步行模式的功能性电刺激不同治疗时间对脑卒中患者下肢功能影响的随机对照研究CSCD

目的:探讨基于正常行走模式的智能化、多通道步行模式功能性电刺激(FES)改善脑卒中患者下肢运动功能的疗效及其与治疗时间的相关性,为步行模式FES的临床应用提供依据。方法:采用Minimize软件将18例脑卒中患者随机分为60 min步行模式FES组(60 min组)和30 min步行模式FES组(30 min组),每组各9例。2组的常规治疗相同,在此基础上,60 min组采用步行模式FES辅助行走30 min+卧位电刺激30 min;30 min组采用步行模式FES辅助行走30 min+卧位安慰刺激30 min。电刺激1次/d,5 d/周,共15次。在治疗前、治疗7次后、治疗15次后、治疗结束1个月后分别进行改良Ashworth量表(MAS)、徒手肌力检查(MMT)、Fugl-Meyer下肢功能评定(FMA-LE)、Berg平衡评定(BBS)、10 m步行测试(10MWT)步速和改良Barthel指数(MBI)评估,以判断患者患侧下肢运动功能和日常生活活动能力的变化。结果:组内比较发现,与治疗前相比,2组治疗7次后、治疗15次后和随访时的MAS、MMT、FMA-LE、BBS差异均有统计学意义(P<0.05);60 min组在治疗后的3次评估中MBI的变化均有统计学意义(P<0.05),而30 min组仅在治疗7次后和治疗15次后的MBI变化有统计学意义(P<0.05);60 min组在治疗7次后和治疗15次后10 MWT步速的差异有统计学意义(P<0.05),而30 min组仅在治疗15次后的10 MWT步速变化有统计学意义(P<0.05)。组间比较发现,治疗7次后,60 min组MAS、10MWT步速改善更明显(P<0.05);治疗15次后,MAS、FMA-LE、MBI组间差异均有统计学意义(P<0.05);随访时,MAS、MBI组间比较差异有统计学意义(P<0.05)。结论:智能化、多通道步行模式功能性电刺激能有效改善脑卒中患者下肢运动功能、平衡、行走和日常生活活动能力;而延长治疗时间(从治疗30 min到60 min)可以达到降低肌张力、改善患侧下肢运动功能、提高步速和生活自理能力的效果,且能够延长生活自理能力的疗效持续时间。

Effects of Functional Electrical Stimulation Based on Walking Pattern with Different Treatment Time on Lower Limb Function in Stroke Patients:A Randomized Controlled Study

Objective:Focusing on the intelligent and multi-channel functional electrical stimulation(FES)based on normal walking patterns,we explored the correlation between therapeutic effect and stimulating time for improving lower extremity motor function of stroke patients,to provide evidence for further clinical applications of FES based on walking patterns.Methods:The Minimize software was used to divided 18 stroke patients randomly into a group treated with 60 min FES in walking pattern(9 patients,60 min-stimulation group),and the rest were treated with 30 min FES in walking pattern(9 patients,30 min-stimulation group).Both groups received conventional rehabilitation treatment.In addition,the 60 min-stimulation group received FES in walking pattern for 30 min and electric stimulation in the decumbent position for 30 min,while 30 min-stimulation group received FES in walking pattern for 30 min and placebo stimulation for 30 min.The electrical stimulation treatment was applied once per day,5 days per week and totally 15 times.Participants’lower extremity motor functions and ability in daily activities were assessed via modified Ashworth scale(MAS),manual muscle test(MMT),Fugl-Meyer assessment-lower extremity(FMA-LE),Berg balance scale(BBS),10 meter walk test(10 MWT)and modified Barthel index(MBI)in 4 time points:before treatment,after treatments for 7 times,after treatments for 15 times and one month follow up.Results:Compared with before treatment,MAS,MMT,FMA-LE and BBS were statistically different in two groups after treatments for 7 times,15 times and one month follow up(P<0.05).In the 60 min-stimulation group,statistically significant differences in MBI assessments appeared in 3 time points after treatment(P<0.05),while the 30 min-stimulation group only had statistical differences after treatments for 7 times and 15 times(P<0.05).Besides,the 60 min-stimulation group had statistically significant differences in walking speed after treatments for 7 times and 15 times,while the 30 minstimulation group only had a statistically significant difference after treatments for 15 times(P<0.05).Comparing between the two groups,the 60 min-stimulation group showed more significantly improvements in MAS and walking speed after treatments for 7 times(P<0.05);After treatments for 15 times,differences were found in MAS,FMA-LE and MBI(P<0.05)and there were still statistical differences between MAS and MBI during the following-up(P<0.05).Conclusion:The intelligent,multi-channel functional electrical stimulation can effectively improve the lower extremity motor function,balance,walking and daily life activities of stroke patients.While prolonged stimulation time(from 30 min-stimulation to 60 min-stimulation)not only can enhance the therapeutic effect of reducing muscle tone,improving motor function of the affected lower limb,improving gait speed and self-care ability,but also can prolong the duration of the efficacy of self-care ability.