等速肌力训练对偏瘫患者上肢运动功能恢复的影响

摘要

目的:研究等速肌力训练结合偏瘫肢体综合运动疗法对脑卒中偏瘫患者上肢运动功能恢复的影响.方法:选择恢复期脑卒中偏瘫患者40例,随机分为观察组和对照组各20例.对照组接受常规偏瘫肢体综合运动疗法、作业治疗、ADL训练以及传统物理因子治疗等对症治疗;观察组在此基础上另外配合偏瘫上肢等速肌力训练.干预前后分别使用BIODEX system-3等速肌力测试系统检测肩屈伸生物力学指标,Fugl-Meyer运动功能量表(FMA)评分上肢部分,改良Ashworth痉挛量表评分,NRS数字疼痛量表(NRS)评分来评定患侧上肢的运动功能、肌张力及疼痛.结果:经过3周治疗,2组患者肩屈伸生物力学指标、FMA上肢运动功能评分、NRS疼痛评分均较前有显著改善,且观察组优于对照组(P＜0.05);2组患者肌张力均较前改善,但治疗前后差异无统计学意义.结论:等速肌力训练可增强脑卒中偏瘫患者肩关节屈伸肌力,且不会加剧肌肉痉挛和肩关节疼痛,有效促进脑卒中偏瘫患者上肢功能的改善.%Objective:Through the training and test analysis of the shoulder joint,to observe the effect of isokinetic strength training on upper limb motor function recovery of patients with hemiplegia.Methods:Forty cases of hemiplegia after stroke were selected and randomly divided into experimental group and control group,with 20 cases in each group.The control group and experimental group received limb training,transfer training,physical factor treatment and other routine hemiplegia limb rehabilitation therapy,and the experimental group was given hemiplegia upper limb isokinetic muscle strength training additionally.Before and 3 weeks after treatment,the isokinetic muscle strength test was carried out,and the integrated motor function score of upper limb (Fugl-Meyer assessment of motor function,FMA) and muscle tone (modified Ashworth scale,MAS) and pain score (numeric pain scale,NRS)were assessed.Results:After treatment for 3 weeks,shoulder flexion biomechanical indicators,FMA scores,and NRS pain scores were significantly improved in both two groups than before,and the experimental group was better than the control group (P＜0.05).The muscle tension in the two groups of patients was increased from the baseline,but there was no significant difference before and after treatment.Conclusions:Isokinetic muscle training can enhance the shoulder joint flexion strength,and does not exacerbate the muscle spasm and shoulder pain of hemiplegic stroke patients,which can effectively improve the upper limb function in patients with hemiplegia after stroke.