目的 结合磁共振弥散张量成像(DTI)技术探讨基于人体行走模式的功能性电刺激(FES)改善脑卒中早期患者下肢运动功能的可能机制.方法 收集2012年8月至2013年9月广东省江门市中心医院神经内科住院的脑卒中患者,将符合入选标准的患者48例,按照年龄、性别、病程、Brunnstrom分期及脑卒中类型进行分层后,应用Minimize计算机软件随机分为四通道FES组(18例)、双通道FES组(15例)及安慰刺激组(15例).3组患者常规治疗相同,四通道FES组采用基于正常行走模式设计的FES治疗仪治疗,刺激胫前肌、股四头肌内外侧头、腓肠肌及股二头肌;双通道FES组刺激胫前肌、腓骨长短肌;安慰刺激组电极放置与治疗组相同,但治疗时不予电流输出.3组患者在治疗开始前和治疗3周中的每周均进行Fugl-Meyer下肢运动功能(FMA)脑卒中患者姿势评定量表(PASS)、Brunel平衡量表(BBA)、Berg平衡量表(BBS)及改良Barthel指数(MBI)康复功能评定,部分患者在治疗前和治疗3周后给予DTI检查.结果 3组患者一般资料及治疗前各项评定结果差异无统计学意义.组内比较,治疗1周、2周和3周后,3组PASS、BBA、BBS、FMA及MBI评分与治疗前比较,差异均有统计学意义(均P＜0.05);治疗3周后,四通道FES组和双通道FES组的患侧FA值与治疗前比较,差异有统计学意义(P＜0.05).组间比较,治疗1周后,3组MBI评分组间比较,差异有统计学意义(P =0.037),其中四通道组[(52±12)分]与安慰刺激组[(38±18)分]比较差异有统计学意义(P＜0.05);治疗2周后,四通道FES组的PASS、MBI评分[(29±3)分、(73±13)分]分别与双通道FES组[(24±8)分、(60±17)分]比较,四通道FES组的PASS、BBA、BBS、FMA及MBI[(29±3)分、(8.3±2.4)分、(37±7)分、(22±5)分、(73±13)分]分别与安慰刺激组[(21±7)分、(6.2±3.1)分、(24±16)分、(15±8)分、(47±20)分]比较,双通道FES组的MBI[(60±17)分]与安慰刺激组[(47±20)分]比较,差异均有统计学意义(均P ＜0.05);治疗3周后,四通道FES组的FMA[(25±5)分]与双通道FES组[(20±7)分]比较,有近似统计学意义(P=0.055);四通道FES组的PASS、BBS、FMA及MBI[(31±3)分、(43±8)分、(25±5)分、(81±13)分]与安慰刺激组[(25±8)分、(29±17)分、(17±9)分、(54±25)分]比较,双通道FES组的MBI[(71±15)分]与安慰刺激组[(54±25)分]比较,差异有统计学意义(P＜0.05).治疗3周后,3组患侧FA变化值明显升高,四通道FES组[(0.321±0.172)分]与安慰刺激组[(0.217±0.135)分]比较(P =0.020),双通道FES组[(0.333±0.164)分]与安慰刺激组[(0.217±0.135)分]比较(P =0.049),差异均有统计学意义.3组DTT结果显示,四通道FES组患侧纤维束明显增多,健侧纤维束改善不明显;双通道FES组和安慰刺激组改善不明显.结论 与传统的双通道FES相比,基于行走模式的FES疗效更显著,更有利于实现脑卒中后早期患者大脑结构和功能重组,促进运动功能恢复.
