| 张伟,刘永涛,谷玉静,等.等速肌力训练联合肌电生物反馈治疗对脑卒中后偏瘫患者下肢痉挛及步行能力的影响[J].中华物理医学与康复杂志,2026,48(9):778-784 |
| 等速肌力训练联合肌电生物反馈治疗对脑卒中后偏瘫患者下肢痉挛及步行能力的影响 |
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| DOI：10.3760/cma.j.cn421666-20251110-00999 |
| 中文关键词: 等速肌力 肌电生物反馈治疗 脑卒中 痉挛 步行能力 |
| 英文关键词: Isokinetic EMG Biofeedback Stroke Spasticity Walking ability |
| 基金项目:河南省中医药科学研究专项课题（2023ZXZX1163）；张仲景传承与创新专项课题（GZY-KJS-2022-040-2） |
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| 中文摘要: |
| 目的 探讨等速肌力训练联合肌电生物反馈治疗对脑卒中后偏瘫患者下肢痉挛及步行能力的影响。 方法 选取符合纳入标准的脑卒中后偏瘫患者60例，采用随机数字表法将其分为对照组、等速组及观察组，每组20例。3组患者均给予常规康复训练，等速组在此基础上增加膝关节屈、伸肌等速肌力训练，观察组则在等速组干预基础上辅以肌电生物反馈治疗。3组患者均每日治疗1次，每周治疗6 d，持续治疗4周。于治疗前、治疗4周后采用Tardieu量表（MTS）、改良Ashworth量表（MAS）评估患者伸膝肌痉挛程度，采用等速肌力测试仪评估患者伸膝肌力及屈膝肌力，并计算伸膝肌峰力矩（EPT）及屈膝肌峰力矩（FPT），采用10 m步行测试（10MWT)及三维步态分析与训练系统评估患者步行能力，具体分析指标包括步速、步频、步幅及屈膝角度等。 结果 治疗后3组患者的MTS量表R1、R2、R2-R1及X分级、MAS评分、EPT、FPT、10MWT以及各项步态参数指标均较治疗前明显改善（P<0.05）；并且观察组、等速组上述各项指标均显著优于对照组水平（P<0.05）；同时观察组的MTS量表R1、R2-R1、X评级［分别为（75.65±21.10）°、（13.25±6.57）°和（1.15±0.81）级］、MAS评分［（1.25±0.79）分］、EPT、FPT［分别为（49.9±11.78）N·m、（46.45±10.44）N·m］、10MWT［（35.86±10.73）m/min］、步频、步幅及屈膝角度［分别为（37.15±11.15）步/分钟、（41.71±13.39）cm和（45.95±12.60）°］亦较等速组明显改善（P<0.05）。 结论 等速肌力训练联合肌电生物反馈治疗可有效缓解脑卒中后偏瘫患者伸膝肌痉挛，增强下肢肌力，增大膝关节活动范围，改善患者下肢步行能力，该联合治疗模式值得临床推广、应用。 |
| 英文摘要: |
| Objective To investigate the effects of isokinetic strengthening training combined with electromyographic (EMG) biofeedback therapy on lower limb spasticity and walking ability in post-stroke hemiplegic patients. Methods A total of 60 post-stroke hemiplegic patients meeting the inclusion criteria were enrolled and randomly divided into a control group, an isokinetic group, and an observation group using a random number table, each of 20. All groups received conventional rehabilitation training. The isokinetic group additionally underwent isokinetic strengthening training for knee flexors and extensors, while the observation group received EMG biofeedback therapy in addition to the isokinetic intervention. All patients were treated once daily, 6 days per week, for 4 consecutive weeks. Before and after treatment, the Tardieu Scale (MTS) and Modified Ashworth Scale (MAS) were used to assess knee extensor spasticity. An isokinetic dynamometer evaluated knee extensor and flexor strength, calculating extension peak torque (EPT) and flexion peak torque (FPT). Walking function was assessed using the 10-meter walk test (10MWT) and a three-dimensional gait analysis system, with parameters including step frequency, step length, and knee flexion angle. Results After treatment, all three groups showed significant improvements in MTS parameters (R1, R2, R2-R1, X grade), MAS scores, EPT, FPT, 10MWT, and gait parameters compared to baseline (P<0.05). The observation and isokinetic groups demonstrated significantly greater improvements than the control group (P<0.05). Furthermore, the observation group showed significantly superior outcomes compared to the isokinetic group in MTS parameters ［R1: (75.65±21.10)°, R2-R1: (13.25±6.57)°, X grade: (1.15±0.81)］, MAS score ［(1.25±0.79)］, EPT ［(49.9±11.78) N·m］, FPT ［(46.45±10.44) N·m］, 10MWT ［(35.86±10.73) m/min］, step frequency ［(37.15±11.15) steps/min］, step length ［(41.71±13.39) cm］, and knee flexion angle ［(45.95±12.60)°］ (all P<0.05). Conclusions Isokinetic strengthening training combined with EMG biofeedback therapy can effectively relieve knee extensor spasticity, enhance lower limb muscle strength, increase knee joint range of motion, and improve walking ability in post-stroke hemiplegic patients. This combined treatment modality is worthy of clinical promotion and application. |
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