第三代功能性电刺激联合任务导向训练对卒中后上肢功能的康复作用

目的探讨第三代功能电刺激(FES)联合任务导向训练对卒中后上肢功能恢复的作用。方法选择病程3~12个月的初发卒中患者40例,按病例单双号分为FES组和对照组,每组20例。两组患者均接受传统的康复训练,1次/d,30 min/次,5 d/周,共12周。FES组另给予12周的FES治疗,1次/d,15 min/次,5 d/周;根据上肢功能状况给予患者被动电刺激、触发反馈电刺激、助力反馈电刺激结合任务导向训练(杯子训练)的作业治疗。疗效评定采用改良的Ashworth量表(MAS)、Brunnstrom分级量表、Fugl-Meyer运动功能量表(上肢部分,FMA)及腕关节背伸的主动关节活动度(WEAROM)测评。结果 (1)治疗前FES组与对照组各项观察指标差异均无统计学意义。(2)治疗后两组MAS和Brunnstrom量表评分均较治疗前有所改善,差异有统计学意义(P0.01);但FES组与对照组比较,MAS和Brunnstrom量表的治疗前-后评分差值分别为(0.7±0.3)、(0.8±0.4)分和(0.6±0.2)、(0.7±0.4)分]差异均无统计学意义。(3)两组FMA评分和WE-AROM均较治疗前提高,差异有统计学意义(P0.05);FES组FMA评分的治疗前-后差值为(8.3±4.0)分,高于对照组的(4.3±2.5)分;FES组WEAROM的治疗前-后差值为(21±10)度,高于对照组的(14±6)度,差异均有统计学意义(P0.05)。结论与传统的康复训练相比,结合了FES治疗的康复训练对于卒中患者上肢运动功能改善及腕关节背伸的关节活动度提高效果更明显。但对上肢痉挛改善效果不明显。

Rehabilitation effect of the third generation functional electrical stimulation combined with task oriented training for upper limb function after stroke

Objective To investigate the rehabilitation effect of the third generation functional electrical stimulation （FES）for upper limb function after stroke. Methods Forty patients with first attack of stroke （the course of disease was 3 to 12 months）were enrolled. They were divided into either a FES group or a control group by case numbers （n=20 in each group）. Both groups received traditional rehabilitation training once a day（30 min）for 12 weeks. The FES group also received FES for 12 weeks, once a day for 15 min. According to the functional status of the upper limbs,the patients were treated with occupational therapies,including passive electrical stimulation,trigger feedback electrical stimulation,and booster feedback electrical stimulation with task-oriented feedback training （cup training ）. The modified Ashworth Scale （MAS）,Brunnstrom Scale （BS）,Fugl-Meyer Scale （FMS）（upper part）,and active range of motion of wrist extension （WEAROM）were used to perform efficacy evaluation. Results （1）There were no significant differences in all the outcome measures before treatment between the FES group and the＆amp;nbsp;control group. （2 ）The MAS and Brunnstrom scale scores of both groups were improved after treatment compared to before treatment. There was significant difference （P 〈0. 01）;but there was no significant difference in the MAS and Brunnstrom scale scores between the FNS group and the control group. （3）The FMS scores and WEAROM in both groups were higher than before treatment. There was significant difference （P〈0. 01）;the difference of the FMS scale before and after treatment in the FES group was 8. 3 ±4. 0 and it was higher than 4. 3 ±2. 5 in the control group;the difference in WE-AROM before and after treatment in the FES group was 21 ±10 and it was higher than 14 ±6 in the control group. There was significant difference （P 〈 0. 01 ）. Conclusion Compared with the traditional rehabilitation training,the rehabilitation training in combination with FES is more obvious for the improvement of arm and hand motor function,as well as the improvement of joint motion range of the wrist dorsiflexion in patients with stroke,but the improvement of upper limb spasticity is not obvious.