步态诱发功能性电刺激对偏瘫足下垂患者步行能力的影响

摘要

目的:比较步态诱发式功能性电刺激(FES)与神经肌肉电刺激(NMES)对脑卒中后足下垂患者下肢运动功能以及步行速度的影响.方法:将30例脑卒中偏瘫足下垂患者随机分为两组,试验组和对照组,均接受神经内科常规药物及康复功能训练,试验组采用步态诱发式FES,刺激患侧腓总神经和胫前肌,2次/天,每次20min,每周7天,共4周.对照组采用NMES.分别在治疗前、治疗后评定偏瘫侧主动踝背伸的角度、FMA下肢运动功能以及步行速度.结果:治疗4周后,两组患者偏瘫侧主动踝背伸的角度、FMA值以及10m最大步行速度较治疗前都有显著改善(P＜0.05).主动踝背伸角度试验组增加了58.3％,对照组增加了29.6％;FMA值试验组增加了38％,对照组增加了19％;10米最大步行速度试验组增加了34％,对照组增加了11％;治疗后与治疗前的差值,两组比较有显著性差异(P＜0.05).结论:常规康复训练结合NMES能够改善偏瘫侧下肢运动功能及步行速度,常规康复训练结合FES后效果更明显,因此步态诱发式FES可以作为一种常规的训练方法在临床上广泛使用.%Objective:To compare the effects of gait induced functional electrical stimulation(FES) and neuromuscular electrical stimulation(NMES) to function of lower limb and walking speed in stroke patients with foot droop.Method:Thirty stroke patients with foot droop were divided into treatment group (gait induced FES) and control group (NMES).All the patients accepted routine medicine and rehabilitation training.The electrodes were placed over the common peroneal nerve and tibialis anterior.Both groups were treated for 20min,2 times per day,7days a week for 4 weeks.The active angle of dorsiflexion,Fugl-Meyer assessment (FMA) score of lower limb and 10-meter maximum walking speed(10MWS) were assessed before and after treatment.Result:After 4-week treatment,the active angles of dorsiflexion,FMA scores of lower limb and 10MWS of both groups improved significantly when compared with that before treatment (P＜0.05).The active angles of dorsiflexion increased 58.3％ and 29.6％,FMA scores of lower limb increased 38％ and 19％ and 10MWS increased 34％ and 11％ in treatment group and control group respectively.There were significant differences changes between both group(P＜0.05).Conclusion:Conventional rehabilitation treatment combined with NMES can improve the function of lower limb and walking speed,while conventional rehabilitation treatment combined with gait induced FES can improve more.So gait induced FES can be commonly used to stroke patients in clinic.