minutes each time. In the treatment group, the low frequency acupoint electrical stimulation was first used, and the intermittent wave of 50 Hz was given to 1:1. The intensity of the stimulation was to show the flexion of the thumb with four fingers flexion, and the extension of the four fingers of the thumb was alternately divided into two groups, for 30 minutes each time. Then we used compulsory exercise therapy to restrict the use of healthy limbs, and forced the patients to hold cups, pens, pick up objects and clothing, brush their teeth, fasten their buckles, and so on. Each exercise was repeated 1015 times. Each treatment for 30 minutes, the two groups are selected hand Sanli, Ouguan, thenar, Daling, Neiguan, Lingdao acupoints. The SEMG signals of the flexor and flexor muscles were collected before and after the treatment. The maximum (Max) and root mean square (RMS) were extracted. The index of hand joint motion (ROM). Fugl-Meyer scale (upper limb). Barthel ADL index was used to extract the maximum value (Max), root mean square (RMS), mean square value (RMS), and the index of hand joint motion (ROM), Fugl-Meyer scale (upper limb). According to the nerve function defect score (upper limb), the effective rate was calculated as the index of curative effect: 1. Low frequency acupoint electrical stimulation combined with compulsory exercise group and electroacupuncture group patients with side extension after treatment, There were significant differences in MAX.RMS of flexor group compared with those before treatment (p0.01), and the difference of MAX-RMS in the treatment group was significantly higher than that in the control group (p0.01), and the difference between the treatment group and the control group was better than that in the control group (p0.01). There were significant differences between the low frequency acupoint electric stimulation and compulsory exercise group and electroacupuncture group after treatment with the Fugl-Meyer scale Barthel ADL index (p0.01), and the difference in the score of Barthel ADL index between the treatment group and the control group was significant compared with that of the control group. The difference (p0.01), the treatment group was better than the control group. The range of motion (ROM) of hand joint in the low frequency acupoint electric stimulation combined with compulsory exercise group and electroacupuncture group was significantly different from that before treatment (p0.01). The results showed that the treatment group was better than the control group. 4. There was significant difference in the scores of nerve function defect between the low frequency acupoint electric stimulation group and the electroacupuncture group after treatment (p0.01), and the treatment group was superior to the control group. Conclusion: 1. Low frequency acupoint electrical stimulation combined with forced exercise therapy and electroacupuncture therapy can improve the contractile function of hand and upper limb, flexor group and the ability to do work per unit time, thus increasing the muscle strength of the affected side and flexor muscle. Improved upper limb motor function. 2. Low frequency acupoint electric stimulation combined with compulsory exercise therapy and electroacupuncture therapy can improve the daily life ability of upper limb and have a positive effect on the recovery of hand grip function, but low frequency acupoint electric stimulation combined with compulsory exercise therapy is better than electroacupuncture therapy.
【学位授予单位】：黑龙江中医药大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R245.97
【参考文献】
相关期刊论文 前10条
1 江征;何坚;蔡素芳;王辉;郭毅坚;;神经肌肉电刺激疗法对脑卒中上肢功能的影响[J];福建中医药大学学报;2010年05期
2 陈英;曹晶晶;杨卫杰;;电针治疗中风偏瘫肩-手综合征疗效观察[J];光明中医;2009年06期
3 侯天舒;封敏;吴巧凤;;“治痿独取阳明”浅析及针灸临床应用[J];甘肃中医;2011年05期
4 王东岩;李庆玲;杜志江;孙立宁;;5 DOF穿戴式上肢康复机器人控制方法研究[J];哈尔滨工业大学学报;2007年09期
5 石学敏;“醒脑开窍”针刺法治疗中风病9005例临床研究[J];中医药导报;2005年01期
6 周运峰;焦凡;石洪霞;;手三里穴临床应用概况[J];河南中医;2010年08期
7 卢岩;王世军;;电针对局灶性脑缺血大鼠脑葡萄糖代谢的影响[J];辽宁中医杂志;2011年05期
8 张丽丽;杜宇征;褚芹;;近年来“醒脑开窍”针刺法治疗中风的临床及基础研究[J];辽宁中医杂志;2011年06期
9 张军峰;许月红;李震中;王惠凌;王洪娟;尹晶;;缺血性脑卒中危险因素知晓率的流行病学调查及趋势分析[J];脑与神经疾病杂志;2007年06期
10 王东岩;王伟;周围;郇靖;张然;;基于表面肌电信号的腕手功能评定与重建研究[J];中国临床保健杂志;2009年02期
相关会议论文 前1条
1 周宇;;基于中风病现代病机学说的手功能障碍巨刺方法探讨[A];2011中国针灸学会年会论文集（摘要）[C];2011年
相关硕士学位论文 前1条
1 朱莹;屈伸肌交替功能性电刺激与电针对中风抓握功能影响的对比研究[D];黑龙江中医药大学;2011年
，本文编号：2122202
本文链接：https://www.wllwen.com/yixuelunwen/zhxiyjh/2122202.html
