基于叠加效应的全身振动联合蹲起同步训练对脑卒中患者步行功能的影响

关键词：全身振动  蹲起训练  脑卒中  协同收缩率  步行功能

Keywords:whole body vibration  squat-up training  stroke  synergistic contraction rate  walking function

摘要：

      摘要 目的：探讨基于叠加效应的全身振动联合蹲起同步训练对脑卒中患者步行功能的影响。 方法：选取复旦大学附属华山医院康复医学科（浦东院区）40例监护或者辅助具下，可以独立步行的脑卒中患者，随机分为全身振动训练组（WBVT组）和对照组，两组均采用常规康复治疗，每天40min。WBVT组在常规康复治疗的基础上增加全身振动联合蹲起同步训练，20min/次/天。对照组在常规康复治疗的基础上增加在全身振动平台上无振动站立，20min/次/天。分别在入组时和干预4周后，采用穿戴式三维步态评估仪对患者步行能力进行评估，使用表面肌电图仪采集患者步行过程中的股直肌和股二头肌长头的肌电信号，并对干预前后的数据进行统计学分析。 结果：经过4周干预，两组的步速和步幅均比治疗前有提高（P<0.05），且WBVT组均优于对照组（P<0.05）；WBVT组膝关节摆动角度较治疗前有提高（P<0.05），明显优于对照组；在患侧单支撑相（SS），WBVT组双侧股直肌和股二头肌协同收缩率干预前后均有差异（P<0.05）；在患侧摆动相（SW），两组双侧股直肌和股二头肌协同收缩率干预前后均有差异（P<0.05），但干预后WBVT组患侧优于对照组（P<0.05）。 结论：基于叠加效应的全身振动联合有节律的蹲起同步训练能够改善患者步行速度、步幅和下肢肌肉协同收缩率，改善患者步行功能。

Abstract:

      Abstract Objective： To explore the synchronization effect of whole-body vibration therapy combined with squat-up training on ambulation of patients with stroke. Method： 40 stroke survivors who could walk independently with supervision or assistive devices， were recruited from the Department of Rehabilitation Medicine， Huashan Hospital Affiliated to Fudan University（Pudong Campus） and were randomly divided into the WBVT group and the control group. Both groups received conventional rehabilitation treatment for 40 minutes per day. The WBVT group was given additional whole-body vibration therapy while squat-up training for another 20 minutes a day. The control group added sham stimulation of standing on the vibration platform with no vibration for the same amount of time per day. At the beginning of enrollment and after 4 weeks intervention， participants received two times evaluation by the wearable three-dimensional gait assessment instrument for the function of walking， and the electromyographic signals of the rectus femoris and long head of the biceps femoris were collected by surface electromyography instrument and statistical analysis on the data before and after the intervention. Result： After 4 weeks intervention， the stride speed and stride length of both groups improved siginificanlty （P<0.05）， while the WBVT group was better than the control group（P<0.05）. The swing angle of knee（flexion or extention）in the WBVT group improved significantly after intervention compared with the control group. At the single leg support phase（SS） of affected side， the differences were found in the synergistic contraction rate of the rectus femoris and biceps femoris in the bilateral lower extremity of the WBVT group after the intervention （P<0.05）. At the swing phase（SW） of affected side， the differences were found in the synergistic contraction rate of the rectus femoris and biceps femoris in the bilateral lower extremity between the two groups before and after the intervention（P<0.05）， but the affected side of the WBVT group was better than that the control group after intervention（P<0.05）. Conclusion： Whole-body vibration therapy combined with rhythmic squat-up synchronous training can improve the stride speed， stride length and synergistic contraction rate of lower limb muscles for better ambulation of patients with stroke.