刘美快,徐乐义,李海燕,等.镜像疗法对脑卒中患者运动功能和平衡功能以及胫骨前肌形态结构的影响[J].中华物理医学与康复杂志,2020,42(5):419-423
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| 镜像疗法对脑卒中患者运动功能和平衡功能以及胫骨前肌形态结构的影响 |
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| DOI：10.3760/cma.j.issn.0254-1424.2020.05.009 |
| 中文关键词: 超声 肌肉结构参数 胫骨前肌 脑卒中 镜像疗法 |
| 英文关键词: Ultrasound Muscle structure Tibialis anterior Stroke Mirror therapy |
| 基金项目:温州市科技局资助项目（Y20170217） |
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| 中文摘要: |
| 目的 观察镜像疗法（MVF）对脑卒中患者运动功能和平衡功能的影响，并采用超声影像观察MVF干预前、后其患侧胫骨前肌（TA）形态结构的变化。 方法 选取符合入选和排除标准的脑卒中患者36例，按随机数字表法分为镜像组（18例）和对照组（18例），2组患者均接受常规药物和常规康复治疗，镜像组患者在此基础上增加MVF训练，而对照组则进行假MVF训练。2组患者均每周训练5 d，连续训练4周。于治疗前和治疗4周后（治疗后）采用FMA量表的下肢部分（FMA-LE)和Berg平衡量表(BBS)分别对2组患者的下肢运动功能和平衡功能进行评估，并采用超声技术获取2组患者胫骨前肌（TA）静息和最大等长收缩(MVC)时羽状角(PA)、肌肉厚度(MT)和肌纤维长度(FL)。 结果 治疗后，2组患侧TA静息和MVC时的PA较组内治疗前均显著增加，且镜像组治疗后患侧TA静息和MVC时的PA均显著高于对照组治疗后，差异均有统计学意义（P＜0.05）；镜像组患侧TA静息和MVC时的MT较组内治疗前和对照组治疗后均显著增加，差异均有统计学意义（P＜0.05）。治疗后，2组患者的FMA-LE和BBS评分较组内治疗前均显著提高，且镜像组的FMA-LE和BBS评分分别为（24.39±6.99）分和（38.67±9.80）分，均显著优于对照组治疗后，差异均有统计学意义（P＜0.05）。 结论 镜像疗法可改善脑卒中患者的下肢运动功能和平衡能力，超声影像可量化评估脑卒中患者TA形态结构的变化，为临床疗效评价提供客观依据。 |
| 英文摘要: |
| Objective To observe the effect of mirror visual feedback (MVF) on the motor functioning and balance of stroke survivors, and to observe any morphological and structural changes in the tibialis anterior (TA) after MVF training. Methods Thirty-six stroke survivors were divided into a mirror group (n=18) and a control group (n=18). Both groups received conventional drugs and routine rehabilitation treatment, while the mirror group was additionally provided with MVF training 5 days a week for 4 weeks. Before and after the treatment, both groups were evaluated using the Fugl-Meyer assessment for the lower extremities (FMA-LE) and the Berg balance scale (BBS). Moreover, the pennation angle (PA), the muscle thickness (MT) and the fascicle length (FL) of the tibialis anterior were measured at rest and in maximum isometric voluntary contraction (MVC) using ultrasonic imaging. Results After the treatment the average PA of the affected side at rest and the MVC of the TA increased significantly in both groups compared with before the treatment, with the average improvement in the mirror group significantly greater than in the control group. The average TA thickness at rest and the MVC were both significantly greater in the mirror group than among the control group after the treatment. The average FMA-LE and BBS scores of both groups had improved significantly, but the mirror group′s average scores were significantly better than those of the control group. Conclusion MVF can improve the motor function and balance ability of stroke survivors. Moreover, ultrasound can be used to evaluate the changes of TA morphology in such patients quantitatively, providing an objective foundation for tracking clinical efficacy. |
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