F波、H反射在卒中后肢体痉挛疗效评估中的研究进展

卒中后肢体痉挛是上运动神经元损伤导致高级中枢失去对脊髓牵张反射的抑制,脊髓 反射性增高引起以牵张反射增强为特征的肌肉张力异常。肢体痉挛是卒中后常见并发症之一,严重影 响了卒中患者功能康复。近年来涌现出各类改善卒中后肢体痉挛的治疗方法,但其疗效评价标准不 一,其中以主观性量表评价为主。笔者搜集了近些年国内外卒中后肢体痉挛治疗的临床研究文献,发 现F波、H反射相关参数等客观评价指标被越来越多地与主观评价量表相结合,运用到各类临床研 究的疗效评价中。相对于H反射,F波具有更加灵敏的特点,能更好反映肢体肌张力的变化,常与改良 Ashworth痉挛量表一起作为缺血性卒中后肢体痉挛疗效的评价指标。     

抗痉挛治疗仪在治疗脑卒中后上肢痉挛中的作用

目的探讨抗痉挛治疗仪在治疗脑卒中后上肢痉挛中的临床效果。方法将40例脑卒中后上肢痉挛的患者随机分为两组,对照组进行常规的康复训练,治疗组在常规康复训练的基础上加用抗痉挛治疗仪进行治疗;分别采用上肢改良Ashworth量表(MAS)、疼痛视觉模拟评分法(VAS)及简化Fugl-Meyer运动功能评定量表(FMA)上肢部分对两组患者治疗前及治疗30d后上肢痉挛程度、疼痛程度及上肢运动功能的变化进行比较。结果治疗前两组MAS分级,VAS评分及FMA评分比较,差异均无统计学意义(P0.05)。治疗后两组MAS分级及VAS评分显著低于治疗前(P0.05),且治疗组降低程度更加显著;两组FMA评分均有显著提高,且治疗组提高程度优于对照组。结论抗痉挛治疗仪能有效降低脑卒中患者肱二头肌痉挛程度,并能缓解疼痛,提高其运动功能。     

手指点穴对改善脑卒中患者上肢痉挛的效果观察

目的：观察中医手指点穴结合常规的康复治疗对于改善脑卒中患者上肢痉挛的疗效。方法60例脑卒中偏瘫上肢痉挛患者随机分为治疗组和对照组,每组30例。2组患者均给予常规药物对症治疗,未给予抗痉挛的药物。治疗过程中,治疗组在第1次手指点穴结束后采用表面肌电的平均积分肌电值（iEM G ）测试肱二头肌、桡侧腕屈肌观察有效时间并结合常规康复治疗。对照组只运用常规康复训练。结果手指点穴后治疗组肱二头肌iEM G 9.85±4.58,桡侧腕屈肌iEM G 9.89±5.38,均低于治疗前（14.43±6.41、13.95±6.02）（P＜0.05）,治疗组改善程度优于对照组（P＜0.05）。结论手指点穴对改善脑卒中患者上肢痉挛的有效时间较好,手指点穴结合常规康复治疗可有效降低脑卒中患者上肢痉挛,效果优于单纯的常规康复治疗。     

平衡阴阳推拿法对脑卒中上肢痉挛的疗效观察

脑卒中后所致的上肢痉挛直接影响患者的运动功能康复,对日常生活质量影响尤为严重,能否有效抑制痉挛状态的出现,或是尽快地缓解痉挛状态,是临床提高上肢康复效果的关键.中医推拿对痉挛的治疗尽管自古都有,但相对还比较笼统,没有一个系统、行之有效的方法,笔者经过近几年结合现代康复功能需要,结合现代康复的一些理念,总结出来一套平衡阴阳推拿治疗脑卒中上肢痉挛的方法,并取得很好疗效.     

