电刺激和运动疗法对早期脑卒中患者运动功能恢复的作用

目的研究经皮电神经刺激疗法(TENS)和运动疗法对早期脑卒中患者运动功能的影响。 方法将发病10 d内的脑卒中患者119例随机分为电刺激组、运动疗法组、综合治疗组和对照组。对照组只用神经内科常规治疗，电刺激组、运动疗法组、综合治疗组在神经内科常规治疗的基础上，分别加用TENS、运动疗法、TENS和运动疗法。治疗前、后均接受Fugl-Meyer运动功能评分法（FMA）和Barthel指数（BI）评测。 结果治疗后电刺激组、运动疗法组、综合治疗组FMA和BI评分比治疗前评分有显著提高（P<0.05）；各治疗组FMA和BI亦高于对照组（P<0.05），且综合治疗组高于电刺激组和运动疗法组（P<0.05）。 结论对脑卒中患者尽早进行双侧肢体电刺激和运动疗法治疗，可明显改善运动功能，提高临床疗效。     

经皮电神经刺激配合磁热振疗法对脊髓损伤中枢性疼痛的疗效观察

目的:探讨经皮电神经刺激（TENS）合并磁热振治疗对脊髓损伤（SCI）中枢性疼痛的效果。方法：将36例SCI后中枢性疼痛患者随机分为观察组(A组)、TENS组（B组）、磁热振治疗组（C组）,每组12例。观察组采用经皮电神经刺激疗法合并磁热振治疗,TENS组只采用经皮电神经刺激疗法,磁热组只采用磁热振疗法。三组均在治疗前、治疗后采用简式McGill疼痛问卷对中枢性疼痛进行评定。结果：疗程结束后,患者疼痛的6项参数值均有降低,TENS组参数值低于磁热组,但两组差异并无显著性;观察组参数值显著低于TENS组或磁热振组（P<0.01）。结论：经皮电神经刺激合并磁热振疗法对治疗SCI后中枢性疼痛优于单纯的经皮电神经刺激疗法和磁热振疗法。     

运动想像和促进技术对偏瘫肩痛康复疗效的影响

目的探讨运动想像和促进技术对偏瘫肩痛的康复疗效。方法31例脑卒中后偏瘫患者被随机分成运动想像和促进技术组（治疗组）18例与一般康复治疗组（对照组）13例。采用Partridge方法进行疼痛程度的评估。结果治疗后两组疼痛程度积分均明显下降（P〈0．01）。治疗组明显优于对照组（P〈0．01）。结论运动想像和促进技术对偏瘫肩痛的康复治疗有一定的疗效。     

经皮神经电刺激并超短波治疗偏瘫肩痛

目的：探讨经皮神经电刺激并超短波治疗偏瘫肩痛的疗效。方法：72例偏瘫肩痛患者随机分为2组，电刺激组36例，采用经皮神经电刺激（TENS）并超短波治疗；超短波组36例，接受单纯超短波治疗。结果：治疗20 d后，电刺激组肩痛程度明显减低,上肢运动功能达〉4级由27.7%提高到66.6%，有效率明显优于超短波组（P〈0.01）。结论：TENS并超短波治疗能显著提高偏瘫肩痛的临床效果。     

推拿疗法治疗脑卒中后非肩-手综合征性肩痛的疗效观察

目的观察推拿疗法对脑卒中上肢运动功能障碍患者非肩-手综合征性肩痛的治疗效果。方法60例脑卒中后肩痛的患者分为对照组30例和观察组30例,两组均给予常规内科治疗和康复治疗;观察组在此基础上采用推拿疗法治疗。根据发病时间长短不同治疗10～30d,每日2～3次。治疗后30d时测定上肢被动或主动上举180°时是否有肩痛。结果对照组肩痛发生率80%,观察组肩痛发生率43.3%(P<0.01)。结论推拿疗法治疗脑卒中后肩痛有效。     

