【作者】 贾为宗；

【导师】 王凤阳；

【作者基本信息】 河北师范大学 ， 民族传统体育， 2008， 硕士

【摘要】 脑卒中是目前我国第一大致残,第二大致死的疾病,幸存者以偏瘫最为常见。偏瘫是脑卒中患者最常见的后遗症之一。由于病发后恢复缓慢,就医时间长,给社会、家庭及个人带来了沉重的经济负担和精神压力。为了使患者早日康复重返社会,减轻病发所带来的负担和压力,给患者提供能够促进其康复且方便可行的方法尤为重要。传统体育疗法是脑卒中偏瘫康复的一个重要手段。易筋经是我国古代流传下来,又经国家健身气功管理中心新编的四套健身气功之一,也是传统体育疗法的一种。经常练习可达到形神共养、内外兼修的效果。研究目的与意义:通过进行常规康复并练习易筋经的实验组与只进行常规康复的对照组实验期康复效果的比较,探讨易筋经对脑卒中偏瘫患者康复的作用和意义。研究内容与目标:1.练习三个月健身气功易筋经前后评价脑卒中偏瘫患者的平衡能力、上下肢运动功能的康复效果。2.通过练功,分析易筋经对脑卒中偏瘫患者心理情感的影响。3.分析两组患者实验前后患侧上肢肱二、肱三头肌和下肢股四、股二头肌最大收缩时的表面肌电图,比较表面肌电积分值与协同收缩率的变化情况。研究对象与方法:选取河北省人民医院康复中心的脑卒中偏瘫患者34例,随机分为实验组18例,对照组16例。实验组进行3个月易筋经练习,30分/次,1次/天,5天/周;实验过程中两组患者均进行相同的常规康复训练;实验前后分别对两组患者采用Berg平衡量表(BBS)、Fugl-Meyer平衡功能评测(FM-B)、Fugl-Meyer运动功能评定(FMA)、Zung抑郁自评量表和Zung焦虑自评量表进行评测;同时采用德国BIOVISION公司出品的16道表面肌电图仪,测试肘关节屈曲和伸展时的肱二头肌、肱三头肌,以及膝关节屈曲和伸展时的股四头肌、股二头肌在最大等长收缩状态下的表面肌电。研究结果:1.平衡功能:实验组在BBS、FM-B的改善明显优于对照组(P<0.05)。2.上下肢运动功能:实验组在上肢FMA和下肢FMA的改善明显优于对照组(P<0.053.抑郁、焦虑情感方面:实验组Zung抑郁自评量表和Zung焦虑自评量表指数与对照组相比有明显改善(P<0.05)。4.上下肢表面肌电的积分肌电值与协同收缩率(1)上肢肌肉:肘关节屈曲时,实验组肱二头肌积分肌电值比对照组增大明显(P<0.05)、肱三头肌积分肌电值变化无显著性差异(P>0.05)、协同收缩率减小有显著性差异(P<0.05)。肘关节伸展时:实验组肱二头肌积分肌电值比对照组减小明显(P<0.05)、肱三头肌积分肌电值增加显著(P<0.05)、协同收缩率减小有显著性差异(P<0.05)。(2)下肢肌肉:膝关节屈曲时,实验组股四头肌积分肌电值比对照组减小明显(P<0.05)、股二头肌积分肌电值增加明显(P<0.05)、协同收缩率减小有显著性差异(P<0.05)。膝关节伸展时:实验组股四头肌积分肌电值比对照组增大明显(P<0.05)、股二头肌积分肌电值无明显变化(P>0.05)、协同收缩率减小无显著性差异(P>0.05)。结论:脑卒中偏瘫患者通过三个月易筋经锻炼的实验研究发现,在常规康复训练中结合易筋经锻炼,能够促进脑卒中偏瘫患者的康复。表现如下方面:(1)促进脑卒中偏瘫患者上、下肢运动功能的改善;(2)促进脑卒中偏瘫患者平衡功能的改善;(3)对脑卒中偏瘫患者抑郁和焦虑情绪有积极改善作用;(4)通过表面肌电测试发现患者主动肌收缩时,积分肌电值增加,收缩功能增强;拮抗肌协同收缩的控制能力有明显改善。更多还原

