全身振动训练对脑卒中患者下肢功能的效果
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摘要
目的探讨在下肢负重训练的基础上,联合全身振动训练对脑卒中患者下肢负重、平衡和步行能力的效果。方法 2017年住院脑卒中患者70例,随机分为对照组和实验组,各35例。两组均予常规康复和下肢负重训练,实验组另予全身振动训练,共6周。治疗前后采用患侧单足负重时间、步长和步速、Berg平衡量表(BBS)和功能性步行分级(FAC)进行评估。结果治疗后,两组患侧单腿负重时间、步长、步速、BBS评分和FAC分级均显著提升(t> 8.835, P <0.001),实验组显著优于对照组(F> 19.644, P <0.001)。结论全身振动训练能进一步改善脑卒中患者下肢负重、平衡和步行功能。
Objective To explore the effect of whole body vibration(WBV) on lower extremities loading, balance and walking for stroke patients based on weight-bearing training.Methods In 2017, 70 stroke inpatients were randomly divided into control group(n = 35) and experimental group(n =35). They all accepted routine rehabilitation and weight-bearing training, while the experimental group accepted WBV in addition, for six weeks. They were assessed with weight-bearing time, gait length and speed, Berg Balance Scale(BBS) and Functional Ambulation Category(FAC) before and after treatment.Results The weight-bearing time, gait length and speed, and the scores of BBS and FAC improved after treatment in both groups(t > 8.835, P < 0.001), and improved more in the experimental group than in the control group(F >19.644, P < 0.001).Conclusion WBV may further improve the abilities of lower extremities for stroke patients.
Objective To explore the effect of whole body vibration(WBV) on lower extremities loading, balance and walking for stroke patients based on weight-bearing training.Methods In 2017, 70 stroke inpatients were randomly divided into control group(n = 35) and experimental group(n =35). They all accepted routine rehabilitation and weight-bearing training, while the experimental group accepted WBV in addition, for six weeks. They were assessed with weight-bearing time, gait length and speed, Berg Balance Scale(BBS) and Functional Ambulation Category(FAC) before and after treatment.Results The weight-bearing time, gait length and speed, and the scores of BBS and FAC improved after treatment in both groups(t > 8.835, P < 0.001), and improved more in the experimental group than in the control group(F >19.644, P < 0.001).Conclusion WBV may further improve the abilities of lower extremities for stroke patients.
引文
[1]王陇德,王金环,彭斌,等.?中国脑卒中防治报告2016?概要[J].中国脑血管病杂志, 2017, 14(4):217-224.
[2]毕齐,张鹏.青年卒中的研究现状和展望[J].中国卒中杂志,2012, 7(4):260-263.
[3]汪钟立,王翔,励建安,等.脑卒中偏瘫患者躯干和下肢运动能力的预后分析[J].中国康复医学杂志, 2003, 18(5):261-263.
[4] Hornby T G, Campbell D D, Kahn J H, et al. Enhanced gait-re‐lated improvements after therapist-versus robotic-assisted loco‐motor training in subjects with chronic stroke:a randomized controlled study[J]. Stroke, 2008, 39(6):1786-1792.
[5] Nameni F. Acute effects of whole-body vibration on testoster‐one responses in the athlete and non athlete[J]. J Sci Med Sport, 2012, 15(1):S145-S146.
[6] Uhm Y H, Yang D J. The effects of whole body vibration com‐bined computerized postural control training on the lower ex‐tremity muscle activity and cerebral cortex activity in stroke pa‐tients[J]. J Phys Ther Sci, 2018, 30(2):300-303.
[7]张国兴,刘四文,杨晓姗.全身振动训练在脑卒中治疗中的应用介绍[J].按摩与康复医学, 2014, 5(7):7-10.
[8]全国第四届脑血管病学术会议.各类脑血管病诊断要点[J].中华神经科杂志, 1996, 12(6):379-380.
