强化躯干肌等速肌力训练对脑卒中偏瘫患者步行功能的影响

目的观察强化躯干肌等速肌力训练对脑卒中偏瘫患者步行功能的影响。方法将60例脑卒中患者按照随机数字表法随机分为观察组与对照组,每组30例。对照组进行常规康复训练治疗,观察组在常规康复训练治疗的基础上增加躯干肌等速肌力训练,治疗前评估两组患者的基线特征,采用等速测力装置对躯干进行力学特征评估,分别选取躯干屈肌群及躯干伸肌群峰力矩作为评估指标,采用三维步态分析系统采集步频、步速、步长等参数。治疗8周后再次评估两组患者上述指标。结果治疗前,两组患者的躯干屈、伸肌群峰力矩,步频、步速及步长的差异无统计学意义(P0.05),经过8周康复训练后,观察组、对照组的上述指标较治疗前均有改善,观察组与对照组治疗后组间比较差异具有统计学意义(P0.05)。结论强化躯干肌等速训练对提高脑卒中偏瘫患者步行功能具有显著促进作用。     

脑卒中偏瘫患者肘关节屈伸肌等速肌力测试研究

目的：通过对脑卒中患者肘关节等速运动的测试分析，探讨脑卒中偏瘫患者肘关节肱二头肌、肱三头肌的功能，为脑卒中后偏瘫上肢的临床治疗和训练提供科学依据。方法：选择14例脑卒中轻偏瘫或处于恢复期的患者．观察在进行肘关节低速（60°/s）、中速（120°/s）、高速（180°/s）等速运动时，肘关节屈曲和伸展运动时的峰力矩、峰力矩，体重比、屈伸肌峰力矩比。比较肘关节高速运动测试时肘屈肌和伸肌的平均功率、做功量和到达峰力矩时间。结果：在低、中、高速3种运动速度测试时，肘屈、伸肌峰力矩及峰力矩体重比，患侧均较对侧减弱．两侧相比差异有显著和非常显著性意义；肘关节屈伸力矩比，在低速运动测试时患侧大于对侧（P〈0．05），中速和高速运动测试时患侧也有增大趋势，但无显著性差异；偏瘫患者在高速运动测试时，患侧肘关节不论是屈肌还是伸肌，其平均功率、做功量均较对侧明显下降，差异有显著性意义；到达峰力矩时间患侧伸肌明显延长，差异有显著性意义．患侧屈肌也较对侧有延长趋势，但无显著性差异。结论：轻偏瘫患者，其患侧肘关节屈伸肌肌力、肌肉耐力、肌肉做功效率均较对侧降低．而伸肌侧下降更明显。提示脑卒中后偏瘫上肢应以训练伸肌肌力为主。     

躯干肌慢速等速向心收缩肌力的测试研究

目的:研究不同速度对躯干肌慢速等速肌力测试的影响,探讨用于躯干肌肌力评定的慢速等速肌力测试合理的速度参数。方法:健康受试者43例,使用美国产BiodexⅡAP型多关节等速测试系统测定躯干肌峰力矩(PT)、相对峰力矩(PT/BW)、总功(TW)、相对总功(TW/BW)和屈伸比值(F/E),测试角速度分别选用30°/s和60°/s。结果:伸展收缩测试时两组间的PT、PT/BW、TW和TW/BW比较差异有显著性意义(P<0.05),屈曲收缩测试时上述指标比较差异无显著性意义(P>0.05),两组间F/E差异有显著性意义(P<0.05)。结论:躯干肌慢速等速测试中,速度明显影响伸展测试值,30°/s比60°/s等速测试似更能反映躯干肌的力学特征,而对屈曲测试值的影响并不明显,在慢速范围内,屈肌肌力测试值似处于稳定的峰值状态。     