推拿疗法结合肩胛带稳定性训练对脑卒中后偏瘫患者肩痛和上肢运动功能的影响

目的 观察推拿疗法结合肩胛带稳定性训练对脑卒中后偏瘫患者肩痛及上肢运动功能的影响。 方法 选取符合入组标准的脑卒中患者96例,采用随机数字表法分为推拿组、易化组和对照组,推拿组,每组患者32例。3组患者均给予神经内科常规药物治疗,推拿组在此基础上接受推拿疗法结合肩胛带稳定性训练,易化组则增加易化技术结合肩胛带稳定性训练,对照组仅增加易化技术治疗。3组患者均于治疗前、治疗4周后（治疗后）以及治疗结束6个月后（随访时）进行疗效评定。评定标准包括采用Fugl-Meyer上肢运动功能评价(FMA-UE)评定患者的上肢功能;采用改良的Barthel指数(MBI)评定患者的日常生活活动能力;采用视觉模拟评分法(VAS)评定患者的肩部疼痛。 结果 治疗后和随访时,3组患者的FMA-UE、MBI和VAS评分与组内治疗前比较,差异均有统计学意义（P<0.05）,其中推拿组随访时的FMA-UE、MBI和VAS评分分别为（48.13±15.0）分、（79.25±15.12）分和（1.49±1.34）分。推拿组和易化组治疗后以及随访时的FMA-UE、MBI和VAS评分与对照组同时间点比较,差异均有统计学意义(P<0.05)。 结论 推拿疗法结合肩胛带稳定性训练可明显缓解脑卒中患者的肩痛并改善其上肢的运动功能。     

促通治疗对偏瘫肩痛患者上肢运动功能的改善作用

目的：观察神经肌电促通治疗仪加神经促通康复治疗对脑卒中后偏瘫肩痛的疗效。方法：选择南京医科大学附属无锡市第二人民医院2002—03／2004—12收治的脑卒中后偏瘫肩痛患者60例，按治疗单的序号分为促通仪组和对照组各30例。对照组采用神经促通技术治疗（30min／次，1次／d）；促通仪组在对照组基础上应用神经肌电促通仪治疗，最大治疗电流19．5mA，治疗频率调整选择（1～1000Hz）自动治疗选择（3～100Hz），根据患者具体情况决定正负电极的放置部位，首先是脊髓通电治疗时间为15min，然后分别给予上下肢通电治疗各15min，共45min。以上治疗1次／d，10次为1个疗程，治疗3个疗程，所有患者治疗前后应用Fugl-Meyer评估方法评定患肩关节活动评分和疼痛评分；同时应用Fud—Meyer运动功能评分量表评定患侧上肢的运动功能。结果：按意向处理分析，两组60例患者均结果分析。①Fugl-Meyer肩关节活动评分：治疗后促通仪组30例总积分显著高于对照组（160比116分，P〈0．01）。②Fugl-Meyer肩关节疼痛评分：治疗后促通仪组30例总积分显著高于对照组（162比78分，P〈0．001）。③上肢Fud—Meyer运动功能评分：治疗后促通仪组得分显著高于对照组（x^2=11．12，P〈0．005）。结论：神经促通技术合并神经肌电促通治疗仪治疗能显著缓解脑卒中后偏瘫肩痛，改善患者的上肢运动功能。     

TENS对脑卒中患者踝跖屈内翻的影响

目的评价经皮神经电刺激（TENS）治疗脑卒中患者踝跖屈内翻的临床疗效，并探讨其作用机制。方法32例恢复期脑卒中患者，存在不同程度的踝跖屈内翻，随机分为TENS组和对照组各16例，在神经发育疗法、手法治疗以及配戴足托治疗的基础上，TENS组加用患侧胫前肌和腓骨长短肌的TENS治疗。于治疗前后用综合痉挛量表（CSS）、肌电图H反射评定腓肠肌的痉挛程度。结果治疗后，TENS组和对照组CSS评分都有明显降低，和治疗前相比均有统计学意义，TENS组CSS降低较对照组明显，但两组间差异无统计学意义；TENS组H反射波潜伏期延长、H／M降低，和治疗前相比差异有统计学意义，对照组无明显变化；目测TENS组患者的痉挛偏瘫步态得到明显改善。结论TENS能减轻脑卒中患者腓肠肌痉挛，有助于踝跖屈内翻和痉挛偏瘫步态的改善。     

不同取穴方法的针刺疗法结合康复训练治疗偏瘫肩痛的疗效观察

目的观察不同取穴方法的针刺疗法结合康复训练对偏瘫后肩痛患者的治疗效果。方法将98例偏瘫后肩痛患者随机分为治疗组50例和对照组48例。治疗组采用分期取穴方法，对照组采用传统取穴方法，2组患者取穴后行针刺和电针治疗，．并配合康复训练，连续治疗3个疗程。治疗前、后采用目测类比评分法（VAS）和Brunnstrom分期法对2组患者肩痛程度和运动功能进行评定。结果治疗组在减轻肩痛程度和提高上肢运动功能方面的疗效均明显优于对照组（P〈0．05或0．01）。结论结合现代医学的解剖、生理及上肢功能的不同阶段制定不同的针刺取穴方法和治疗措施对偏瘫后肩痛患者疗效较好。     

