【作者】 卫哲；

【导师】 王东岩；

【作者基本信息】 黑龙江中医药大学 ， 康复医学与理疗学， 2008， 硕士

【摘要】 目的:1、应用表面肌电信号客观评价脑卒中上肢运动功能。2、观察低频脉冲电疗法对脑卒中后上肢功能的影响。3、分析各因素对疗效影响的差异,优选脑卒中后上肢功能重建的最佳低频脉冲电疗法治疗方案。方法:选择符合纳入标准的脑梗死、脑出血患者40例,采集上肢肩、肘、手腕部活动时主动肌、协同肌的sEMG,提取特征值MAX、IEMG,评价上肢运动功能。将病人随机分为两组,对照组给予常规康复治疗;治疗组给予低频电刺激及常规康复治疗。采用正交试验设计的三因素两水平组合方案,将治疗组病人随机分为4组,进行低频脉冲电治疗。采用sEMG、Fug1-Meyer评定法、CSS、Barthel ADL指数评价各组治疗前后的上肢运动功能。结果:1、脑卒中病人上肢健侧主动肌、协同肌的MAX、IEMG与患侧相比较有显著性差异(P＜0.05)。2、低频脉冲电疗法治疗前后,患侧上肢肌肉的MAX、IEMG比较有显著性差异(P＜0.05)。3、采用低频脉冲电治疗的断续波、50Hz脉冲频率、电极放置于运动点治疗脑卒中后上肢运动功能可以使上肢MAX、IEMG、Fug1-Meyer运动功能分值、Barthel ADL提高较明显,且各因素对疗效的影响从大到小排列为:脉冲波型＞脉冲频率＞电极放置位置。结论:1、脑卒中病人健侧与患侧sEMG不同,不同动作的不同肌肉sEMG不同。相对于Fug1-Meyer运动功能评价、CSS评价以及Barthel ADL评价,sEMG可以更为客观精确的评价脑卒中后肢体功能。2、低频脉冲电疗法对脑卒中后上肢运动功能的重建疗效肯定,它可以提高sEMG的特征值MAX、IEMG的分值;改善上肢Fug1-Meyer运动功能及Barthel ADL能力。3、不同因素对低频脉冲电治疗脑卒中后上肢运动功能疗效的影响不同。低频电刺激脉冲波型断续波、50Hz脉冲频率、电极放置于运动点为本临床研究的最佳治疗方案。更多还原

【Abstract】 Objectives1.With the application of surface EMG to evaluate upper-limbs’ movement function after stroke objectively.2.To observe the influence of low-frequency impulse electrotherapy Rx in upper-limbs’ function after stroke.3.To analyse the difference which various low-frequency electrical stimulating factors influence curative effect in order to optimize low-frequency impulse electrotherapy Rx.Methods40 patients suffered from cerebral hemorrhage or cerebral infarct which according with standard were gathered the sEMG of initiative muscles and cooperative muscles in the movement of upper 1imbs’ shoulder、elbow、wrist. The eigenvalues of sEMG such as MAX、IEMG were extracted to evaluate upper limbs’ movement function.Patients were divided into 2 groups by random.Control group was accepted standard rehabilitation treatment.And electrical stimulating group was accepted standard rehabilitation treatment plus electrical stimulating.Electrical stimulating group was divided into 4 groups by random arranged by Orthogonal test through combination scheme arranged in groups by three factors and two levels.And patients were accepted low-frequency impulse electrotherapy.Each group was assessed with Fugel-Meyer Functional evaluation scale、CSS scale、Barthel ADL scale respectively before and after treatment.Results1、Comparing with MAX、IEMG of initiative muscles and cooperative muscles of healthy side and trouble side in stroke patients’ upper limb,there were significant differences between them(P＜0.05)2、Before and after the treatment of low-frequency impulse electrotherapy,the eigenvalue of sEMG such as MAX、IEMG of upper limbs had the significant differences between them.(P＜0.05)3、The adoption of intermittent wave、impulse frequency of 50Hz、electrodes placed movement point to improve upper limbs’ movement function can significantly boost MAX、IEMG、Fugl-Meyer movement function mark and Barthel ADL of upper limbs.Curative effect influenced by each factor from greatness to lightness was:impulse wave＞impulse frequency＞electrodes placed site.Conclusions1、There were difference between healthy side and trouble side in stroke patients.Different muscles had various sEMG in different movements. Compared with Fugl-Meyer movement function scale、CSS scale、Barthel ADL scale,sEMG can evaluate limbs’ function more accurately and objectively after stroke.2、Low-frequency impulse eleetrotherapy had positive curative effect on the reconstruction of limbs’ function after stroke.It can improve the eigenvalues of sEMG,such as MAX、IEMG;improve Fugl-Meyer movement function and Barthel ADL of upper-limb.3、Different factors had the different curative effects on the treatment of low-frequency impulse electrotherapy with the movement function of limbs after stroke.The optimal project was intermittent wave,50Hz、movement point in low-frequency impulse electrotherapy.更多还原