脑卒中患者躯干肌肌力和躯干控制问题

脑卒中患者除肢体肌力常受损外,躯干肌肌力也常常受损,从而使躯干控制能力受到影响。本文介绍了脑卒中患者躯干肌肌力受损的研究状况及躯干肌肌力和躯干控制能力的评测及躯干控制能力对康复预后的预测问题。     

三维步态分析训练结合等速肌力训练对老年脑卒中后偏瘫患者膝过伸的影响

目的:探讨三维步态分析训练结合等速肌力训练对老年脑卒中后偏瘫患者膝过伸的影响。方法:按照随机数字表法将2018年3月～2019年5月收治的125例老年脑卒中后偏瘫膝过伸患者分为对照组62例和观察组63例,对照组予以等速肌力训练,观察组在对照组基础上增加三维步态分析训练,干预2个月。比较两组干预前后下肢运动功能、步态时空参数和关节运动学参数。结果:干预后观察组Fugl-Meyer运动功能量表及功能性步行量表评分高于对照组(P0.05);干预后观察组步频、步速、步幅及患侧摆动相时间均高于对照组,双支撑相时间、步行周期及患侧支撑相时间低于对照组(P0.05);干预后观察组最大屈膝角度大于对照组,最大伸膝角度小于对照组(P0.05)。结论:三维步态分析训练结合等速肌力训练可改善老年脑卒中后偏瘫膝过伸患者步态功能,提高其下肢运动能力。     

等速肌力训练对脑卒中偏瘫患者下肢功能恢复的影响

目的:观察等速肌力训练对偏瘫患者下肢功能恢复的影响。方法:将我院收治的40例偏瘫患者随机分为观察组和对照组各20例,对照组采用常规康复训练,包括运动治疗(神经促进疗法、平衡功能训练、等张肌力训练、桥式运动、重心转移训练、步态训练、协调与运动控制训练等)、作业治疗、传统康复疗法、物理因子治疗。观察组在常规康复训练的基础上增加偏瘫下肢屈、伸膝肌群等速肌力训练,测试及训练模式为普通等速向心/向心模式。治疗前后分别采用等速肌力测试训练仪的峰力矩值(PT)、Fugl-Meyer运动功能评分、功能独立性评分、Berg平衡功能评分及改良Ashworth肌痉挛分级(MAS)对患者下肢肌痉挛及功能情况进行分析。结果:治疗10周后,2组患者膝关节伸屈膝肌PT、Fugl-Meyer评分、Berg评分及FIM评分均较治疗前明显提高,且观察组更高于对照组(P<0.05)。治疗前后2组患者肌痉挛MAS评分组间及组内比较差异均无统计学意义。结论:等速肌力训练对偏瘫患者下肢功能恢复有明显改善作用。     

核心肌群等速肌力训练对肩峰撞击综合征康复治疗效果的影响

目的观察核心肌群等速肌力训练对肩峰撞击综合征(subacromial impingement syndrome,SAIS)康复治疗效果的影响,优化SAIS康复治疗方案。方法选择2018年1月—2019年6月内蒙古医科大学第二附属医院康复科的SAIS患者,利用随机数字表法随机分成治疗组和对照组。对照组采用传导热治疗、标准物理治疗(physiotherapy,PT)和冷疗,及自行进行肩关节功能锻炼的方法;治疗组采用核心肌群等速肌力训练配合传导热治疗、标准PT治疗、冷疗的方法。两组共治疗8周。分别于治疗前、治疗后对两组患者进行肩关节等速肌力测试[屈肌峰力矩(flexor peak torque,FPT)和伸肌峰力矩(extensor peak torque,EPT)],及进行视觉模拟评分法(visual analogue scale,VAS)、肩关节疼痛和功能障碍指数(Shoulder Pain and Disability Index,SPADI)评分及简明健康状况调查表(Short Form 36 Health Survey Questionnaire,SF-36)评分。结果共纳入SAI...     