[9]金挺剑,叶祥明,林坚,等.强化患侧下肢负重训练对脑卒中患者平衡与功能性步行能力的影响[J].中国康复医学杂志,2009, 24(11):995-998.
[10]王盛,王翔,王彤,等.渐进性全身垂直振动治疗方案对缺血性脑卒中偏瘫早期患者下肢功能与平衡功能的影响[J].中国康复医学杂志, 2017, 32(3):297-300.
[11] Choi W, Han D, Kim J, et al. Whole-body vibration com‐bined with treadmill training improves walking performance in post-stroke patients:a randomized controlled trial[J]. Med Sci Monit, 2017, 23:4918-4925.
[12]师昉,李福亮,吕泽平.台阶训练提高脑卒中患者患肢动态负重及步行能力的效果[J].广西医学, 2016, 38(3):321-323.
[13] Salbach N M, Mayo N E, Higgins J, et al. Responsiveness and predictability of gait speed and other disability measures in acute stroke[J]. Arch Phys Med Rehabil, 2001, 82(9):1204-1212.
[14] Berg K, Wood-Dauphinee S, Willims J I, et al. Measuring balance in the elderly:preliminary development of an instru‐ment[J]. Physiother Can, 1989, 41(6):304-311.
[15]缪鸿石.康复医学理论与实践[M].上海:上海科学技术出版社, 2000:1283-1285.
[16]邵天民,马立军,刘吻,等.运动再学习方案对脑卒中患者下肢运动功能的影响[J].中国康复医学杂志, 2006, 21(5):404.
[17]陈佩顺,黄臻,陈淑贤.早期关节负重训练对脑卒中患者运动功能的影响[J].神经损伤与功能重建, 2007, 2(1):21-22.
[18] Cochrane D J. The potential neural mechanisms of acute indi‐rect vibration[J]. J Sports Sci Med, 2011, 10(1):19-30.
[19]谭景旺,吴雪萍.全身振动训练对老年人下肢功能和慢性疾病影响的研究与进展[J].中国组织工程研究, 2017, 21(8):1288-1293.
[20]李哲,赵玉敏,郭钢花.全身振动训练对脑卒中患者躯干肌痉挛的影响[J].中国康复医学杂志, 2015, 30(8):798-800.
[21]李哲,王国胜,郭钢花.全身振动疗法治疗偏瘫患者踝关节跖屈痉挛的疗效观察[J].中国康复医学杂志, 2014, 29(5):451-454.
[22]龙耀斌,曹锡忠.振动训练对脑卒中偏瘫患者下肢肌张力和运动功能的影响[J].中国康复医学杂志, 2016, 31(10):1099-1103.
[23] Lee J H, Kim S B, Lee K W, et al. The effect of whole-body vibration therapy on the sitting balance of subacute stroke pa‐tients:a randomized controlled trial[J]. Top Stroke Rehabil,2017, 24(6):1-6.
[24]王月丽,曾明,姚云海.振动结合上肢任务导向性训练对脑卒中后偏瘫患者上肢运动功能的影响[J].中国康复医学杂志, 2018, 33(4):447-450.
[25] Monteleone G, De Lorenzo A, Sgroi M, et al. Contraindica‐tions for whole body vibration training:a case of nephrolithia‐sis[J]. J Sports Med Phys Fitness, 2007, 47(4):443-445.
[26]李玉章.全身振动训练的理论与实践[M].上海:第二军医大学出版社, 2010:136.
[27] Rittweger J, Mutschelknauss M, Felsenberg D. Acute chang‐es in neuromuscular excitability after exhaustive whole body vi‐bration exercise as compared to exhaustion by squatting exer‐cise[J]. Clin Physiol Funct Imaging, 2003, 23(2):81-86.
[28] Cardinale M, Lim J. Electromyography activity of vastus lateralis muscle during whole-body vibrations of different fre‐quencies[J]. J Strength Cond Res, 2003, 17(3):621-624.