持续被动运动治疗脑卒中后肩痛的临床研究

目的 观察持续被动运动（CPM）治疗脑卒中后肩痛的疗效。方法 脑卒中患者44例分成对照组和观察组，对照组给予综合康复治疗（包括良肢位摆放、主被动运动训练），观察组在此基础上给予CPM治疗，通过目测类比评分法（VAS）、Fugl-Meyer（FM）上肢功能评分法和功能独立性评测（FIM）评定治疗效果，并进行统计学分析。结果 两组患者治疗前的FM、FIM、VAS评分较治疗后均有明显改善，而观察组治疗后的VAS评分显著优于对照组，差异有统计学意义（P〈0．01）。结论 CPM治疗脑卒中后肩痛有显著协同作用，可提高疗效。     

早期经皮神经电刺激对脑卒中后功能恢复的影响

目的评价早期经皮神经电刺激 (TENS)对脑卒中患者功能恢复的影响。方法 60例发病 14天内的脑卒中患者随机分为观察组和对照组各 3 0例 ,观察组急性期即采用TENS治疗 ,对照组接受模拟电刺激。两组均接受运动再学习训练。治疗前后分别接受Fugl Meyer评价和Barthel指数评测。 结果治疗后两组Fugl Meyer积分和Barthel指数对比均有显著性差异 (P <0 0 5 ,P <0 0 1)。结论对脑卒中患者尽早进行TENS治疗有助于改善运动功能 ,提高生活质量。     

Effects of transcutaneous electrical nerve stimulation on pain in patients with spinal cord injury: a randomized controlled trial

[Purpose] To investigate the effects of transcutaneous electrical nerve stimulation (TENS) on pain in patients with spinal cord injury. [Subjects and Methods] Fifty-two spinal cord injury patients with central pain were randomly allocated into two groups TENS and control with 26 subjects per group. The patients in TENS and control groups were treated with TENS and sham TENS for 20 min (three times a week) for 12 consecutive weeks, respectively. The two group’s pain was assessed using visual analog scale (VAS) and the McGill Pain Questionnaire (including pain rating index-total, pain rating index-affective, pain rating index-sensory, present pain intensity, and number of words chosen) before and after the treatment. [Results] After the intervention, we found significant differences in VAS, pain rating index-total, pain rating index-affective, pain rating index-sensory, present pain intensity, and number of words chosen between the TENS group and the control group. [Conclusion] Our results suggest that TENS effectively decreases pain in patients with spinal cord injury.Key words: Transcutaneous electrical nerve stimulation, Pain, Spinal cord injury     

肌内效贴对脑卒中患者肩关节半脱位后肩痛的疗效观察

目的:观察肌内效贴对脑卒中患者偏瘫侧肩关节半脱位后肩痛的疗效。方法:56例脑卒中肩关节半脱位后肩痛患者,按照随机数字表法分为治疗组与对照组(各28例),两组患者均实施常规康复治疗及宣教,治疗组在此基础上结合肌内效贴干预。分别于治疗前和治疗6周后通过X线测量法测量肩峰与肱骨头间距(AHI)、肩关节视觉模拟评分(VAS)疼痛、Fugl-Meyer上肢功能评分、肩痛侧腋神经及肌皮神经的运动神经传导测定,对两组治疗结果进行疗效评价。结果:治疗前,两组患者AHI值、VAS评分、Fugl-Meyer上肢功能评分无明显差异(P0.05),且检测所有患者肩痛侧腋神经(刺激部位:Erb点;记录部位:三角肌)及肌皮神经(刺激部位:Erb点;记录部位:肱二头肌)后发现两组中某些患者肌皮神经(30例,53.57%)、腋神经(31例,55.36%)波幅明显低于正常值,而潜伏期轻度延长或正常(提示轴索损伤)。两组治疗6周后,治疗组各项评分改善优于对照组(P0.05)且无不良事件发生。结论:在常规康复治疗的基础上,肌内效贴在脑卒中患者偏瘫侧肩关节半脱位后肩痛早期防治中,具有良好的疗效,其相应机制有待进一步研究。     

