孟洋洋　徐立伟　胡志

[摘要] 目的 探討使用运动想象疗法联合肌电生物反馈疗法对脑卒中偏瘫患者下肢功能的影响。 方法 将在朝阳市中心医院康复医学科收治的48例脑卒中偏瘫患者按随机数字表法分为对照组（A）16例、生物反馈组（B）16例和联合治疗组（C）16例，三组患者均给予常规康复训练，B组在此基础上加用肌电生物反馈治疗，C组则在常规康复治疗的基础上加用运动想象联合肌电生物反馈疗法进行治疗。分别于治疗前及治疗4周后对患者采用简化Fugl-Meyer量表下肢部分、ADL评分（改良Barthel指数）、Berg（BBS）平衡量表和Holden步行功能分级（FAC）对各组患者的下肢功能进行评定，另外用SPECT观察局部脑血流灌注的变化情况。 结果 （1）组内比较：治疗4周后，三组患者的各项指标包括FMA评分、ADL评分、BBS评分、FAC及局部脑血流灌注情况分别较组内治疗前有明显改善，差异均有统计学意义（P<0.05）。（2）组间比较：治疗后，B组的各指标与A组相比，差异均有统计学意义（P<0.05）；C组的各指标与A、B两组比较，差异亦有统计学意义（P<0.05）。 结论 运动想象疗法结合肌电生物反馈疗法对脑卒中偏瘫患者下肢功能的恢复疗效更显著。

[关键词] 运动想象；生物反馈；脑卒中；康复

[中图分类号] R743.3 [文献标识码] A [文章编号] 1673-9701（2018）20-0005-04

Effects of exercise imagination combined with electromyographic biofeedback therapy on lower extremity function in the patients with cerebral stroke complicated with hemiplegia

MENG Yangyang1 XU Liwei2 HU Zhi3 SHI Zhaojuan2

1.Chengde Medical College， Chengde 067000， China； 2.Department of Rehabilitative Medicine， Chaoyang Central Hospital in Liaoning， Chengde Medical College， Chaoyang 122000， China； 3.Department of Nuclear Medicine， Chaoyang Central Hospital in Liaoning， Chengde Medical College， Chaoyang 122000， China

[Abstract] Objective To investigate the effect of exercise imagination combined with electromyographic biofeedback therapy on lower extremity function in the patients with cerebral stroke complicated with hemiplegia. Methods A total of 48 patients with cerebral stroke complicated with hemiplegia who were treated in the Department of Rehabilitative Medicine， Chaoyang Central Hospital were randomly divided into control group（A） of 16 cases， biofeedback group（B） of 16 cases and combination therapy group（C） of 16 cases based on the random number table. All three groups were given routine rehabilitation training. Group B was further given EMG biofeedback therapy on this basis. Group C was treated with exercise imagination combined with electromyographic biofeedback therapy on the basis of the routine rehabilitation therapy； before treatment and after 4 weeks of treatment， the lower extremity of the simplified Fugl-Meyer scale， ADL score（modified Barthel index）， Berg（BBS） balance scale and Holden walking functional grading（FAC） were applied to the function of lower extremities of each group of patients. In addition， changes in local cerebral blood flow perfusion were observed by SPECT. Results （1）Intragroup comparison： after 4 weeks of treatment， all indexes of the three groups including FMA score， ADL score， BBS score， FAC， and local cerebral blood flow perfusion were significantly improved compared with those before the intragroup treatment， and the differences were statistically significant（P<0.05）. （2）Comparison between groups： After treatment， all the indexes in group B were statistically significantly different from those in group A（P<0.05）； all indexes in group C were also statistically significantly different from those in group A and group B（P<0.05）. Conclusion The combination of exercise imagination therapy and electromyographic biofeedback therapy is more effective in the recovery of lower extremity function in the patients with cerebral stroke complicated with hemiplegia.

[Key words] Exercise imagination； Biofeedback therapy； Cerebral stroke； Rehabilitation

脑卒中是一种急性脑血管病，近年来，随着急救医学水平的提高，卒中后患者生存率也相应升高[1]，即使经过康复锻炼后，仍有50%～60%的患者会遗留一些运动、感觉等功能障碍[2]，直接的结果导致致残率明显升高。其中下肢的功能与患者的独立能力和日常生活能力关系最为密切，是患者重新回归社会的基本条件，因此探讨恢复下肢功能更好的治疗方法是非常必要的。本研究将运动想象疗法联合肌电生物反馈疗法进行临床试验，旨在探讨联合应用这两种疗法对脑卒中患者下肢功能恢复的疗效，为临床治疗提供依据。……