基于易罐辅助的肌肉能量技术对于卒中后痉挛患者患侧上肢功能的影响

关键词：易罐  肌肉能量技术  抗阻训练  脑卒中  肌痉挛

Keywords:easy cupping therapy  muscle energy technology  resistance training  stroke  spasm

摘要：

      摘要 目的：观察在易罐辅助下肌肉能量技术（MET）对于脑卒中后上肢痉挛患者上肢功能的治疗效果，并与被动牵伸治疗的疗效作比较；探讨MET中的抗阻动作对患者上肢肌痉挛产生的影响。 方法：在院内收集卒中后上肢痉挛患者44例，随机分为易罐联合肌肉能量技术训练的试验组（22例）和牵伸训练的对照组（22例）。治疗前、治疗4周后分别采用简式Fugl-Meyer评分上肢部分（FMA-UE）、改良Ashworth评估（MAS）、徒手肌力评估（MMT）、临床痉挛指数（CSI）和肘关节伸展的被动活动度，并通过表面肌电图设备采集在等长收缩状态肘关节屈曲时肱二头肌的积分肌电值和肘关节伸展时肱二头肌的协同收缩率来评价上肢功能情况。 结果：治疗4周后，两组的FMA-UE评分较治疗前均有显著提高（P<0.001），且试验组得分优于对照组（P<0.05）；试验组干预前后MMT、MAS和CSI均无显著变化（P>0.05）且试验组和对照组相比也无明显差异（P>0.05）；两组肘关节伸展的被动活动度，治疗4周后均有显著改善（P<0.05），且两组活动度改善程度相近（P>0.05）；治疗后，等长收缩状态下，试验组患侧屈肘时肱二头肌的积分肌电值（iEMG）较干预前显著增大（P<0.05），而对照组干预前后无明显变化（P>0.05）；伸肘时两组的患侧肱二头肌协同收缩率较干预前显著减小（P<0.05），且试验组的协同收缩率变化要显著大于对照组（P<0.05）。 结论：4周易罐辅助的MET训练可以有效改善脑卒中后上肢痉挛患者的上肢功能，且其治疗效果要优于被动牵伸治疗；MET中的抗阻动作有效增强了肱二头肌的肌力，同时未增加上肢的痉挛程度。

Abstract:

      Abstract Objective： Muscle energy technique （MET） training combined with easy cupping therapy was performed on the upper limb flexors of spastic side in patients with post-stroke spasticity and the effect on the improvement of spasticity degree was compared with the effect of passive stretching. The effect of resistance training on the degree of upper limb flexor spasm in patients with post-stroke spasm was also observed. Method： Forty-four patients with upper limb spasm after stroke were collected in hospital and randomly divided into the experimental group （n=22） and the control group （n=22）. Experimental group was treated by easy cupping therapy combined with muscle energy technology training，while control group was treated by passive stretching. Fugl-Meyer upper extremity score （FMA-UE）， Modified Ashworth scale（MAS）， manual muscle test（MMT）， clinical spasticity index（CSI） and passive motion of elbow extension were used before treatment and 4 weeks after treatment， respectively. The integrated electromyography （EMG） of the biceps in elbow flexion and the co-contraction rate of the biceps in elbow extension were collected by surface EMG equipment to evaluate the function of the upper limb. Result： After 4 weeks of treatment， the FMA-UE score of both groups was significantly higher than that before treatment （P<0.001）， and the score of experimental group was better than that of control group （P<0.05）. There were no significant changes in MMT， MAS and CSI in the experimental group before and after intervention （P>0.05）， and no significant differences between the experimental group and control group （P>0.05）. After 4 weeks of treatment， the passive range of motion of elbow extension in both groups was significantly improved （P<0.05）， and the improvement of the range of motion in both groups was similar （P>0.05）. After treatment， the integrated electromyography （iEMG） of the biceps muscle during elbow flexion in the experimental group significantly increased when compared with that before intervention （P<0.05）， while there was no significant change in the control group before and after intervention （P>0.05）. During elbow extension， the cosystolic rate of biceps on the affected side of the two groups significantly decreased when compared with that before intervention （P<0.05）， and the change of cosystolic rate in the experimental group was significantly greater than that in the control group （P<0.05）. Conclusion： Both groups， the MET assisted by the easy cupping therapy and the passive stretching have positive significance for the functional rehabilitation of the affected upper limb of the patients with post-stroke spasm， and the experimental group has better effect than that of the control group. In patients with post-stroke spasm， resistance training of the spasmodic side flexors increases the strength of the elbow flexors （mainly the biceps） without increasing the degree of spasticity.