等速肌力训练在脑卒中偏瘫患者上肢康复中的应用研究进展

等速肌力训练是目前国际上最先进的肌力训练方法,在脑卒中偏瘫患者上肢康复中的应用逐渐增多,但缺乏统一标准的训练范式,且对上肢运动功能改善的有效性有待证实。本文总结近年来等速肌力训练在脑卒中偏瘫患者上肢功能康复中的应用现状,归纳常见的训练方案,总结其优势和不足,旨在为进一步的临床研究提供参考。     

偏瘫患者膝关节伸屈肌等速肌力测试研究

目的了解偏瘫病人恢复独立行走后患肢和健肢的肌力、屈伸肌力比,探讨膝关节不稳定的原因。方法采用Ｃｙｂｅｘ ＮＯＲＭ系统对１０例脑卒中偏瘫病人进行膝伸、屈肌等速肌力测试。结果３种角速度６０、１２０、１８０（°／ｓ）向心和６０°／ｓ离心伸屈肌峰力矩平均值健侧均高于患侧,伸肌１２０°、１８０°／ｓ和屈肌６０°、１８０°／ｓ健侧峰力矩显高于患侧（Ｐ值均＜０．０５）,离心伸肌６０°／ｓ时（Ｐ＜０．０５）;离     

Accuracy and cut-off points of different models of knee extension strength analysis to identify walking performance in individuals with chronic stroke

BackgroundAdequate muscle strength is essential for walking performance in individuals with stroke.ObjectiveTo investigate the accuracy of different forms of muscle knee extension strength analysis to identify high or low walking performance in individuals with chronic stroke.MethodsTwenty-eight participants with a chronic stroke for more than six months participated. Independence for walking was judged by measurement of walking performance assessed for comfortable walking speed (CWS), maximum walking speed (MWS), and the Six Minute Walk Test (6MWT). Peak knee extension torque of the paretic side, non-paretic side, sum of the sides (SS), and difference in the sides (DS) was assessed during concentric movements using an isokinetic dynamometer.ResultsThe equation with greatest predictive capacity for CWS and MWS included the DS as the main predictor (R² of 0.65 and 0.71, respectively, p < 0.05). The variable with the greatest predictive capacity for 6MWT was time since injury (R² of 0.68, p < 0.05). The highest percentile for CWS in the receiver operating characteristic curve of DS was 25 Nm/kg (cut-off: -12.75 for CWS of 0.498 m/s). The 75th percentile of the 6MWT (324.3 m) was used as the cut-off for the SS (2.1 Nm/kg). The area under the curve for CWS was 0.76 (p < 0.05) on the DS and 0.75 (p < 0.05) for 6MWT on the SS.ConclusionThe models of muscle knee extension strength analysis using the SS and DS presented moderate accuracy to identify walking performance in individuals with chronic stroke.     

Effects of repeated ankle stretching on calf muscle-tendon and ankle biomechanical properties in stroke survivors

Background

The objective of this study was to investigate changes in active and passive biomechanical properties of the calf muscle–tendon unit induced by controlled ankle stretching in stroke survivors.

Methods

Ten stroke survivors with ankle spasticity/contracture and ten healthy control subjects received intervention of 60-min ankle stretching. Joint biomechanical properties including resistance torque, stiffness and index of hysteresis were evaluated pre- and post-intervention. Achilles tendon length was measured using ultrasonography. The force output of the triceps surae muscles was characterized via the torque–angle relationship, by stimulating the calf muscles at a controlled intensity across different ankle positions.

Findings

Compared to healthy controls, the ankle position corresponding to the peak torque of the stroke survivors was shifted towards plantar flexion (P < 0.001). Stroke survivors showed significantly higher resistance torques and joint stiffness (P < 0.05), and these higher resistances were reduced significantly after the stretching intervention, especially in dorsiflexion (P = 0.013). Stretching significantly improved the force output of the impaired calf muscles in stroke survivors under matched stimulations (P < 0.05). Ankle range of motion was also increased by stretching (P < 0.001).