【Abstract】 Stroke is the first mutilational and the second lethal disease in our country at present.The hemiplegia is the most common symptom in the survivors, Also hemiplegia is one of the most common sequelae in the stroke patients. Because of the slow-moving recovery and the long time medical treatment, the heavy burdens of economy and spirit are being touched to the individual, family and society. It will be important to offer an advanced and convenient recovery method , so as to help the patient to come back society early and lessen the burden and stress from the disease.Traditional athletic therapy is one of the important methods to the recovery of stroke hemiplegia. Yi jinjing is one of traditional athletic therapies in our country from the ancient times. It is also one of four new-edited health-care qigongs of National health-care qigong management center. It will has the effect of sharing of body and spirit , exercising of exterior and interior from the regular exercise.Purposes and meaningsThe purpose and meaning of our study are to compare the rehabilitation efficacy with the two groups, one is adding the Yi jinjing training in general rehabilitation ,the another is only in general rehabilitation .In order to approach the effect and meaning of Yi jinjing training in the rehabilitation of patients in stroke hemiplegia.Contents and objects1. Exercise the three-month health-care qigong—Yi jinjing, evaluate the rehabilitation efficacy of patients in stroke hemiplegia before and after the training in balance function and the motor function of upper and lower limb.2. Through out the training, analyze the influence of Yi jinjing to the patients of stroke hemiplegia in psychological feeling.3. Analyze the surface electromyography which are the maximal isometric contraction of trouble-side muscles of biceps brachii ,triceps brachii , quadriceps fexoris and biceps femoris in the two group patients before and after the training. Compare the changes between the surface integrated electromyographic(IEMG) and cocontraction ratio(CR). Objects and methodsWe choose 34 stroke hemiplegic patients from the rehabilitation center in Hebei People’s Hospital. These patients are divided into two groups in random. One is experiment group,18 patients .The other is control group,16 patients.The experiment group is handled in Yi jinjing therapy for 3 months,30 minutes per time,1 time per day, 5 days per week. All the patients are received the same general rehabilitation through the whole course. The patients in two groups are received the measurement in Berg Balance Scale(BBS), Balance subscale of the Fugl-Meyer test(FM-B), Fugl-Meyer motor assessment(FMA) and the scale of depression and anxiety of Zung in the beginning and the end of the experiment.At the same time, we test the surface electromyographic with the machine of surface electromyography in 16 paths of the company called BIOVISION from Germany. The conditions which are the maximal isometric contraction include the changes of musculus biceps brachii and musculus triceps brachii in flexion and extension of elbow joint,and the changes of musculus quadriceps fexoris and musculus biceps femoris in flexion and extension of knee jointResults1. Balance function: the improvements of BBS and FM-B in experiment group surpass the control group obviously (P<0.05) .2. The motor function of upper and lower limb: the improvements of FMA of upper and lower limb in experiment group surpass the control group obviously (P<0.05) .3. The feeling of depression and anxiety: The index number of the scale of depression and anxiety of Zung in experiment group surpass the control group obviously (P<0.05) .4. The IEMG and CR in muscles of upper and lower limb(1)muscle of upper limb:In the flexion condition of elbow joint, the IEMG of musculus biceps brachiib in experiment group increase obviously compared with the control group (P<0.05),the changes of IEMG of musculus triceps brachii have no significant differences(P>0.05),The dim of CR have significant differences (P<0.05).In extension condition of elbow joint, the IEMG of musculus biceps brachiib in experiment group decrease obviously compared with the control group (P<0.05), the IEMG of musculus triceps brachii increase obviously(P<0.05), The dim of CR have significant differences(P<0.05).(2)muscle of lower limb:In the flexion condition of knee joint, the IEMG of musculus quadriceps fexoris in experiment group decrease obviously compared with the control group (P<0.05), the IEMG of musculus biceps femoris increase obviously(P<0.05), The dim of CR have significant differences(P<0.05).In the extension condition of knee joint, the IEMG of musculus quadriceps fexoris in experiment group increase obviously compared with the control group (P<0.05), the changes of IEMG of musculus biceps femoris have no significant differences(P>0.05), The dim of CR have no significant differences(P>0.05). ConclusionsThe conclusion is that through out Yi jinjing therapy for 3 months, the method which with general rehabilitation and Yi jinjing therapy will promote the rehabilitation of the stroke hemiplegic patients. The appearances are as follows:(1)Promote the improvement of upper and lower limb in motor function of the stroke hemiplegic patients.(2)Promote the improvement in balance function of the stroke hemiplegic patients.(3)Have a positive and improved effect to the feeling of depression and anxiety of the stroke hemiplegic patients.(4)The test of SEMG to patients acquire that the contractile function of agonistic muscle is strengthened, and the control ability of the coordinational construction in antagonistic muscle is improved obviously.更多还原