目的:研究低频穴位电刺激(LFES)对中风患者拇指到手指运动肌肉表面肌电图(sEMG)信号的影响,并评价LFES对脑卒中后手功能恢复的临床疗效。
方法:将符合纳入标准的60例患者随机分配到LFES组或电针(EA)组,每组30名患者。两组均接受常规治疗,电针组采用《针灸》中的穴位治疗,而LFES组采用先前研究的穴位治疗。sEMG特征值(最大值和RMS),中国脑卒中临床神经功能缺损量表(CSS),Brunnstrom运动功能评估,改良Ashworth量表(MAS),治疗前后测量Lindmark手功能评分和Lovett肌肉力量分类。
结果:治疗后,两组均显示sEMG特征值改善,Brunnstrom运动功能评分,Lindmark手部功能评分,与治疗前相比,洛维特肌力分级,LFES组的改善明显优于EA组(P<0.05)。两组患者的CSS评分及MAS分级均较治疗前有所下降,LFES组的下降程度明显优于EA组(P<0.05)。LFES组总有效率为92.86%,EA组为79.31%。两组间差异有统计学意义(P<0.05)。
结论:LFES和EA在中风后恢复拇指到手指的运动功能方面均有效,如第一背侧骨间肌和短伸肌的最大值和均方根值增加所证明的,CSS分数下降,Brunnstrom运动功能评分增加,MAS分类减少,增加的Lindmark手功能评分,和增加的洛维特肌肉力量分类。然而,LFES比EA表现出更明显的改善和更好的疗效,值得临床推广。
OBJECTIVE: To examine the effect of low-frequency acupoint electrical stimulation (LFES) on the surface electromyographic (sEMG) signals of the
thumb-to-finger movement muscles in stroke patients, and to evaluate the clinical efficacy of LFES on hand function recovery after stroke.
METHODS: Sixty patients who met the inclusion criteria were randomly assigned to a LFES group or an electroacupuncture (EA) group, with 30 patients in each group. Both groups received conventional treatment, and the EA group was treated with acupoints from the book of Acupuncture and Moxibustion, while the LFES group was treated with acupoints from a previous
study. The sEMG characteristic values (maximum value and RMS), Chinese Stroke Clinical Neurological Deficit Scale (CSS), Brunnstrom Motor Function Evaluation, Modified Ashworth Scale (MAS), Lindmark Hand Function Score and Lovett Muscle Strength Classification were measured before and after treatment.
RESULTS: After treatment, both groups showed improvement in sEMG characteristic values, Brunnstrom motor function score, Lindmark hand function score, and Lovett muscle strength classification compared with before treatment, and the improvement in the LFES group was significantly better than that in the EA group (P < .05). The CSS score and MAS classification of both groups decreased compared with before treatment, and the decrease in the LFES group was significantly better than that in the EA group (P < .05). The total effective rate of the LFES group was 92.86%, and that of the EA group was 79.31%. The difference between the 2 groups was statistically significant (P < .05).
CONCLUSIONS: Both LFES and EA were effective in restoring
thumb-to-finger movement function after stroke, as evidenced by the increased maximum value and root mean square values of the first dorsal interosseous muscle and the extensor pollicis brevis muscle, the decreased CSS score, the increased Brunnstrom motor function score, the decreased MAS classification, the increased Lindmark hand function score, and the increased Lovett muscle strength classification. However, LFES showed more obvious improvement and better efficacy than EA, which is worthy of clinical promotion.