本文選題：偏癱痙攣型腦癱 + 步態(tài)　； 參考：《天津體育學(xué)院》2017年碩士論文

【摘要】：痙攣型偏癱腦癱是最常見的腦癱類型之一。這一類型腦癱患者因一側(cè)肢體受累而呈偏癱代償步態(tài),這一步態(tài)具有步行期間運(yùn)動神經(jīng)協(xié)調(diào)性差,存在步幅短,步頻高,穩(wěn)定性差的特點(diǎn)。同時有健側(cè)支撐相過長,擺動相較短的問題。臺灣治療師葉蒼甫老師在Bobath療法基礎(chǔ)上提出了健側(cè)負(fù)重方法以干預(yù)偏癱腦癱兒童的病理步態(tài)。單側(cè)負(fù)重是一種非正常的負(fù)重干預(yù)手段。目前國內(nèi)有關(guān)單側(cè)負(fù)重步行可能對人體步行模式的影響研究仍是空白,而國外有關(guān)研究有很多,且有相關(guān)研究支持單側(cè)負(fù)重對腦卒中代償步態(tài)有治療意義。腦癱代償步態(tài)和腦卒中代償步態(tài)有高度相似性。因此本實(shí)驗(yàn)擬測定偏癱痙攣腦癱兒童健側(cè)下肢踝關(guān)節(jié)處負(fù)重干預(yù)對步行周期中雙側(cè)下肢運(yùn)動學(xué)參數(shù)的影響,以及下肢主要肌肉表面肌電(sEMG)的變化。以期了解健側(cè)負(fù)重干預(yù)后步行能力的變化。探討運(yùn)動控制系統(tǒng)在負(fù)重步行中的調(diào)控作用。對進(jìn)一步了解健側(cè)負(fù)重對偏癱腦癱患兒的影響,探究健側(cè)負(fù)重治療方法的有效性。研究對象和方法:選取12名偏癱痙攣型腦癱患兒,受試者在實(shí)驗(yàn)過程中在健側(cè)下肢踝關(guān)節(jié)處佩戴負(fù)重用的沙袋之后進(jìn)行20分鐘的沙袋負(fù)重步行訓(xùn)練干預(yù)。在干預(yù)前、干預(yù)即刻和干預(yù)后分別采集受試者雙側(cè)下肢的運(yùn)動學(xué)、sEMG指標(biāo)。并對這些數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)處理分析。研究結(jié)果:1.干預(yù)即刻健側(cè)和患側(cè)支撐期時長和干預(yù)前相比均有顯著縮小(P0.05),干預(yù)后健側(cè)下肢支撐期時長相比干預(yù)即刻顯著增大(P0.05)。2.患側(cè)步長均在干預(yù)即刻和干預(yù)后均呈增大趨勢,無顯著性。3.干預(yù)即刻和干預(yù)后患側(cè)膝踝關(guān)節(jié)活動范圍無顯著性變化。4.健側(cè)脛骨前肌、股二頭肌、腓腸肌在干預(yù)即刻的支撐期擺動期平均振幅與干預(yù)前相比均顯著增大(P0.05)。健側(cè)脛骨前肌、患側(cè)脛骨前肌擺動期平均振幅干預(yù)后與干預(yù)即刻相比顯著縮小(P0.05)。健側(cè)脛骨前肌擺動期平均振幅干預(yù)即刻與干預(yù)前相比顯著增大(P0.05)。6.健側(cè)腓腸肌支撐期平均振幅干預(yù)即刻與干預(yù)前相比顯著增大(P0.05)。健側(cè)腓腸肌支撐期平均振幅干預(yù)后與干預(yù)即刻相比顯著縮小(P0.05)。健側(cè)腓腸肌擺動期平均振幅干預(yù)后與干預(yù)即刻相比顯著縮小(P0.05)。健側(cè)腓腸肌支撐期平均振幅干預(yù)即刻與干預(yù)前相比顯著增大(P0.05)。7.患側(cè)股二頭肌擺動期平均振幅干預(yù)即刻與干預(yù)前相比顯著增大(P0.05)。患側(cè)股二頭肌支撐期、擺動期平均振幅干預(yù)后與干預(yù)即刻比顯著縮小(P0.05)。健側(cè)股二頭肌支撐期、擺動期平均振幅干預(yù)即刻與干預(yù)前比顯著增大(P0.05)。8.患側(cè)股直肌擺動期平均振幅干預(yù)后與干預(yù)即刻相比顯著增大(P0.05)�；紓�(cè)股直肌支撐期平均振幅干預(yù)即刻與干預(yù)前相比顯著增大(P0.05)。健側(cè)股直肌擺動期平均振幅干預(yù)即刻與干預(yù)前相比顯著增大(P0.05)。健側(cè)股直肌支撐期平均振幅干預(yù)后與干預(yù)前相比顯著縮小(P0.05)。研究結(jié)論:1.健側(cè)負(fù)重干預(yù)即刻雙下肢的擺動期支撐期均有顯著性增大,干預(yù)后二者均有減小趨勢,其中健側(cè)支撐期減小更大,患側(cè)相對維持增長不變,提示干預(yù)后患側(cè)步行穩(wěn)定性提高。雙下肢步行周期中擺動期時間占比在干預(yù)即刻均有增長,提示步態(tài)能力得到提高。干預(yù)即刻干預(yù)后患側(cè)跨步長、步長均有增加趨勢,步態(tài)參數(shù)得到改善。2.單側(cè)負(fù)重該干預(yù)對于患側(cè)膝踝關(guān)節(jié)活動范圍改善意義不大。健側(cè)負(fù)重干預(yù)在干預(yù)即刻打破了原有的的步態(tài)模式,但在干預(yù)后已經(jīng)重新建立起步態(tài)模式。3.下肢各肌肉表面肌電數(shù)據(jù)表明下肢單側(cè)負(fù)重會增加除健側(cè)股直肌外其他七塊肌肉的激活程度,但在干預(yù)后迅速恢復(fù)干預(yù)前水平。而健側(cè)股直肌扔保持低激活水平,提示患側(cè)股直肌肌肉激活相對提高,提高提示健側(cè)負(fù)重干預(yù)會增大下肢主要肌群的激活水平,使得步態(tài)穩(wěn)定性提高。下肢肌肉的協(xié)同性分析表明健側(cè)負(fù)重干預(yù)對于步態(tài)具有改善作用。
[Abstract]:Spastic hemiplegic cerebral palsy is one of the most common types of cerebral palsy. This type of cerebral palsy suffers from hemiplegia compensatory gait. This gait has the characteristics of poor coordination of motor nerve during walking, short stride, high step frequency and poor stability. At the same time, it has the problem of long stride support and short swing. Taiwan therapist On the basis of Bobath therapy, Mr. Ye Cangfu proposed a healthy side weight method to interfere with the pathological gait of children with hemiplegic cerebral palsy. Unilateral weight-bearing is an abnormal weight bearing intervention. At present, the study