综合康复治疗脑卒中后上肢痉挛的临床研究

目的 研究中枢与外周综合性康复治疗脑卒中后上肢肌张力增高患者的效果.方法 纳入75例上肢肌张力增高的脑卒中患者,实验组38例,对照组37例,对照组采用醒脑开窍针刺法和任务导向性上肢功能训练,实验组在对照组的基础上增加深层肌肉刺激仪(DMS)治疗.治疗前及治疗6周后,采用上肢简化Fugl-Meyer(FMA-UE)、上肢...     

脑卒中患者偏瘫侧徒手指部感觉刺激前后上肢正中神经F波的变化研究

目的探讨偏瘫侧徒手指部感觉刺激(MDSS)对脑卒中患者上肢正中神经F波的影响。方法选择自2019年6月至2022年10月于安徽医科大学第二附属医院康复医学科进行康复治疗的30例脑卒中后偏瘫患者为研究对象, 患者偏瘫侧拇指屈肌改良Ashworth量表(MAS)等级均≥1级, 予其偏瘫侧MDSS治疗, 并检测双侧上肢(刺激前)及偏瘫侧上肢(刺激后即时)正中神经F波。结果与健侧相比, 刺激前患者偏瘫侧上肢正中神经F波波幅明显升高, 差异有统计学意义(P<0.05)。与刺激前相比, 拇指屈肌MAS等级≤2级患者刺激后偏瘫侧上肢正中神经F波波幅明显降低, 拇指屈肌MAS等级≥3级患者刺激后偏瘫侧上肢正中神经F波波幅明显升高, 差异均有统计学意义(P<0.05)。结论不同MAS等级患者中MDSS后偏瘫侧上肢正中神经F波波幅的变化显示, MDSS不仅可以抑制与肌痉挛有关的紧张性运动单位兴奋性, 在肌痉挛严重时还可提高主要与肌肉爆发力有关的运动性运动单位兴奋性。     

肉毒杆菌毒素A在脑卒中后肢体痉挛中的应用

Ａ型肉毒毒素是近年来治疗脑卒中后肢体痉挛的一个新进展,国外已有多项试验证实了它的有效性及安全性,国内的研究也正在展开,本文综述了肉毒毒素的特点及其在脑卒中后肢体痉挛治疗的临床应用状况。     

以强直症状为主的帕金森病患者的F波研究

目的 :研究以强直症状为主的帕金森病 (PD)患者脊髓α运动神经元的兴奋性是否增高。方法 :选取一组以强直症状为主的PD患者与一组年龄、性别匹配的正常人作对照研究 ,分别测定其静息、易化状态时的F波 ,并进行比较。结果 :以强直症状为主的帕金森病患者F波多项参数增加 ,易化现象明显受损。结论 :以强直症状为主的帕金森病患者脊髓α运动神经元的兴奋性有增高     

老年脑卒中患者肢体瘫痪后骨密度的变化

目的探讨老年脑卒中患者肢体瘫痪对其骨密度的影响。方法发病3d以内入院的170例急性期老年脑卒中患者,男93例,女77例,年龄60~84(66±5.9)岁。170例中脑梗死患者114例,脑出血患者56例。分别于发病3d内及发病1年后采用美国Lunar公司生产的DEXA双能X线骨密度仪测量第1腰椎正位、双侧股骨颈及双侧桡骨远端骨密度。结果发病3d内双侧股骨颈、双侧桡骨骨密度两侧比较无统计学差异(P>0.05)。发病1年后L1、股骨颈(健侧)、股骨颈(患侧)、桡骨(健侧)、桡骨(患侧)骨密度均明显减少,分别为-2.8%(P<0.001)、-2.5%(P<0.01)、-10.2%(P<0.001)、-3.9%(P<0.001)和-11.3%(P<0.001)。发病1年后双侧股骨颈、双侧桡骨骨密度比较有显著统计学差异(P均<0.001)。结论老年脑卒中患者肢体瘫痪后骨密度下降,患侧更明显。     

脑卒中后上肢痉挛的针灸及康复护理体会

我科对2011-01—2013-03收治的60例脑卒中后上肢痉挛患者进行针灸及康复治疗,同时科学合理的护理措施是取得良好疗效的保障。现将我科的针灸护理体会报道如下。     

