利用脑卒中后下肢联合反应提高运动控制能力的研究  

Effect of associated reaction in lower extremity on improvement of motion control in stroke patients

作　　者：郑洁皎[1] 俞卓伟 徐国会[1] 徐悦莹[1] 夏汶[1] 杨寅[1] 徐洲[1] 

机构地区：[1]复旦大学附属华东医院康复医学科,上海200040 [2]老年医学研究所

出　　处：《老年医学与保健》2011年第2期73-76,共4页Geriatrics & Health Care

基　　金：上海市申康医院管理中心资助项目（编号：SHDCI2007205）;上海市科委基金项目（编号：06JC14027）

摘　　要：目的 研究脑卒中后如何利用姿势反射出现的联合反应（AR）在早期诱导出瘫痪肌群的主动性收缩,转化为有效运动控制能力的康复训练技术.方法 通过对94例脑卒中患者健下肢做本体感觉神经肌肉促进技术（PNF）最大阻力技术的内收、外展动作时.利用联合反应原理,诱发患下肢的Raimiste现象,通过动态表面肌电信号实时监测双下肢肌群电生理信号,进行健/患侧的相关性分析.结果 脑卒中患者在健下肢做PNF最大阻力技术的内收、外展动作时.BrunnstromⅢ-Ⅳ期时,患,健侧肌肉的相关性R的绝对值均大于0.5,具有相关性;患侧的协同收缩率CCR均大于健侧的协同收缩率CCR.随着脑卒中后运动功能的恢复,BrunnstromⅣ期时,患侧和健侧的协同收缩率CCR没有统计学差异.结论 在脑卒中后早期,利用联合反应原理,对健下肢进行PNF最大阻力技术训练,能够诱发患下肢相应肌群早期产生主动收缩,增加姿势性张力;在脑卒中痉挛和共同运动期,增加患下肢瘫痪肌群的张力,交互抑制痉挛肌群的张力,能够放松痉挛的肌肉,从而抑制异常姿势模式,促进患侧建立正常的运动模式,提高下肢的运动控制能力.Objective To induce active movement of involved side muscular group by association reaction, and further transform to effective rehabilitation technique. Methods Correlation analysis of surface electromyography （sEMG） between non-involved and involved sides was conducted when association reaction （AR） was induced with maximum resistance （MR） in the process of proprioceptive neuromuscular facilitation and co-contraction ratio （CCR） was obtained to identify the degrees of contraction pattern. Results In the phase of Brnnnstrum 11-IV correlation coefficients of non-involved/invol- ved side muscle were more than 0.5 when abduction and adduction of non-involved lower extremity were performed with maximum resistance. The muscular co-contraction ratio of involved side increased significantly, compared with that of noninvolved side. Nevertheless, along with improvement of motion function in hemiplegic limb, there was no significant difference in CCR between both sides. Conclusions AR with lower extremity PNF and MR could be utilized to induce active movement of involved side in early stage of stroke. It also could be applied to relax plasticity and to inhibit abnormal posture, further to improve normal movement model and to enhance motion control.

关 键 词：脑卒中 联合反应 运动控制 

分 类 号：R743[医药卫生—神经病学与精神病学]