不同强度电刺激对脑卒中患者本体感觉与平衡功能的影响
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湖南省自然科学基金 2021JJ70091;湖南省卫生健康委员会指导课题 202103101709;苏州市科技发展计划 SKYD2022070 ~~;


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    摘要:

    目的:目前对随机共振理论可以改善脑卒中后患者的运动控制能力的研究不多,且效果并不确切。感觉障碍康复是脑卒中康复的重要组成部分,在康复训练中增加神经系统对输入信号的感知能力,特别是本体感觉的感知与处理能力,将有助于患者运动控制能力的恢复。基于随机共振现象,本研究开发设计一种增强脑卒中患者的电噪声刺激方法,探讨不同强度电刺激前后脑卒中患者患侧膝关节本体感觉与平衡功能的变化。方法:2023年3至12月招募在湖南省人民医院住院的脑卒中康复患者。测定患者的电刺激阈值并随机分为实验组1(120%阈值刺激组)、实验组2(80%阈值刺激组)、实验组3(40%阈值刺激组)和对照组(0%,不施加电刺激),每组17例。比较患者刺激前后的Berg平衡能力测试表(Berg Balance Scale,BBS)评分及膝关节屈曲30°、90°、120°的角度重建值与实际值的差值。结果:治疗前4组患者BBS评分差异均无统计学意义(均P>0.05)。各实验组治疗后BBS评分均较治疗前显著提高(均P<0.05),对照组BBS评分降低(P<0.05)。治疗后,4组BBS评分比较差异有统计学意义(P<0.05),多重比较显示:对照组与各实验组BBS评分差异有统计学意义(均P<0.05),实验组1和实验组2 BBS评分均显著高于实验组3(均P<0.05)。治疗前4组患者膝关节角度重建差值差异无统计学意义(P>0.05)。治疗后,4组角度重建差值比较有统计学意义(P<0.05),多重比较显示:对照组与各实验组角度重建差值差异均有统计学意义(均P<0.05),对照组角度重建差值均大于各实验组(均P<0.05)。结论:基于随机共振理论的电噪声刺激可以改善脑卒中患者的本体感觉及平衡功能。

    Abstract:

    ObjectiveCurrent research on the application of stochastic resonance theory to improve motor control in post-stroke patients is limited, and its effects are inconclusive. Sensory rehabilitation is a crucial component of stroke recovery. Enhancing the nervous system’s ability to perceive and process proprioceptive inputs during rehabilitation training can aid in restoring motor control. This study developed an electrical noise stimulation method based on the stochastic resonance phenomenon to investigate changes in proprioception of the affected knee joint and balance function in stroke patients before and after different intensity electrical stimulations.MethodsStroke rehabilitation inpatients were recruited from Hunan Provincial People’s Hospital between March and December 2023. Patients’ electrical stimulation thresholds were measured, and they were randomly divided into 4 groups: An experimental group 1 (120% threshold stimulation), an experimental group 2 (80% threshold stimulation), an experimental group 3 (40% threshold stimulation), and a control group (0%, no stimulation), with 17 patients in each group. The Berg Balance Scale (BBS) scores and the difference between the reconstructed and actual angles of knee flexion at 30°, 90°, and 120° were compared before and after the stimulation.ResultsBefore the treatment, there was no significant difference in BBS scores among the 4 groups (all P>0.05). After the treatment, BBS scores significantly improved in all experimental groups (all P<0.05), but significantly decreased in the control group (P<0.05). Post-treatment comparisons showed significant differences in BBS scores among the 4 groups (P<0.05). Multiple comparisons indicated significant differences in BBS scores between the control group and each experimental group (P<0.05), with the experimental groups 1 and 2 scoring significantly higher than the experimental group 3 (P<0.05). No significant differences were observed in knee joint angle reconstruction errors among the 4 groups before the treatment (P>0.05). Post-treatment comparisons showed significant differences in angle reproduction errors (P<0.05). Multiple comparisons showed significant differences between the control group and each experimental group (P<0.05), with the control group exhibiting greater errors than all experimental groups (all P<0.05).ConclusionElectrical noise stimulation based on the stochastic resonance theory can improve proprioception and balance function in stroke patients.

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