目的 結閤磁共振瀰散張量成像(DTI)技術探討基于人體行走模式的功能性電刺激(FES)改善腦卒中早期患者下肢運動功能的可能機製.方法 收集2012年8月至2013年9月廣東省江門市中心醫院神經內科住院的腦卒中患者,將符閤入選標準的患者48例,按照年齡、性彆、病程、Brunnstrom分期及腦卒中類型進行分層後,應用Minimize計算機軟件隨機分為四通道FES組(18例)、雙通道FES組(15例)及安慰刺激組(15例).3組患者常規治療相同,四通道FES組採用基于正常行走模式設計的FES治療儀治療,刺激脛前肌、股四頭肌內外側頭、腓腸肌及股二頭肌;雙通道FES組刺激脛前肌、腓骨長短肌;安慰刺激組電極放置與治療組相同,但治療時不予電流輸齣.3組患者在治療開始前和治療3週中的每週均進行Fugl-Meyer下肢運動功能(FMA)腦卒中患者姿勢評定量錶(PASS)、Brunel平衡量錶(BBA)、Berg平衡量錶(BBS)及改良Barthel指數(MBI)康複功能評定,部分患者在治療前和治療3週後給予DTI檢查.結果 3組患者一般資料及治療前各項評定結果差異無統計學意義.組內比較,治療1週、2週和3週後,3組PASS、BBA、BBS、FMA及MBI評分與治療前比較,差異均有統計學意義(均P＜0.05);治療3週後,四通道FES組和雙通道FES組的患側FA值與治療前比較,差異有統計學意義(P＜0.05).組間比較,治療1週後,3組MBI評分組間比較,差異有統計學意義(P =0.037),其中四通道組[(52±12)分]與安慰刺激組[(38±18)分]比較差異有統計學意義(P＜0.05);治療2週後,四通道FES組的PASS、MBI評分[(29±3)分、(73±13)分]分彆與雙通道FES組[(24±8)分、(60±17)分]比較,四通道FES組的PASS、BBA、BBS、FMA及MBI[(29±3)分、(8.3±2.4)分、(37±7)分、(22±5)分、(73±13)分]分彆與安慰刺激組[(21±7)分、(6.2±3.1)分、(24±16)分、(15±8)分、(47±20)分]比較,雙通道FES組的MBI[(60±17)分]與安慰刺激組[(47±20)分]比較,差異均有統計學意義(均P ＜0.05);治療3週後,四通道FES組的FMA[(25±5)分]與雙通道FES組[(20±7)分]比較,有近似統計學意義(P=0.055);四通道FES組的PASS、BBS、FMA及MBI[(31±3)分、(43±8)分、(25±5)分、(81±13)分]與安慰刺激組[(25±8)分、(29±17)分、(17±9)分、(54±25)分]比較,雙通道FES組的MBI[(71±15)分]與安慰刺激組[(54±25)分]比較,差異有統計學意義(P＜0.05).治療3週後,3組患側FA變化值明顯升高,四通道FES組[(0.321±0.172)分]與安慰刺激組[(0.217±0.135)分]比較(P =0.020),雙通道FES組[(0.333±0.164)分]與安慰刺激組[(0.217±0.135)分]比較(P =0.049),差異均有統計學意義.3組DTT結果顯示,四通道FES組患側纖維束明顯增多,健側纖維束改善不明顯;雙通道FES組和安慰刺激組改善不明顯.結論 與傳統的雙通道FES相比,基于行走模式的FES療效更顯著,更有利于實現腦卒中後早期患者大腦結構和功能重組,促進運動功能恢複.
목적 결합자공진미산장량성상(DTI)기술탐토기우인체행주모식적공능성전자격(FES)개선뇌졸중조기환자하지운동공능적가능궤제.방법 수집2012년8월지2013년9월광동성강문시중심의원신경내과주원적뇌졸중환자,장부합입선표준적환자48례,안조년령、성별、병정、Brunnstrom분기급뇌졸중류형진행분층후,응용Minimize계산궤연건수궤분위사통도FES조(18례)、쌍통도FES조(15례)급안위자격조(15례).3조환자상규치료상동,사통도FES조채용기우정상행주모식설계적FES치료의치료,자격경전기、고사두기내외측두、비장기급고이두기;쌍통도FES조자격경전기、비골장단기;안위자격조전겁방치여치료조상동,단치료시불여전류수출.3조환자재치료개시전화치료3주중적매주균진행Fugl-Meyer하지운동공능(FMA)뇌졸중환자자세평정량표(PASS)、Brunel평형량표(BBA)、Berg평형량표(BBS)급개량Barthel지수(MBI)강복공능평정,부분환자재치료전화치료3주후급여DTI검사.결과 3조환자일반자료급치료전각항평정결과차이무통계학의의.조내비교,치료1주、2주화3주후,3조PASS、BBA、BBS、FMA급MBI평분여치료전비교,차이균유통계학의의(균P＜0.05);치료3주후,사통도FES조화쌍통도FES조적환측FA치여치료전비교,차이유통계학의의(P＜0.05).조간비교,치료1주후,3조MBI평분조간비교,차이유통계학의의(P =0.037),기중사통도조[(52±12)분]여안위자격조[(38±18)분]비교차이유통계학의의(P＜0.05);치료2주후,사통도FES조적PASS、MBI평분[(29±3)분、(73±13)분]분별여쌍통도FES조[(24±8)분、(60±17)분]비교,사통도FES조적PASS、BBA、BBS、FMA급MBI[(29±3)분、(8.3±2.4)분、(37±7)분、(22±5)분、(73±13)분]분별여안위자격조[(21±7)분、(6.2±3.1)분、(24±16)분、(15±8)분、(47±20)분]비교,쌍통도FES조적MBI[(60±17)분]여안위자격조[(47±20)분]비교,차이균유통계학의의(균P ＜0.05);치료3주후,사통도FES조적FMA[(25±5)분]여쌍통도FES조[(20±7)분]비교,유근사통계학의의(P=0.055);사통도FES조적PASS、BBS、FMA급MBI[(31±3)분、(43±8)분、(25±5)분、(81±13)분]여안위자격조[(25±8)분、(29±17)분、(17±9)분、(54±25)분]비교,쌍통도FES조적MBI[(71±15)분]여안위자격조[(54±25)분]비교,차이유통계학의의(P＜0.05).치료3주후,3조환측FA변화치명현승고,사통도FES조[(0.321±0.172)분]여안위자격조[(0.217±0.135)분]비교(P =0.020),쌍통도FES조[(0.333±0.164)분]여안위자격조[(0.217±0.135)분]비교(P =0.049),차이균유통계학의의.3조DTT결과현시,사통도FES조환측섬유속명현증다,건측섬유속개선불명현;쌍통도FES조화안위자격조개선불명현.결론 여전통적쌍통도FES상비,기우행주모식적FES료효경현저,경유리우실현뇌졸중후조기환자대뇌결구화공능중조,촉진운동공능회복.