on the effect of single load walking on human walking pattern is still blank, but there are many foreign related research and related research. The effect of the compensatory gait of cerebral palsy and the compensatory gait of cerebral apoplexy is highly similar. Therefore, this experiment is to determine the effect of weight intervention on the kinematic parameters of bilateral lower limbs in the walking cycle and the surface electromyography of the main muscles of the lower limbs (s EMG) changes. In order to understand the changes in walking ability after the healthy side weight loss. Explore the control function of the exercise control system in the load walking. To further understand the effect of the healthy side weight on the hemiplegia cerebral palsy children, explore the effectiveness of the method of the side weight treatment. Research object and method: 12 children with hemiplegic spastic cerebral palsy were selected. In the course of the experiment, a sandbag loaded walking training intervention was carried out for 20 minutes after wearing a sand bag in the ankle joint of the healthy side of the lower extremities. Before intervention, the kinematics of the lower limbs of the lower limbs of the subjects were collected and the sEMG indexes were collected. The data were analyzed statistically. The results were: 1. intervention on the immediate side of the healthy side. There was a significant reduction in the length of the patient's support period and before the intervention (P0.05). After intervention, the phase ratio of the healthy side of the lower limb was significantly increased (P0.05) and the lateral step of.2. was increased in both immediate and post intervention. No significant.3. intervention had no significant changes in the range of the knee and ankle joint activity after the intervention of.4.. The average amplitude of the lateral tibial anterior muscle, the two head of the femoris and the gastrocnemius muscle during the intervention period was significantly higher than that before the intervention (P0.05). The average amplitude of the lateral tibial anterior muscle in the healthy side, the average amplitude of the lateral tibial muscle in the affected side of the tibial muscle was significantly reduced (P0.05). The mean amplitude of the wobble period of the anterior tibial muscle in the healthy side was immediately and before the intervention. The average amplitude intervention of the gastrocnemius muscle support phase in the healthy side of the healthy side was significantly increased compared with that before the intervention (P0.05). The average amplitude of the amplitude of the prop in the healthy side of the gastrocnemius muscle was significantly smaller than that of the intervention (P0.05). The mean amplitude of the sway gastrocnemius muscle in the healthy side was significantly smaller than that of the intervention (P0.05) after intervention (P0.05). The healthy side of the gastrocnemius was significantly reduced (P0.05). The mean amplitude intervention of the muscle support period was significantly