Interpretation

At the joint level, repeated stretching loosened the ankle joint with increased passive joint range of motion and decreased joint stiffness. At the muscle–tendon level, repeated stretching improved calf muscle force output, which might be associated with decreased muscle fascicle stiffness, increased fascicle length and shortening of the Achilles tendon. The study provided evidence of improvement in muscle tendon properties through stretching intervention.     

肌力训练对偏瘫步态的影响及下肢功能评定与步态分析间的相关性

目的　本文探讨了偏瘫患者在恢复期行患肢膝关节屈伸肌群肌力训练的效果 ,以及下肢功能评定与步态分析之间的相关性。方法　 5 0例脑卒中患者随机分为观察组 ( 30例 )和对照组 ( 2 0例 ) ,二组患者康复训练相同 ,观察组患者在恢复期增加患肢股四头肌、绳肌肌力训练。治疗前后分别采用Fugl Meyer法、Barthel指数法及足印法对二组患者下肢功能及步态进行分析。结果　观察组患者步态较对照组明显改善 (P<0 .0 1)、运动功能与活动能力显著提高 (P <0 .0 1)。步态的对称性与下肢运动功能、平衡功能显著相关 (r =-0 .79,-0 .71、P <0 .0 1) ,与活动能力无关 (r =-0 .2 1,P >0 .0 5 ) ;步速与下肢运动功能、平衡功能、活动能力均显著相关 (r =0 .80、0 .78、0 .76 ,P <0 .0 1)。结论　偏瘫患者在恢复期行患肢膝屈伸肌群肌力训练有助于运动功能提高、步态改善 ;通过足印法步态分析可初步了解下肢步行能力。     

Effect of increases in plantarflexor and hip flexor muscle strength on the levels of effort during gait in individuals with hemiparesis

BACKGROUND: Following a stroke, strength gain of the trained affected lower-limb muscles has been observed to result in a change in gait speed, but its effect on other variables related to gait performance has scarcely been studied. The aim of this study was to assess the effect of strength gain of the affected plantarflexors and hip flexors on bilateral levels of effort during gait, in the sagittal plane of movement. METHODS: The levels of effort of 24 chronic hemiparetic participants (mean (standard deviation (SD)): 57.3 (SD 15.5) years), who had strength gains in the ankle and hip muscles following a strengthening programme, were estimated with the muscular utilization ratio during self-selected and maximal speeds. The ratio relates the net moment in gait relative to the muscle's maximal capability. The peak value and the area under the curve of the ratio were used as main outcome measures. FINDINGS: Regardless of speed, strength gains have been noted to cause a significant 12-17% decrease in the peak value of the ratio of the affected plantarflexors and hip flexors with a reduction of the area under the curve of the affected hip flexors' ratio and a trend toward a decrease for the affected plantarflexors at maximal speed. A significant, albeit small increase in self-selected and maximal gait speeds (P<0.05) was also observed post-training. Regardless of assessment time, the peak value of the affected plantarflexors' ratio was greater than that of the affected hip flexors at self-selected speed (P=0.006) and the area under the curve of the affected hip flexors' ratio was greater than that of the affected plantarflexors (P=0.007) at maximal speed. Generally, negative associations (-0.32-0.83) were noted between the changes in the peak value of the ratio and strength but not between the changes in gait speed. INTERPRETATION: The decrease in the peak value of the ratio could be explained by the increase in strength. Becoming stronger, hemiparetic participants favoured a reduction of their levels of effort during walking instead of substantially increasing their gait speed.     