A randomized, double-blind, placebo-controlled study of the efficacy and safety of botulinum toxin type A in upper limb spasticity in patients with stroke

OBJECTIVE: To study the efficacy and safety of botulinum toxin type A (BtxA) in the treatment of upper limb muscle spasticity, caused by stroke. METHODS: This was a randomized, controlled trial. Patients received either placebo injections or a total of 1000 IU of BtxA (Dysport) into five muscles of the affected arm. Muscle tone was assessed using the Modified Ashworth Scale (MAS). Other outcome measures were the change in the joint range of motion (ROM), the Barthel index, pain score, goal attainment and the subjective evaluation of benefit by patients and investigators. The patients were assessed blind to randomization at baseline and 4, 8, 12 and 16 weeks after treatment. RESULTS: Fifty nine patients were recruited and received treatment. One patient was lost to follow-up before the last scheduled visit of the study. The group of patients who received BtxA had a significant reduction in the summed MAS score at week 4 compared with the placebo group (P=0.004). The magnitude of benefit over the 16 week follow-up period was significantly reduced for the BtxA group in the wrist (P=0.004) and the finger joints (P=0.001) when compared with the placebo. There was no statistically significant difference between the groups in the joint ROM, muscle pain, goal-attainment or the Barthel index scores at week 4 of the study. At week 16, the BtxA group showed significantly greater improvement in the passive ROM at the elbow (P=0.036). The patients' global assessment of benefit at the end of the study showed that 16 (50%) patients in the placebo group had 'much improved' or had 'some improvement' compared with 24 (92.3%) patients in the BtxA group (P=0.007). The investigators' rating for the same item was 16 (50%) and 23 (88.4%) patients, respectively (P=0.002). Sixteen and twenty patients in the BtxA and placebo groups, respectively, had an adverse event. The most frequently reported adverse events were accidental injury, respiratory and urinary tract infections and muscle pain. CONCLUSION: The findings of the present study suggest that treatment with BtxA in a dose of 1000 units reduces muscle tone in patients with post-stroke upper limb spasticity. This effect is sustained for at least 16 weeks. BtxA is safe in the dose used in this study. IMPORTANT NOTE: The authors wish to emphasize that the botulinum toxin preparation used in this study was Dysport (Ipsen Ltd) which has a different therapeutic equivalence from other commercially available product, Botox (Allergan Inc.).     

F wave to height or limb length ratios as rational alternatives for F wave latency in clinical electrodiagnostic medicine

Objective

To delineate the F wave latency/height (Fmin/He) or F wave latency/limb length (Fmin/L) ratio as a more useful alternative for the currently reported shortest latency in milliseconds.

Methods

One hundred and sixty-six healthy volunteers, 85 upper limbs and 84 lower limbs entered the study. Minimum F wave latencies were determined in median, ulnar, tibial and peroneal nerves. The Fmin/He and Fmin/L ratios of each nerve were calculated.

Results

F latencies of all nerves had significant correlation with height and limb length but there was no correlation between either Fmin/He or Fmin/L and height in any nerve except for peroneal Fmin/He (p = 0.04, r = 0.23).

Conclusions

Using the Fmin/He or Fmin/L ratios are more accurate than reporting only the F wave minimum latency, since these ratios incorporate corrections for height and/or limb length. This method also eliminates the false positive and negative reports caused by using a single reference table for all heights.

Significance

A unique reference table can be produced using the Fmin/He or Fmin/L for all populations and races, so that the comparison between different population samples can be done easily. Also data of different investigations can be pooled together for meta-analysis purposes when a single reference table is used for different samples.     

Intra-rater reliability of the modified Tardieu scale to quantify spasticity in elbow flexors and ankle plantar flexors in adult stroke subjects

Objectives:

The purpose of this study was to investigate Iintra-rater reliability of the Modified Tardieu Scale (MTS) in elbow flexors and ankle plantar flexors in adult subjects with stroke.

