早期关节挤压结合被动对角线运动对偏瘫运动功能转归的影响

目的：探讨在BrunnstromⅠ期应用关节挤压技术结合被动对角线运动对偏瘫运动功能转归的影响.方法：选择铜陵市人民医院神经内、外科住院治疗的BrunnstromⅠ期偏瘫患者67例,随机分为治疗组和对照组.治疗组采用我们自己设计的改自PNF技术的结合了关节挤压技术的被动对角线运动,治疗时注意患肢的被动运动速率与患者意想动作的进度同步.对照组采用目前普遍运用的治疗方法,根据分期Brunnstrom分期适当选用神经发育疗法的Rood、Bobath、Brunnstrom、PNF等技术,在BrunnstromⅠ、Ⅱ期用刷擦、冰块、挤压、牵拉来诱发肌肉反应,通过健肢抗阻来引出患肢的联合反应直至促发共同运动,在运动功能达BrunnstromⅢ期时,开始促进共同运动中的随意运动成分改出为分离运动,逐步脱离共同运动模式,进而在正常运动模式的基础上逐步优化运动技巧.治疗前及治疗6周后运用简化Fugl-Meyer运功能量表（FMA）评定肢体运动功能,采用Barthel指数（Barthel index,BI）评定患者ADL能力,并测定治疗后两组患者的Brunnstrom分期.结果：治疗后两组患者的FMA、BI评分均较治疗前明显改善（P＜0.01）,但治疗组的评分明显高于对照组（P＜0.01）,治疗组Brunntrom分级明显优于对照组（P＜0.01）.结论：尽早在BrunnstromⅠ期运用符合正常运动模式的被动运动并结合运动想象和刺激关节本体感受器的关节挤压,可以减少BrunnstromⅢ期的停留时间,加快分离运动的引出.

The effects of joint extrusion technology combined passive diagonal movement on the prognosis of motor function in hemiplegia

Objective： To investigate the application of joint extrusion technology combined passive diagonal movement on the prognosis of motor function in hemiplegia. Methods：67 cases were randomly divided into treatment and control groups. Treatment group was treated with the passive di- agonal movement our own design adapted from PNF technique combines joint extrusion technology, attention to the rate of passive movement syn- chronized the patient imagination. Control group is now widely used method of treatment,according to the selection stage Brunnstrom stage appropri- ate neurodevelopmental therapy Rood, Bobath, Brunnstrom,PNF techniques,in Brunnstrom Ⅰ , Ⅱ period rub with a brush, ice, compression, stretch to induced muscle response,through the key resistance to limb joint reaction leads to llmb joint moverment until the trigger, the motor function of Brunnstrom Ⅲ period,began to promote the common movement of voluntary movement to change the composition of the separatist movement, and gradually out of joint movement patterns,then the normal movement patterns based on the gradual optimization of motor skills. Before treatment and after 6 weeks of use features to simplify operation Fugl--Meyer Scale （FMA） assessment of motor function,using the Barthel Index （Barthel index, BI） assessment of patients with ADL ability, and determination of the two groups after the treatment of patients with Brunnstrom stages. Result： Af ter treatment,the FMA,BI score was significantly improved compared with before treatment （P〈0.01） ,but the treatment group＇s score was signifi- cantly higher （P〈0.01）, significant treatment group Brunntrom classification than the control group （P〈0.01）. Conclusion： Early use of the passive movement with normal movement patterns stimulate the joint proprioceptor,can reduce the time of Brunnstrom Ⅲ period,lead to separatist move- ment.