Thera-Band抗阻肌力训练对脑卒中患者下肢运动功能及步态的影响

目的 观察Thera-Band渐进抗阻肌力训练对脑卒中后患者下肢运动功能及步态的影响。 方法 将脑卒中后偏瘫患者48例按随机数字表法分为治疗组（24例）和对照组（24例）。对照组采用常规康复治疗,治疗组在常规康复治疗基础上增加Thera-Band弹力带对偏瘫侧肌肉进行渐进抗阻训练。分别于治疗前和治疗8周后（治疗后）采用Fugl-Meyer运动功能评定量表(FMA)、Berg平衡量表(BBS)、功能独立性评定量表（FIM）中的行走和上下楼梯功能检测标准以及GaitWatch步态分析对2组患者进行评定。 结果 治疗后,治疗组的FMA评分［(24.54±2.47)分］、Berg评分［(39.21±2.25)分］、FIM评分［(12.46±1.06)分］、步频［(79.00±8.08)steps/min］、步幅［(59.75±3.31)cm］、步速［(40.29±5.04)cm/s］以及对照组的FMA评分［(20.67±2.65)分］、Berg评分［(28.92±2.90)分］、FIM评分［(11.92±0.97)分］、步频［(69.17±8.11)steps/min］、步幅［(56.38±3.46)cm］、步速［(36.08±4.84)cm/s］与组内治疗前比较,均有显著改善,差异均有统计学意义(P<0.05）,且治疗组患者的FMA评分、Berg评分以及GaitWhatch步频、步幅、步速与对照组治疗后比较,差异均有统计学意义（P<0.05）。 结论 Thera-Band弹力带渐进抗阻训练结合常规康复训练可有效地改善脑卒中患者运动和步行能力。     

Ankle range of motion is key to gait efficiency in adolescents with cerebral palsy

Background

Gait in young people with cerebral palsy is inefficient and there is a lack of relevant indicators for monitoring the problem. In particular, the impact of gait kinematics on gait efficiency is not well documented. The aim of this study is to examine the relationship between gait efficiency, gait kinematics, lower limb muscle strength, and muscular spasticity in adolescents with cerebral palsy.

Methods

Ten ambulatory adolescents with spastic cerebral palsy were recruited. The energy expenditure index during gait, gait kinematics, flexion and extension knee isometric muscle strength, and quadriceps spasticity were assessed.

Findings

Energy expenditure index (1.5 (0.7) beats/m) was strongly correlated with the ankle and knee flexion/extension ranges of motion (r = −0.82, P < 0.01 and r = −0.70, P < 0.02, respectively) and also with maximal plantar flexion (r = 0.74, P < 0.05) during gait. Knee flexion strength was the only strength measurement correlated with energy expenditure index (r = −0.85; P < 0.01).

Interpretation

This study suggests that ankle and knee flexion/extension ranges of motion during gait are key kinematics factors in gait efficiency in adolescents with cerebral palsy.     

骨盆训练对中风步态的影响

目的：在普通的步态训练方法中增加新的骨盆训练措施，探索骨盆训练对中风患者步态的影响。方法：随机将78例中风步态异常者分为对照组（39例）和试验组（39例），对照组采用普通的步态训练方法，试验组则在上述基础上增加骨盆训练措施，如骨盆旋转运动，侧方运动、上下运动、旋前运动、前伸运动、后缩运动、前缩运动和后伸运动。治疗前和治疗后，由专人用Barthel指数、Brunnstrom恢复六阶段理论以及Fugl-Meyer躯体能力评定量表评测每痊参试者。结果进行相关的统计学处理。结果：治疗后试验组和对照组的Brunnstrom偏瘫下肢运动功能分级经过等级秩和检验，P值小于0.05，其差异具有显著性意义。治疗后试验组和对照组的Barthel指数和瘫痪下肢Fugl-Meyer运动能力评定积分经过常规t检验，P值均小于0.05，其差异具有显著性意义。结论：该试验结果显示在普通的步态训练方法中增加骨盆训练的措施，不仅可以提高中风患者日常生活活动能力改善的程度，还可以提高下肢运动功能恢复的效率，进一步改善步态。