Materials and Methods:

A total of 91 subjects with stroke participated in this test-retest study. Intra-rater reliability of the MTS was investigated by a qualified and trained physiotherapist for elbow flexors and ankle plantar flexors in two sessions. A rater was one who performed the procedure and an observer only records the angles so that the rater was blinded to findings. Outcome measures in this study were measurable components of MTS, which are angle of muscle reaction (R1), passive range of motion (R2), dynamic component (R2-R1), and quality of muscle reaction (grade 0 – 4) termed as MTS score.

Results:

Intra-rater reliability of MTS was very good for R1, R2, R2-R1, and MTS score (ICC > 0.85, P<0.0001) across two sessions in elbow flexors and ankle plantar flexors.

Conclusion:

MTS is a reliable clinical tool for measurement of spasticity in the elbow flexors and ankle plantar flexors in adult subjects with stroke.     

Comparison of botulinum toxin injection and neurotomy in patients with distal lower limb spasticity

Background and purpose:  We compared the efficacy of botulinum toxin injection (BTI) and tibial nerve neurotomy (TNN) in an open-label study of 34 post-stroke hemiplegic patients with distal lower limb deformation.
Methods:  The dose of BT was 300 U (Botox). TNN was performed with a 6–12 month delay on the motor branches of the tibial nerve. Muscles to be treated were selected according to the distal deformity (equinus, varus and clawing toes). Patients were assessed following each treatment for spasticity, motor control, range of movements, balance, gait and the Rivermead Motor Assessment.
Results:  TNN (M3, M6 and Y1) resulted in a more significant effect than BTI (D15, M2 and M5) on most of the measures: ankle plantar flexor spasticity, range of movement in dorsiflexion and eversion, foot position in upright situation, Functional Ambulation Categories (barefoot), RMA, gait velocity (comfortable condition), subjective benefit and use of walking aids. Patients treated for tibialis posterior or flexor digitorum longus spasticity often complained of subjective sensory disorders at the plantar sole over a period of 4–6 weeks.
Conclusion:  In conclusion, TNN is more effective than BTI on most of the functional parameters. The interest of BTI lies in the preliminary testing of the efficacy of a technique for reducing spasticity on lower limb function.     

Effects of repeated abobotulinumtoxinA injections in upper limb spasticity

Introduction: The efficacy of single injections of abobotulinumtoxinA (Dysport) is established in adults with upper limb spasticity. In this study we assessed the effects of repeated injections of abobotulinumtoxinA over 1 year. Methods: Patients (n = 258, safety population) received 500 U, 1,000 U, or 1,500 U (1,500‐U dose included 500‐U shoulder injections) for up to 4 or 5 treatment cycles. Assessments included treatment‐emergent adverse events (TEAEs), muscle tone, passive and active range of motion (X_V1, X_A), angle of catch (X_V3), Disability Assessment Scale (DAS) score, Modified Frenchay Scale (MFS) score, and Physician Global Assessment (PGA) score. Results: The incidence of TEAEs decreased across cycles. Muscle tone reduction and X_V1 remained stable across cycles, whereas X_V3 and X_A continued to improve at the finger, wrist, and elbow flexors. DAS and PGA improved across cycles. MFS improved best with 1,500 U. Discussion: A favorable safety profile and continuous improvements in active movements and perceived and active function were associated with repeated abobotulinumtoxinA injections in upper limb muscles. Muscle Nerve 57 : 245–254, 2018     

Analysis of F response in upper motoneurone lesions

The F response can provide a measure of motoneurone excitability (MNE) and so it may be used to investigate upper motoneurone disorders. This report studies the F-wave configuration in patients with stroke to evaluate the changes of the central excitability of the motoneurones at different times after an acute cerebral insult. Various parameters of the F response, including amplitude (absolute and F%/M), duration, and persistence have been determined in 26 patients with unilateral hemiplegia and in 32 healthy subjects of both sexes in the same age range. The investigation was carried out applying a series of 20 supramaximal stimuli at 0.5 Hz on tibial and ulnar nerves bilaterally. In all patients a detailed clinical examination and a CT scan were performed. Our results indicate that an initial stage of reduced spinal motoneuron excitability evidenced by a decreased F amplitude and persistence was present in the early phases after a stroke, followed within 90 days by an enhanced MNE. Moreover, F-wave amplitude shows a positive correlation with weakness and increased tone.     

