重复性任务性训练联合神经肌肉电刺激对重度瘫痪急性脑卒中患者下肢功能的影响

关键词：重复性任务性训练  神经肌肉电刺激  急性脑卒中  下肢  重度瘫痪

Keywords:repetitive task training  neuromuscular electrical stimulation  acute stroke  lower limb  severe paralysis

摘要：

      摘要 目的: 研究重复性任务性训练联合神经肌肉电刺激对重度瘫痪的急性脑卒中患者下肢功能影响。 方法：将36例重度瘫痪的急性脑卒中患者分为治疗组和对照组，每组18例，对照组给予常规康复治疗和高强度神经肌肉电刺激治疗；治疗组在此基础上进行重复性任务性训练，内容包括坐位训练、坐-站训练和站立训练。分别于治疗前、治疗后2个月采用简式Fugl-Meyer下肢功能评分(FMA)进行下肢运动功能的评定，采用功能性步行分级（FAC）进行步行功能的评定，采用功能独立性评定量表（FIM）进行日常生活活动能力的评定。 结果：治疗后2个月，2组FMA和FIM评分均明显优于治疗前（P<0.05），而且治疗组FMA和FIM评分优于对照组（P<0.01）；治疗组FMA和FIM的评分改变量（△FMA和△FIM评分）均优于对照组（P<0.01）；治疗组的FAC分级更高，比对照组获得了更好的步行功能（P=0.004）。 结论：重复性任务性训练联合神经肌肉电刺激能更有效地改善重度瘫痪的急性脑卒中患者的下肢运功功能、步行功能和日常生活活动能力。

Abstract:

      Abstract Objective：To study effects of repetitive task training combined with neuromuscular electrical stimulation on lower limb function in acute stroke patients with severe paralysis. Method：A total of 36 acute stroke patients with severe paralysis were randomly divided into two groups( n=18 in each). The patients in control group received conventional rehabilitative program and higher intensity of neuromuscular electrical stimulation. The patients in treatment group received extra repetitive task training on the basis of control group，including sit，sit-to-stand and stand training. The lower limb motor function，walking function and activities of daily living(ADL) were assessed with Fugl-Meyer score of lower extremity assessment(FMA)，functional ambulation classification（FAC）and the FIM before and after treatment. Result: Two month after treatment the scores of FMA and FIM were better than the scores before treatment both in the two groups significantly（P<0.05），and the patients in treatment group gained better scores significantly（P<0.01）. The changes of scores both on FMA and FIM in treatment group were better than control group statistically（P<0.01）. The patients in treatment group obtained better walking function as for FAC（P=0.04）. Conclusion：Repetitive task training combined with neuromuscular electrical stimulation could more effectively improve motor function of lower limb，walking function and ADL in acute stroke patients with severe paralysis.