对侧控制型功能性电刺激对脑卒中患者上肢功能的影响  

Effects of contralaterally controlled functional electrical stimulation on upper limb functions in patients with stroke

作　　者：沈滢[1] 殷稚飞[1] 戴文骏[1] 伊文超[1] 李勇强[1] 张文通[1] 蔡可书[1] 单春雷[1] 

机构地区：[1]南京医科大学第一附属医院康复医学科,南京210029

出　　处：《中国康复医学杂志》2014年第12期1119-1123,1184,共6页Chinese Journal of Rehabilitation Medicine

基　　金：江苏省"六大人才高峰"项目(N2011-WS-100);江苏省卫生厅兴卫工程重点学科基金项目(XK20200903)

摘　　要：目的:研究对侧控制型功能性电刺激(CCFES)对脑卒中患者上肢功能的影响。方法:将60例脑卒中患者随机分为CCFES组(n=30)和对照组(n=30)。两组均接受常规康复训练。CCFES组在患侧腕背伸肌给予CCFES,将电极置于双侧腕背伸肌运动点,首先采取三点法对健侧产生轻微腕背伸动作(<10%完全动作幅度)、中等腕背伸动作(50%完全动作幅度)、完全腕背伸动作时的肌电值进行标定,然后调节刺激器使患侧腕关节产生与健侧三个相同幅度的动作,记录所需电流强度。治疗时健侧做腕背伸动作以触发刺激器,给予患侧腕背伸肌相对应强度的电刺激以产生与健侧相似的动作。输出波形为方波,电流频率60Hz,脉冲宽度200μs,持续时间20min。对照组在患侧腕背伸肌运动点给予神经肌肉电刺激(NMES),输出波形为方波,电流频率60Hz,脉冲宽度200μs。两组治疗方案均为每次20min,每日1次,每周5次,连续治疗3周。分别于治疗前、治疗3周后采用上肢Fugl-Meyer评分法、上肢运动力指数(MI)、偏瘫上肢功能测试-香港版(FTHUE-HK)、主动腕背伸活动度(AROM)对患者上肢功能进行评定。结果:治疗3周结束时,CCFES组上肢Fugl-Meyer、MI、FTHUE-HK评分及腕背伸AROM均较治疗前显著提高(P<0.05);对照组上肢Fugl-Meyer、MI、FTHUE-HK较治疗前有明显提高(P<0.05);且CCFES组上肢Fugl-Meyer和FTHUE-HK评分均明显优于对照组(P<0.05)。结论:对侧控制型功能性电刺激能明显提高脑卒中患者上肢功能,较神经肌肉电刺激效果更佳。Objective：To investigate the effects of contralaterally controlled functional electrical stimulation （CCFES） on upper limb functions in subjects with stroke.Method：Sixty subjects with stroke were randomly assigned to treatment group （n=30） and control group （n=30）.Subjects in treatment group received CCFES to the affected wrist extensors,while control group received neuromuscular electrical stimulation （NMES）.The parameters of two kinds of electrical stimulation were square wave with pulse width of 200μs and frequency of 60Hz,and these electrical stimulation treatments lasted for 20min per session,5 sessions per week for 3 weeks.The two groups all received traditional rehabilitation therapy in addition to the electrical stimulation treatment.The stimulation intensity of CCFES was based on myoelectric value got from the unaffected side while subjects voluntarily extended their wrist with minimal contraction （less than 10% maximal voluntary contraction[MVC]）,moderate contraction （about 50% MVC） and complete contraction （=MVC）.The myoelectric intensities of these 3 kinds contractions were recorded.Then during treatment,the unaffected wrist extended voluntarily to trigger affected wrist 3 contractions with the same amplitude by regulating the stimulation.Fugl-Meyer assessment （FMA） for upper limb function,upper limb motricity index （MI）,FTHUE-HK score and active ROM （AROM） of wrist extension were measured before and after 3 weeks treatment.Result：After treatment,subjects in treatment group showed significant improvements in all the measurements （P〈0.05）; subjects in control group showed obviously improvements in upper limb FMA,MI and FTHUE-HK scores （P〈0.05）.And subjects in treatment group showed significant higher FMA and FTHUE-HK scores than those in control group（P 〈 0.05）.Conclusion：The CCFES could facilitate the improvement of upper limb function in stroke subjects,and had better effects than NMES.

关 键 词：对侧控制型功能性电刺激 脑卒中 上肢功能 

分 类 号：R246.6[医药卫生—针灸推拿学]