穴位体表电刺激治疗肩关节周围炎和腰椎间盘突出症的临床对照研究

本文参照针灸理论和临床经验选取穴位,对53 名肩周炎患者和27 名腰椎间盘突出症患者采用韩氏穴位神经刺激仪( HANS) 进行体表神经电刺激(Transcutaneous Electric Nerve Stimulation , TENS) 治疗,观察其治疗效果,并随机选取同一时期肩周炎患者21 例、腰椎间盘脱出症患者24 例,采用常规理疗作为对照。结果表明,(1) 穴位TENS治疗对肩周炎和腰椎间盘突出症均有即时和长期的止痛作用,其即时止痛效果显著优于常规理疗;(2) 在改善关节功能及提高日常活动能力方面,TENS的疗效与常规理疗相近似。我们认为,鉴于HANS 治疗简便易行,建议在临床上得到更广泛的应用;该法如与常规理疗配合应用,有望增加疗效     

Percutaneous electrical nerve stimulation: an alternative to TENS in the management of sciatica.

Sciatica is a common pain problem and current pharmacologic therapies have proven inadequate for many patients. The objective of this sham-controlled investigation was to compare a novel non-pharmacologic technique, percutaneous electrical nerve stimulation (PENS), to transcutaneous electrical nerve stimulation (TENS) in the management of the radicular pain associated with sciatica. Sixty-four consenting patients with sciatica due to lumbar disc herniation were treated with PENS, TENS and sham-PENS according to a randomized, single-blinded, cross-over study. All patients had been maintained on a stable oral non-opioid analgesic regimen for at least 6 weeks prior to entering the study. Each treatment modality was administered for a period of 30 min three times per week for 3 weeks, with 1 week 'off' between each modality. Both PENS and TENS treatments were administered using a stimulation frequency of 4 Hz. The pre-treatment assessment included the health status survey short form (SF-36), as well as visual analog scales (VAS) for radicular pain, physical activity and quality of sleep. The pain VAS was also repeated after each treatment session. At the end of each 3-week treatment block, the SF-36 was repeated. After receiving all three treatment modalities, a global assessment questionnaire was completed. Both PENS (42%) and TENS (23%) were significantly more effective than the sham (8%) treatments in decreasing VAS pain scores. The daily oral analgesic requirements were also significantly reduced compared to the pre-treatment values with PENS (P<0.01) and TENS (P<0.05). However, PENS was significantly more effective than TENS (and sham-PENS) in improving physical activity and quality of sleep. The SF-36 evaluation confirmed the superiority of PENS (versus TENS and sham-PENS) with respect to post-treatment functionality. In the overall assessment, 73% of the patients reported that PENS was the most desirable modality (versus 21% for TENS and 6% for sham-PENS). Finally, 71% of the patients stated that they would be willing to pay extra to receive PENS therapy compared to 22% and 3% for TENS and sham-PENS, respectively. In this sham-controlled study, we concluded that PENS was more effective than TENS when administered at a stimulation frequency of 4 Hz in providing short-term pain relief and improved functionality in patients with sciatica.     

穴位点按联合虚拟情景训练在脑卒中患者肩关节半脱位伴疼痛的应用研究

目的:探讨穴位点按联合虚拟情景训练在脑卒中后肩关节半脱位伴疼痛中的临床应用。方法:将60例脑卒中肩关节半脱位伴疼痛患者,按照随机方式分成2组:对照组30例给予穴位点按(点按肩贞、肩井、肩髃等穴位)疗法联合常规康复治疗,治疗组30例在对照组基础上增加虚拟情景训练,治疗周期为4周,2组患者于治疗前和治疗后均进行肩峰与肱骨头X线测量间距(AHI)、目测类比量表法(VAS)、上肢运动功能量表(FMA)评估。结果:治疗4周后,2组患者AHI、VAS均低于治疗前(P<0.05),FMA高于治疗前(P<0.05)。治疗后,治疗组AHI、VAS评分低于对照组(P<0.05),FMA评分高于对照组(P<0.05)。结论:治疗组的穴位点按联合虚拟情景训练可以缓解脑卒中后肩关节半脱位伴疼痛的症状和半脱位上肢的运动功能,值得临床推广。     

Transcutaneous Electrical Nerve Stimulation Reduces Acute Low Back Pain during Emergency Transport