[29] Zhang L, Weng C, Liu M, et al. Effect of whole-body vibra‐tion exercise on mobility, balance ability and general health sta‐tus in frail elderly patients:a pilot randomized controlled trial[J]. Clin Rehabil, 2014, 28(1):59-68.
[30] Rittweger J. Vibration as an exercise modality:how it may work, and what its potential might be[J]. Eur J Appl Physiol,2010, 108(5):877-904.
[31] Fagnani F, Giombini A, Di Cesare A, et al. The effects of a whole-body vibration on muscle performance and flexibility in female athletes[J]. Am J Phys Med Rehabil, 2006, 85(12):956-962.
[32] Cochrane D J, Stannard S R. Acute whole body vibration training increase vertical jump and flexibility performance in elite female field hockey players[J]. Br J Sports Med, 2005, 39(11):860-865.
[33] Miyara K, Matsumoto S, Uema T, et al. Effect of whole body vibration on spasticity in hemiplegic legs of patients with stroke[J]. Top Stroke Rehabil, 2018, 25(2):90-95.
[34]王朴,张弛,阳筱甜,等.全身振动改善脑卒中患者肢体运动功能障碍:目前证据不足[J].中国组织工程研究, 2014, 18(38):6205-6209.
[2]毕齐,张鹏.青年卒中的研究现状和展望[J].中国卒中杂志,2012, 7(4):260-263.
[3]汪钟立,王翔,励建安,等.脑卒中偏瘫患者躯干和下肢运动能力的预后分析[J].中国康复医学杂志, 2003, 18(5):261-263.
[4] Hornby T G, Campbell D D, Kahn J H, et al. Enhanced gait-re‐lated improvements after therapist-versus robotic-assisted loco‐motor training in subjects with chronic stroke:a randomized controlled study[J]. Stroke, 2008, 39(6):1786-1792.
[5] Nameni F. Acute effects of whole-body vibration on testoster‐one responses in the athlete and non athlete[J]. J Sci Med Sport, 2012, 15(1):S145-S146.
[6] Uhm Y H, Yang D J. The effects of whole body vibration com‐bined computerized postural control training on the lower ex‐tremity muscle activity and cerebral cortex activity in stroke pa‐tients[J]. J Phys Ther Sci, 2018, 30(2):300-303.
[7]张国兴,刘四文,杨晓姗.全身振动训练在脑卒中治疗中的应用介绍[J].按摩与康复医学, 2014, 5(7):7-10.
[8]全国第四届脑血管病学术会议.各类脑血管病诊断要点[J].中华神经科杂志, 1996, 12(6):379-380.
[9]金挺剑,叶祥明,林坚,等.强化患侧下肢负重训练对脑卒中患者平衡与功能性步行能力的影响[J].中国康复医学杂志,2009, 24(11):995-998.
[10]王盛,王翔,王彤,等.渐进性全身垂直振动治疗方案对缺血性脑卒中偏瘫早期患者下肢功能与平衡功能的影响[J].中国康复医学杂志, 2017, 32(3):297-300.
[11] Choi W, Han D, Kim J, et al. Whole-body vibration com‐bined with treadmill training improves walking performance in post-stroke patients:a randomized controlled trial[J]. Med Sci Monit, 2017, 23:4918-4925.
[12]师昉,李福亮,吕泽平.台阶训练提高脑卒中患者患肢动态负重及步行能力的效果[J].广西医学, 2016, 38(3):321-323.
[13] Salbach N M, Mayo N E, Higgins J, et al. Responsiveness and predictability of gait speed and other disability measures in acute stroke[J]. Arch Phys Med Rehabil, 2001, 82(9):1204-1212.
[14] Berg K, Wood-Dauphinee S, Willims J I, et al. Measuring balance in the elderly:preliminary development of an instru‐ment[J]. Physiother Can, 1989, 41(6):304-311.
