Chung S, Bai Z, Rymer W Z, Zhang L Q
Rehabilitation Institute of Chicago, Department of Physical Medicine & Rehabilitation, Department of Rehabilitation Medicine, Seoul National University, Seoul, South Korea.
Conf Proc IEEE Eng Med Biol Soc. 2005;2005:3672-5. doi: 10.1109/IEMBS.2005.1617279.
Spasticity, contracture, and muscle weakness are major sources of disability in stroke. Changes of torque-generating capacity as well as reflex and non-reflex properties of ankle plantar flexors induced by strenuous stretching in chronic hemiplegia were investigated. Twelve subjects with a unilateral stroke and 10 healthy controls underwent 30 minutes of strenuous intelligent stretching treatment. Reflex and non-reflex components of spastic hypertonia and force-generating capacity of ankle plantar flexors were investigated. Dorsiflexion (DF) range of motion (ROM) was increased (p=0.002) and passive stiffness and passive resistant torque of the spastic muscles were decreased (p=0.004 and 0.007, respectively), while reflex hyper-excitability diminished slightly but with no statistical significance. The maximal voluntary contraction (MVC) torque of the spastic ankle plantar flexors was increased after the forceful stretching treatment (p=0.041). In contrast, the stretching treatment of the healthy plantar flexors did not change any of the variables measured before and after stretching. The stroke subjects who gained more DF ROM or larger decrement of stiffness achieved greater increment of the peak torque generation after the stretching (r=0.597 with p=0.040 and r=-0.746 with p=0.005, respectively). These results suggest that the strenuous dynamic stretching could improve the force-generating capacity of spastic muscles as well as reduce the passive stiffness and increase ROM.
痉挛、挛缩和肌肉无力是中风导致残疾的主要原因。研究了慢性偏瘫患者在剧烈拉伸后踝跖屈肌的扭矩产生能力以及反射和非反射特性的变化。12名单侧中风患者和10名健康对照者接受了30分钟的剧烈智能拉伸治疗。研究了踝跖屈肌痉挛性张力亢进的反射和非反射成分以及力量产生能力。背屈（DF）活动范围（ROM）增加（p = 0.002），痉挛肌肉的被动僵硬度和被动抵抗扭矩降低（分别为p = 0.004和0.007），而反射性过度兴奋略有降低但无统计学意义。强力拉伸治疗后，痉挛性踝跖屈肌的最大自主收缩（MVC）扭矩增加（p = 0.041）。相比之下，健康跖屈肌的拉伸治疗未改变拉伸前后测量的任何变量。在拉伸后，获得更多DF ROM或更大僵硬度降低的中风患者在峰值扭矩产生方面有更大的增加（分别为r = 0.597，p = 0.040和r = -0.746，p = 0.005）。这些结果表明，剧烈动态拉伸可以提高痉挛肌肉的力量产生能力，同时降低被动僵硬度并增加ROM。