Background: Patients with acute low back pain may require emergency transport because of pain and immobilization. Transcutaneous electrical nerve stimulation (TENS) is a nonpharmaceutical therapy for patients with low back pain. Objective: To evaluate the efficacy of paramedic‐administered TENS in patients with acute low back pain during emergency transport. Methods: This was a prospective, randomized study involving 74 patients transported to hospital. The patients were randomly assigned to two groups: group 1 (n= 36) was treated with true TENS, while group 2 (n= 36) was treated with sham TENS. The authors recorded pain and anxiety as the main outcome variables using a visual analog scale (VAS). Results: The authors recorded a significant (p < 0.01) pain reduction (mean ± standard deviation) during transport in group 1 (79.2 ± 6.5 mm VAS to 48.9 ± 8.2 mm VAS), whereas pain scores remained unchanged in group 2 (75.9 ± 16.4 mm VAS and 77.1 ± 11.2 mm VAS). Similarly, the scores for anxiety were significantly reduced (p < 0.01) in group 1 (81.7 ± 7.9 mm VAS to 69.2 ± 12.1 mm VAS) after treatment. No significant change was noted (84.5 ± 5.8 mm VAS and 83.5 ± 8.9 mm VAS, respectively) in group 2. Conclusions: TENS was found to be effective and rapid in reducing pain during emergency transport of patients with acute low back pain and should be considered due to its ease of use and lack of side effects in the study population.     

核心肌群训练联合经皮神经电刺激治疗产后非特异性下背痛的疗效观察

目的：探讨核心肌群训练联合经皮神经电刺激(TENS)治疗产后非特异性下背痛（NLBP）的有效性。方法：选取2021年10月至2022年9月在首都医科大学附属北京妇产医院女性盆底功能障碍诊治中心就诊的产后NLBP患者共50例。采用随机数字表法分为观察组和对照组,各25例。对照组给予针对下背部肌筋膜触发点的TENS治疗,观察组在此基础上联合核心肌群训练。在治疗前、治疗后和随访4周后,分别采用视觉模拟评分法（VAS）、Oswestry功能障碍指数（ODI）以及爱丁堡产后抑郁量表 (EPDS)进行疗效评价。结果：治疗后2组VAS评分、ODI指数均明显低于治疗前（P＜0.05）,且观察组明显低于对照组（P＜0.05）。随访4周,对照组VAS评分、ODI指数明显高于治疗后（P＜0.05）,观察组VAS评分、ODI指数与治疗后比较无统计学差异。对照组治疗后EPDS评分与治疗前无统计学差异,而观察组治疗后及随访4周EPDS评分均显著低于治疗前（P＜0.05）。结论：核心肌群训练联合TNES可有效改善产后NLBP患者的疼痛、功能障碍以及抑郁情绪状态,减少NLBP的复发。     

Extracorporeal shock wave therapy for chronic calcific tendinitis of the shoulders: a functional and sonographic study

OBJECTIVES: To evaluate the therapeutic effect of extracorporeal shock wave therapy (ESWT) in shoulders with chronic calcific tendinitis, to compare the functional outcomes of ESWT and transcutaneous electric nerve stimulation (TENS) therapy, and to investigate which types of calcium deposit effectively respond to ESWT. DESIGN: Randomized controlled trial. SETTING: Outpatient clinics of the departments of physical medicine and rehabilitation and of orthopedics and traumatology of a veterans hospital in Taiwan. PARTICIPANTS: Sixty patients with continuous shoulder pain for 6 months or more and with radiographically and sonographically verified calcific tendinitis. Patients were randomly allocated to receive ESWT (33 shoulders) or TENS treatment (30 shoulders). INTERVENTIONS: ESWT was performed with 2000 shock waves at 2Hz and energy level between.26 and.32mJ/mm(2) per session. Treatment was given in 2 sessions, 14 days apart. TENS therapy was given 3 times a week for 4 weeks.Main Outcome Measures: Mean Constant score, visual analog scale (VAS), manual muscle test, and changes of sonographic size and shape of calcium deposits were calculated for 4 time points: at baseline, 2 weeks, 4 weeks, 12 weeks posttherapy. RESULTS: In both groups, Constant score and VAS improved significantly at 2-, 4-, and 12-week follow-ups (P<.05), and the size of calcium deposits decreased significantly at the 4- and 12-week follow-ups. Moreover, the arc-shaped calcific plaques of the rotator cuff were markedly meliorated with ESWT. CONCLUSIONS: ESWT is more effective in the treatment of chronic calcific tendinitis of the shoulder than is TENS therapy, especially for arc-type calcific plaque.