[15]缪鸿石.康复医学理论与实践[M].上海:上海科学技术出版社, 2000:1283-1285.
[16]邵天民,马立军,刘吻,等.运动再学习方案对脑卒中患者下肢运动功能的影响[J].中国康复医学杂志, 2006, 21(5):404.
[17]陈佩顺,黄臻,陈淑贤.早期关节负重训练对脑卒中患者运动功能的影响[J].神经损伤与功能重建, 2007, 2(1):21-22.
[18] Cochrane D J. The potential neural mechanisms of acute indi‐rect vibration[J]. J Sports Sci Med, 2011, 10(1):19-30.
[19]谭景旺,吴雪萍.全身振动训练对老年人下肢功能和慢性疾病影响的研究与进展[J].中国组织工程研究, 2017, 21(8):1288-1293.
[20]李哲,赵玉敏,郭钢花.全身振动训练对脑卒中患者躯干肌痉挛的影响[J].中国康复医学杂志, 2015, 30(8):798-800.
[21]李哲,王国胜,郭钢花.全身振动疗法治疗偏瘫患者踝关节跖屈痉挛的疗效观察[J].中国康复医学杂志, 2014, 29(5):451-454.
[22]龙耀斌,曹锡忠.振动训练对脑卒中偏瘫患者下肢肌张力和运动功能的影响[J].中国康复医学杂志, 2016, 31(10):1099-1103.
[23] Lee J H, Kim S B, Lee K W, et al. The effect of whole-body vibration therapy on the sitting balance of subacute stroke pa‐tients:a randomized controlled trial[J]. Top Stroke Rehabil,2017, 24(6):1-6.
[24]王月丽,曾明,姚云海.振动结合上肢任务导向性训练对脑卒中后偏瘫患者上肢运动功能的影响[J].中国康复医学杂志, 2018, 33(4):447-450.
[25] Monteleone G, De Lorenzo A, Sgroi M, et al. Contraindica‐tions for whole body vibration training:a case of nephrolithia‐sis[J]. J Sports Med Phys Fitness, 2007, 47(4):443-445.
[26]李玉章.全身振动训练的理论与实践[M].上海:第二军医大学出版社, 2010:136.
[27] Rittweger J, Mutschelknauss M, Felsenberg D. Acute chang‐es in neuromuscular excitability after exhaustive whole body vi‐bration exercise as compared to exhaustion by squatting exer‐cise[J]. Clin Physiol Funct Imaging, 2003, 23(2):81-86.
[28] Cardinale M, Lim J. Electromyography activity of vastus lateralis muscle during whole-body vibrations of different fre‐quencies[J]. J Strength Cond Res, 2003, 17(3):621-624.
[29] Zhang L, Weng C, Liu M, et al. Effect of whole-body vibra‐tion exercise on mobility, balance ability and general health sta‐tus in frail elderly patients:a pilot randomized controlled trial[J]. Clin Rehabil, 2014, 28(1):59-68.
[30] Rittweger J. Vibration as an exercise modality:how it may work, and what its potential might be[J]. Eur J Appl Physiol,2010, 108(5):877-904.
[31] Fagnani F, Giombini A, Di Cesare A, et al. The effects of a whole-body vibration on muscle performance and flexibility in female athletes[J]. Am J Phys Med Rehabil, 2006, 85(12):956-962.
[32] Cochrane D J, Stannard S R. Acute whole body vibration training increase vertical jump and flexibility performance in elite female field hockey players[J]. Br J Sports Med, 2005, 39(11):860-865.
[33] Miyara K, Matsumoto S, Uema T, et al. Effect of whole body vibration on spasticity in hemiplegic legs of patients with stroke[J]. Top Stroke Rehabil, 2018, 25(2):90-95.
[34]王朴,张弛,阳筱甜,等.全身振动改善脑卒中患者肢体运动功能障碍:目前证据不足[J].中国组织工程研究, 2014, 18(38):6205-6209.