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刘 鹏,王艳君,毛玉瑢,黄东锋,李 乐.减重步行训练改善脑卒中患者小腿肌肉形态结构的生物力学研究[J].中国康复医学杂志,2012,27(9):792~796
减重步行训练改善脑卒中患者小腿肌肉形态结构的生物力学研究    点此下载全文
刘 鹏  王艳君  毛玉瑢  黄东锋  李 乐
中山大学附属第一医院康复医学科,广州市越秀区中山二路58号,510080
基金项目:中央高校基本科研业务费专项资金资助项目(11yRpy22)
DOI:
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摘要:
      摘要 目的:观察减重步行训练(BWSTT)后脑卒中患者小腿肌肉形态结构及运动功能的改变,从肌肉层次探讨BWSTT对脑卒中患者下肢运动功能影响的生物力学机制。 方法:将15例亚急性期脑卒中患者随机分为实验组(8例)和对照组(7例),实验组进行BWSTT加常规的物理治疗,对照组仅进行常规的物理治疗,并保证两组训练量相等。连续训练3周,每周5天,每天1次,每次60min。两组患者健侧、患侧在训练前后均进行以下评定:①用B型超声检测不同踝关节角度下胫骨前肌(TA)、腓肠肌内侧头(MG)的形态结构参数,包括羽状角、肌肉厚度及肌纤维长度;②用便携式肌力与关节活动测试仪测量踝关节的肌力和活动度;③下肢采用Fugl-Meyer量表(FMA)评分;④下肢采用改良Ashworth痉挛量表(MAS)评分。 结果:训练后,实验组患侧TA的羽状角、肌肉厚度和MG的肌纤维长度均显著增加(P<0.05),而对照组小腿肌肉参数在训练前后的差异均无显著性意义(P>0.05);训练后实验组患侧的踝关节肌力显著增加(P<0.05),而对照组踝关节肌力在训练前后的差异无显著性意义(P>0.05);训练后实验组下肢FMA评分显著提高(P<0.05),下肢MAS评分显著降低(P<0.05),而对照组下肢FMA评分和MAS评分在训练前后的差异均无显著性意义。 结论:BWSTT较传统的步态训练方法更能有效改善脑卒中患者下肢FMA评分和MAS评分及踝关节肌力,通过改变患者肌肉肌腱的形态结构可改善患者的运动功能。
关键词:脑卒中  超声  减重步行训练  运动功能  生物力学
Effects of body weight support treadmill training on the architectural parameters and motor function of calf muscles in stroke survivors: a biomechanical study    Download Fulltext
Dept. of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-sen University,
Fund Project:
Abstract:
      Abstract Objective: To evaluate the architectural parameters and motor function changes of calf muscles after body weight support treadmill training (BWSTT) in subacute stroke survivors, and to investigate fascicular changes as mechanisms underlying the effects of BWSTT on motor function. Method: Fifteen subacute stroke survivors were recruited and randomly assigned to BWSTT combined with conventional physical therapy, except for conventional gait training (experimental group, n=8) and conventional physical therapy only (control group, n=7). All patients were treated in 60-min sessions every weekday for 3 weeks. The muscle architectural parameters of tibialis anterior(TA) and medial gastrocnemius(MG) including the pennation angle, thickness, and fascicle length were measured at various ankle positions using ultrasonography. The muscle strength and the joint angle were recorded by hand-hold dynamometer. Modified Ashworth scale (MAS) and the Fugl-Meyer assessment (FMA) were also evaluated. Assessments were performed at baseline and after the 3-week treatment. Result: The experimental group had larger pennation angle and thickness in TA and longer fascicle length in MG than those at baseline (P<0.05). However, there was no such trend in control group. Ankle muscle strength enhanced after BWSTT (P<0.05), but that was not found in control group (P<0.05). After the gait training, FMA scores improved (P<0.05) and MAS scores of lower limb reduced (P<0.05) in experimental group. However, there was no significant difference of assessment scores in control group (P>0.05). Conclusion: BWSTT can improve the motor function of subacute stroke patients by changing the muscle architecture. BWSTT is feasible and more effective than conventional gait training with regard to clinical assessment scales.
Keywords:stroke  ultrasound  body weight support treadmill training  motor function  biomechanical
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