本文關(guān)鍵詞： 肌電值 生物反饋 腦卒中 手功能　出處：《瀘州醫(yī)學(xué)院》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的腦卒中（stroke）的發(fā)病率在國內(nèi)外呈現(xiàn)逐年上升的趨勢，隨著現(xiàn)代醫(yī)學(xué)診療水平的提高，腦卒中后病死率降低，但致殘率卻大大增加。根據(jù)神經(jīng)發(fā)育原理，腦卒中后肢體功能恢復(fù)過程呈現(xiàn)下肢恢復(fù)比上肢快，并由近端向遠(yuǎn)端恢復(fù)的特點，所以手功能恢復(fù)時間較上肢恢復(fù)時間長。然而，手的功能在日常生活中卻具有重要的作用，所以近年來對腦卒中后手功能恢復(fù)的研究逐漸成為熱點。其中，肌電生物反饋療法(Electro-myographic biofeedback therapy)是研究較多的一種康復(fù)治療方法。它作為肌電反饋治療的一種，近年來越來越多地應(yīng)用于腦卒中患者肢體功能障礙，并取得了較好的療效。本研究旨在探討一種有效的方法治療腦卒中后手功能障礙，以減少腦卒中患者因手活動受限而對日常生活造成的影響,同時也對手功能的評定方法作進(jìn)一步探討。通過研究肌電生物反饋對腦卒中患者偏癱側(cè)手功能的影響，尋找有效的改善偏癱患者手功能的方法。方法1、預(yù)實驗：選擇同1w內(nèi)在我科住院的2例性別、年齡、病程、病變性質(zhì)均相同或相似的患者進(jìn)行預(yù)實驗，從入選時到肌電生物反饋療法治療11w內(nèi)，每周觀察兩名患者橈側(cè)腕伸肌主動收縮時的最大肌電值,腕關(guān)節(jié)背伸主動活動度(active range of motion, AROM)，食指和拇指2min內(nèi)對捏與松開的次數(shù)，F(xiàn)ugl-Meyer評定量表（Fugl-Meyer assessment，F(xiàn)MA）上肢腕手功能評分：包括腕背伸、屈曲、環(huán)轉(zhuǎn)運動、手指共同屈曲、手指共同背伸、鉤狀抓握、側(cè)捏等，總分24分。采集預(yù)實驗中各項實驗數(shù)據(jù)，參照實驗結(jié)果，根據(jù)所選研究對象的疾病情況進(jìn)行正式實驗的設(shè)計。2、正式實驗：將符合條件的腦卒中患者80例按入院先后順序編號后按照SPSS21產(chǎn)生的隨機序列號隨機分為試驗組和對照組，每組40例。兩組均常規(guī)予以運動療法，包括：感覺刺激、肌力訓(xùn)練、平衡訓(xùn)練、關(guān)節(jié)活動度訓(xùn)練、牽伸訓(xùn)練、易化與抑制技術(shù)等。40min/次，5次/w。試驗組在相同運動療法基礎(chǔ)上加用肌電生物反饋治療，刺激時間為10s，間歇時間為10s。20min/次，5次/w。將兩組結(jié)果進(jìn)行比較，分別觀察入選時、治療后3w、治療后6w、治療后9w患者各項評定指標(biāo)的變化情況。結(jié)果治療前，兩組患者的橈側(cè)腕伸肌主動收縮時的最大肌電值，腕關(guān)節(jié)背伸AROM，食指和拇指2min內(nèi)對捏與松開的次數(shù)，簡化FMA上肢腕手功能評分均沒有明顯差異(P0.05)；經(jīng)過治療后對照組各項評分均有提高(P 0.001)，與對照組比較，試驗組各項評分均有顯著提高(P 0.05)，差異有統(tǒng)計學(xué)意義(P 0.05)。結(jié)論1、采用橈側(cè)腕伸肌主動收縮時的最大肌電值，腕關(guān)節(jié)背伸AROM，，食指和拇指2min內(nèi)對捏與松開的次數(shù)，簡化FMA上肢腕手功能評分對判斷腦卒中后手功能恢復(fù)有指導(dǎo)意義。2、肌電生物反饋治療配合運動療法可有效改善腦卒中后患者偏癱側(cè)手功能障礙，療效優(yōu)于單用運動療法。
[Abstract]:Objective the incidence of stroke stroke is increasing year by year at home and abroad. With the improvement of modern medical diagnosis and treatment, the fatality rate of stroke decreases, but the disability rate increases greatly. The recovery process of limb function after stroke is faster than that of upper limb, and the recovery time of hand function is longer than that of upper limb, so the recovery time of hand function is longer than that of upper limb. However, hand function plays an important role in daily life. So in recent years, the research on hand function recovery after stroke has gradually become a hot topic. Among them, electromyographic biofeedback therapy (EMG) is a kind of rehabilitation therapy, which is a kind of electromyography feedback therapy. In recent years, more and more applications have been applied to the limb dysfunction of stroke patients, and good results have been obtained. This study aims to explore an effective method for the treatment of hand dysfunction after stroke. In order to reduce the influence of hand movement limitation on daily life in stroke patients and to further explore the evaluation method of hand function, the effects of myoelectric biofeedback on hemiplegic hand function in stroke patients were studied. Methods (1) Pre-experiment: two patients with the same sex, age, course of disease and pathological changes were selected to carry on the pre-experiment, which had the same sex, age, course of disease and pathological changes. From the time of selection to the electromyoelectric biofeedback therapy for 11 weeks, the maximal myoelectric values of two patients with active contraction of extensor Carpi radialis were observed weekly. Active range of wrist extension active range of motion, AROMN, forefinger and thumb within 2 minutes of kneading and loosening the Fugl-Meyer Assessment FMA-Fugl-Meyer Assessment FMAs of upper limb wrist and hand function score: wrist extension, flexion, circumflex movement, joint flexion of finger, joint extension of finger, joint extension of finger, and so on. Hook grip, side pinch, total score of 24 points. Collect the experimental data in the preliminary experiment, refer to the experimental results, According to the disease condition of the selected subjects, the design of the formal experiment. 2. The formal experiment: 80 patients with stroke who met the criteria were randomly divided into the experimental group and the control group according to the random serial number produced by SPSS21 after the number of patients were numbered according to the order of admission. 40 cases in each group were treated with routine exercise therapy, including sensory stimulation, muscle strength training, balance training, joint motion training, and drafting training. The experiment group was treated with EMG biofeedback on the basis of the same exercise therapy. The stimulation time was 10s, the interval time was 10s. The results of the two groups were compared. Results before treatment, the maximal myoelectric value of radial extensor carpal muscle, the times of wrist dorsal extension of AROM, the number of kneading and loosening of forefinger and thumb within 2 minutes after treatment were measured. There was no significant difference in the score of wrist and hand function in simplified FMA. After treatment, all scores in the control group were improved (P 0.001), compared with that in the control group. All the scores in the test group were significantly improved (P 0.05), and the difference was statistically significant (P 0.05). Conclusion 1. The maximum myoelectric value of radial extensor carpal muscle and the times of pinch and release of wrist dorsal extension AROM, forefinger and thumb within 2 minutes were used. The simplified FMA score of wrist-hand function of upper limb is of guiding significance in judging the recovery of hand function after stroke. EMG biofeedback therapy combined with motor therapy can effectively improve hemiplegic hand dysfunction after stroke, and the curative effect is better than that of motor therapy alone.
【學(xué)位授予單位】：瀘州醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743.3

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