F波监测面神经功能评估价值实验研究

目的 探讨F波监测对听神经瘤压力模型大鼠面神经功能评估的价值.方法 对58例模型及对照组SD大鼠行面神经F波监测,记录其潜伏期、波幅及与M波比值(F/M);继而行生物素化葡聚糖胺(BDA)面神经逆行示踪,计数面神经核BDA阳性神经元标记率(BDA+-N%);光、电镜检查小脑脑桥角池段面神经;统计分析F/M与BDA+-N%的相关性,并探讨与面神经病理改变的关系.结果 与两对照组比较,小-大各肿瘤组F波潜伏期延长或部分丢失,F/M依次为77.13%,48.91%和11.54%(P<0.001);BDA+-N%依次为77.28%,48.28%和11.55%(P<0.001).各组F/M与BDA+-N%呈线性正相关(r=0.996,P<0.001).面神经光、电镜观察显示病损随球囊体积增大逐渐加重.结论 面神经F波改变可以用于评估面神经功能完整性,反映其病损程度,应有助于术中面神经监测和术后功能预测.     

The utility of F wave chronodispersion in lumbosacral radiculopathy

The sensitivity of F wave chronodispersion (Fc) in evaluating nerve root pathology is unknown. We compared Fc in 91 patients with clinical and EMG evidence of L5 or S1 radiculopathy with Fc in 81 controls in order to evaluate its sensitivity in lumbosacral radiculopathy. F waves were obtained by stimulating the peroneal and tibial nerves behind the knee and recording from the extensor digitorum brevis (L5 predominant) and flexor hallucis brevis (S1 predominant) muscles, respectively. Fc was calculated by subtracting the shortest F wave latency from the longest and, in controls, ranged from 0.2 to 23.4 ms in the peroneal nerve, and from 1.2 to 13.4 ms in the tibial nerve (95th percentile = 13 ms for the peroneal nerve and 9.2 ms for the tibial nerve). In the patient group, Fc also ranged from 0.2 to 23.4 ms in the peroneal nerve, and from 0.4 to 18.2 ms in the tibial nerve. Only 5 (5.5%) and 8 (11.3%) patients for the peroneal and tibial nerves, respectively, had Fc values which fell beyond the 95th percentile, a percentage far below the sensitivity of F wave latency measurement and not substantially different from chance. Thus we conclude that Fc has no substantial additional value in evaluating lumbosacral radiculopathy over that of F wave latency.     

After-effects of pedaling exercise on spinal excitability and spinal reciprocal inhibition in patients with chronic stroke

Purpose of the study: To evaluate the after-effects of pedaling on spinal excitability and spinal reciprocal inhibition in patients with post-stroke spastic hemiparesis. Materials and methods: Twenty stroke patients with severe hemiparesis participated in this study and were instructed to perform 7 min of active pedaling and 7 min of passive pedaling with a recumbent ergometer at a comfortable speed. H reflexes and M waves of paretic soleus muscles were recorded at rest before, immediately after and 30 min after active and passive pedaling. The Hmax/Mmax ratio and H recruitment curve were measured. Reciprocal inhibition was assessed using the soleus H reflex conditioning test paradigm. Results: The Hmax/Mmax ratio was significantly decreased after active and passive pedaling exercise. The decreased Hmax/Mmax ratio after active pedaling lasted at least for 30 min. The H recruitment curve and reciprocal inhibition did not change significantly after active or passive pedaling exercise. Conclusions: Pedaling exercise decreased spinal excitability in patients with severe hemiparesis. Pedaling may be effective in rehabilitation following stroke.