higher than before the intervention (P0.05) the mean amplitude intervention of the two head muscles in the.7. affected side of the affected side was significantly higher than before the intervention (P0.05). The average amplitude of the amplitude of the swinging stage was significantly reduced (P0.05) at the stage of the swinging stage and the intervention of the two heads of the healthy side, and the swing period of the wobble period. The mean amplitude intervention was significantly higher than that before intervention (P0.05) the average amplitude of the amplitude of the lateral femoral rectus muscle in.8. affected side was significantly increased (P0.05). The mean amplitude intervention of the lateral femoral rectus muscle in the affected side was significantly higher than before the intervention (P0.05). The intervention of the mean amplitude of the lateral femoral rectus muscle in the healthy side was compared with that before the intervention. A significant increase (P0.05). The average amplitude of the amplitude of the lateral femoral rectus muscle in the healthy side was significantly reduced compared with that before the intervention (P0.05). Conclusion: 1. a significant increase in the support period of the wobble period of the immediate double lower limbs was significantly increased by the intervention of the healthy side of the healthy side, and the two all decreased after the intervention, in which the support period of the healthy side decreased more, and the relative maintenance of the affected side remained unchanged. The stability of the patient's walking was increased after the intervention. The time period of the wobble period was increased at the moment of intervention in the walking cycle of the lower extremities, suggesting that the gait ability was improved. The step length of the affected side after intervention was increased, and the gait parameters improved the significance of the.2. unilateral load to improve the range of the knee and ankle joint activities. The intervention of healthy side weight intervention broke the original gait pattern immediately after intervention, but the data of the muscle surface electromyography of the lower extremities of.3. had been reestablished after the intervention. The activation degree of the other seven muscles except the lateral femoral rectus muscles in the lower extremities was increased, but the level of the other muscles before intervention was quickly restored after intervention. The lower activation level of the rectus femoris is maintained, which suggests that the muscle activation of the rectus femoris is relatively improved. It suggests that the intervention of the healthy side will increase the activation level of the main muscles of the lower extremities and improve the stability of the gait. The synergistic analysis of the lower limb muscles indicates that the intervention of the healthy side weight is improved in the gait.

【學(xué)位授予單位】：天津體育學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：G804.6

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