Shen Cui-Cui, Lei Kuok-Tong, Jiang Jin-Feng, Miao Dan, Xiong Jia-Wei
Department of Acupuncture and Moxibustion, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi 214000, Jiangsu Province, China.
Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China.
Evid Based Complement Alternat Med. 2020 Aug 31;2020:3805628. doi: 10.1155/2020/3805628. eCollection 2020.
The withdrawal reflex is a defensive reaction to nociceptive stimuli and can be used to regulate locomotor gait during rehabilitation. We investigated the effect of successive needle-pricking of the plantar and dorsal foot surfaces on poststroke lower limb function. Thirty-five hemiplegic patients, within one month after primary stroke, with an affected lower limb (Brunnstrom stage III) were randomly divided into intervention and control groups. Both groups received routine drug treatment, rehabilitation training, and upper limb acupuncture treatment on the hemiplegic side. The control group also received routine acupuncture on the hemiplegic side of the lower limb, while the intervention group received successive needle-pricking on the sole and instep of both the unaffected and affected side feet. Outcomes were assessed before inception (D0) and after three (D3) and six (D6) treatment days, using Brunnstrom stage (Ueda assessment), total Fugl-Meyer lower extremity assessment (FMA-LE) and its subscores (FMA-LE-ss), active lower limb range of motion (AROM-LL), Modified Ashworth Scale Score (MAS-LL), and manual muscle testing (MMT-LL). The Brunnstrom stage was better in the intervention group than in the control group at both D3 and D6 ( < 0.01). The total FMA-LE score and sections B, C, D, and G FMA-LE-ss were significantly better in the intervention group than in the control group at D3 and D6 ( < 0.05). The AROM-LL hip and knee flexion and hip extension improved more in the intervention group than in the control group ( < 0.05). In the intervention group, MAS-LL hip flexion significantly improved at D6 ( < 0.01). Improvement in lower limb joints on the MMT-LL in the intervention group exceeded that in the control group at D6 ( < 0.01). Successive needle-pricking on the plantar and dorsal foot aspects of Brunnstrom stage III in poststroke patients contributed to rapid lower limb motor function improvement via the withdrawal reflex. This trial is registered with ChiCTR1900020633.
牵张反射是对伤害性刺激的一种防御反应，可用于在康复过程中调节运动步态。我们研究了对足底和足背表面进行连续针刺对中风后下肢功能的影响。35例初次中风后1个月内、患侧下肢（Brunnstrom分期III期）的偏瘫患者被随机分为干预组和对照组。两组均接受常规药物治疗、康复训练以及偏瘫侧上肢针刺治疗。对照组还接受偏瘫侧下肢常规针刺治疗，而干预组接受对患侧和健侧足的足底和足背进行连续针刺。在治疗开始前（D0）、治疗3天（D3）和6天（D6）后，使用Brunnstrom分期（上田评估）、Fugl-Meyer下肢总评估（FMA-LE）及其子评分（FMA-LE-ss）、主动下肢活动范围（AROM-LL）、改良Ashworth量表评分（MAS-LL）和徒手肌力测试（MMT-LL）对结果进行评估。在D3和D6时，干预组的Brunnstrom分期均优于对照组（<0.01）。在D3和D6时，干预组的FMA-LE总分以及B、C、D和G节段FMA-LE-ss均显著优于对照组（<0.05）。干预组的AROM-LL髋关节和膝关节屈曲以及髋关节伸展改善程度大于对照组（<0.05）。在干预组中，D6时MAS-LL髋关节屈曲显著改善（<0.01）。在D6时，干预组MMT-LL下肢关节的改善程度超过对照组（<0.01）。对中风后Brunnstrom III期患者的足底和足背进行连续针刺，通过牵张反射促进了下肢运动功能的快速改善。本试验已在中国临床试验注册中心注册，注册号为ChiCTR1900020633。
