肌力训练对脑卒中恢复期偏瘫患者大腿表面肌电的影响

Objective To explore the effect of muscle strength exercise on surface electromyography (sEMG) over thigh in stroke patients with hemiplegia during convalescence so as to gain objective evidence for rehabilitation therapy of stroke patients. Methods Thirty-five stroke patients with hemiplegia during convalescence were enrolled in this study, and were divided into two groups, treatment group (n=19) and control group (n=16). The treatment group underwent muscle strength exercise for 6 weeks. Before and after treatment, sEMG signals over vastus medialis (VM), rectus femoris muscle (RF),vastus lateralis (VL), biceps femoris (BF) and semitendinosus (ST) and semimembranosus (SM) during maximal isometric voluntary contraction (MIVC) of the affected knee extension and flexion were recorded.Torque of knee joint extension and flexion, root mean square (RMS) and co-contraction ratio (CR) were computed. No rehabilitation training was performed in control group. The above mentioned indexes of control group were also recorded. Results After treatment, obvious changes were observed in MIVC torque of the affected knee flexion [ (18.02±6.52) nm vs (13.12±5.79) nm, P＜0.05] and extension [ (45.72±17.21 ) nm vs (34.76± 17.19) nm, all P＜0.05 ]. There were no significant differences in CR of flexion and extension. No statistical difference was observed in MIVC torque and CR of flexion and extension before and after treatment in control group (all P＞0.05). RMS value significantly improved when RF, VL, ST and SM over affected thigh were agonist after treatment [ (146.60±60.85) μV vs (97.02±57.17) μV, (172.65±60.73) μV vs ( 131.46 ± 52.15 ) μV, ( 188.69 ± 89.60) μV vs ( 130.57 ± 73.76) μV, all P＜0.05 ]. There were no significant differences of RMS value in the VM and BF before and after treatment (all P＞0.05), and no RMS changes were noted in control group (all P＞0.05). Conclusions Strength exercise may improve strength of flexion and extension over lower limbs in stroke patients with hemiplegia during convalescence, however, it will not induce abnormal contraction of flexion and extension. sEMG combined with torque measurement may assess functional status of hemiplegic limbs effectively.     

综合吞咽功能训练治疗结肠代食管术后复杂性吞咽困难一例

目的探讨结肠代食管术后所致复杂性吞咽困难的治疗新策略。 方法选取结肠代食管术后吻合口狭窄致复杂性吞咽困难患者1例,采用增强气道保护训练、舌压抗阻反馈训练、Masake吞咽训练法、用力吞咽法、VitalStim电刺激对患者进行吞咽功能治疗。治疗前、后,采用临床吞咽功能评估、功能性经口摄食量表(FOIS)、视频吞咽造影检查（VFSS）、高分辨率咽腔压力测定对患者的吞咽功能进行评定。 结果FOIS由1级进展至7级,吞咽造影数字化分析显示,治疗前患者的咽腔收缩率为50%,治疗后咽腔收缩率为23%。高分辨率咽腔压力测定显示,患者治疗前腭咽压力峰值为82.8mmHg,治疗后为156.9mmHg;治疗前腭咽收缩持续时间为310ms,治疗后为525ms;治疗前下咽压力峰值为53.7mmHg,治疗后为103.2mmHg;治疗前下咽收缩持续时间390ms,治疗后为1030ms。复查吞咽造影显示患者会厌谷残留减少,吻合口较前明显开放,渗漏消失。患者可完全经口进食,拔除空肠造瘘管。 结论对于结肠代食管术后吻合口重度狭窄所致吞咽困难的患者,经扩张治疗无效后,可通过综合吞咽功能训练增加咽部推动力以促进吞咽功能改善。