Objective To explore the possible mechanisms for improving lower extremity motor function in patients with early stroke through combining magnetic resonance diffusion tensor imaging (DTI) technology and functional electrical stimulation (FES) based on human walking patterns.Methods From August 2012 to September 2013,a total of 48 eligible patients were stratified according to age,gender,disease course,Brunnstrom staging and types of stroke.And the Minimize software was used to divided them randomly into four-channel FES group (n =18),dual-channel FES group (n =15) and comfort stimulation group (n =15).For all three groups,general medication and standard rehabilitation were provided.Based on normal walking pattern design of FES treatment,four-channel FES groups received the stimulations of quadriceps,hamstring,anterior tibialis and medial gastrocnemius.For the dual-channel FES group,the stimulations of tibialis anterior,peroneus longus and peroneus brevis muscles were applied.In comfort electrical stimulation group,the electrode positions were identical to the stimulation group,but there was no current output during stimulation.Before and after 3-week treatment,three groups received weekly rehabilitation evaluations of Fugl-Meyer assessment (FMA),posture assessment of stroke scale (PASS),Brunel balance assessment (BBA),Berg balance scale (BBS) and modified Barthel index (MBI).Before and after treatment,DTI examination was performed for some patients.Results Among three groups,general patient profiles and pre-treatment evaluations showed no significant difference.For intra-group comparisons versus pre-treatment,at week 1,2 and 3,the scores of PASS,BBA,BBS,FMA and MBI had statistically significant differences (P ＜ 0.05) ; At week 3 post-treatment,when four-channel and doublechannel FES groups were compared versus pre-treatment,the scores of ipsilateral FA had statistically significant differences (P ＜ 0.05).At week 1 post-treatment,MBI had statistically significant difference among 3 groups (P =0.037).As compared with placebo,four-channel group had statistically significant difference [(52 ± 12) vs (38 ± 18),P ＜0.05] ; At week 2 post-treatment,the scores of PASS and MBI were (29 ±3,73 ± 13) in four-channel FES group versus (24 ±8,60 ± 17) in dual-channel FES group.And the scores of PASS,BBA,BBS,FMA and MBI were (9 ± 3,8.3 ± 2.4,37 ± 7,22 ± 5,73 ± 13) in four-channel FES group versus (21 ± 7,6.2 ± 3.1,24 ± 16,15 ± 8,47 ± 20) in comfort electrical stimulation group.When dual-channel FES and comfort stimulation groups were compared,MBI had significant statistical difference [(60 ± 17) vs (47 ± 20),P ＜ 0.05].At week 3 post-treatment,fourchannel and dual-channel FES groups were compared,there was also statistical significance in FMA [(25 ± 5) vs (20 ± 7),P =0.055].The scores of PASS,BBS,FMA and MBI were (31 ± 3,43 ± 8,25 ± 5,81 ± 13) in four-channel FES group versus (25 ± 8,29 ± 17,17 ± 9,54 ± 25) in comfort stimulation group respectively.When dual-channel FES and comfort stimulation groups were compared,the scores of MBI were (71 ± 15) and (54 ± 25) respectively.And the difference was statistically significant (P ＜0.05).At week 3 post-treatment,the scores of FA significantly increased [four-channel FES group (0.321 ± 0.172) vs comfort stimulation group (0.217 ± 0.135) (P =0.020)].When dual-channel FES group (0.333 ±0.164) and comfort stimulation group (0.217 ±0.135) (P =0.049) were compared,the differences were statistically significant.DTI showed that four-channel FES group increased significantly,but contralateral fiber bundle was not obvious.And the improvements of dual-channel FES and comfort stimulation groups were insignificant.Conclusion Compared with traditional dual-channel FES,functional electrical stimulation based on human walking patterns is more efficacious.And it helps to restore brain structure and function and promote motor function recovery in patients with early stroke.
