Department of Rehabilitation Medicine, First Hospital of Changsha, Changsha 410005, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2022 Jun 28;47(6):755-761. doi: 10.11817/j.issn.1672-7347.2022.220063.
Stroke patients may have various sensory-motor disorders, such as spasticity, muscle weakness or sensory damage. Spasticity affects 20% to 40% of stroke patients. Patients with spasticity may have problems such as pain, motor function damage, and the decreased range of motion, which leads to decline of activity and quality of daily life. Extracorporeal shock wave therapy (ESWT) is a technique that can improve post-stroke spasticity. Whole body vibration (WBV), as a passive neuromuscular muscle stimulation technique, can improve the posture control, muscle strength, and muscle work of different people. At present, there are still few studies using WBV combined with ESWT for the treatment of hemiplegic patients with stroke. This study aims to explore the effects of WBV combined with ESWT on spasticity of the affected lower limb and gait function in stroke patients.
From March 2020 to March 2021, 50 hemiplegic patients with stroke were treated in the Department of Rehabilitation Medicine of the First Hospital of Changsha and they were assigned into a control group and a combined group, 25 cases per group. Both groups carried out conventional treatment, while the control group undertook the ESWT and fake WBV based on conventional treatment, and the combined group undertook ESWT after WBV and conventional treatment. Modified Ashworth Scale (MAS), Lower Extremity portion of the Fugl-Meyer Motor Assessment (FMA-LE), Berg Balance Scale (BBS), and parameters of three-dimensional gait analysis including kinematic parameters (peak value of hip flexion and knee flexion) and spatiotemporal parameters (velocity, cadence and stride length) were assessed before and after 4-week treatment between the 2 groups.
After 4 weeks of treatment, MAS scores in 2 groups were lower than before (both <0.05), and the combined group was lower than the control group (<0.001); BBS and FMA-LE scores were higher than those before treatment (both <0.05), and the combined group was higher than the control group (both <0.001); in the control group, the walking speed, stride frequency, and stride length were higher than those before treatment (all <0.05), and there was no significant difference between the peak value of flexion hip and peak value of flexion knee (both <0.05); the peak value of hip flexion, peak value of knee flexion, step speed, step frequency, and stride length in the combined group were higher than those before treatment (all <0.05), and were higher than those in control group (<0.05 or <0.001).
WBV combined with ESWT can improve the spasticity and motor function of the affected lower extremity, balance, and gait in hemiplegic patients with stroke.
脑卒中患者可能存在多种感觉运动障碍，如痉挛、肌肉无力或感觉损伤。痉挛影响 20%至 40%的脑卒中患者。痉挛患者可能存在疼痛、运动功能损伤和运动范围减小等问题，这导致活动能力和日常生活质量下降。体外冲击波疗法（ESWT）是一种可以改善脑卒中后痉挛的技术。全身振动（WBV）作为一种被动神经肌肉刺激技术，可以改善不同人群的姿势控制、肌肉力量和肌肉工作能力。目前，使用 WBV 联合 ESWT 治疗脑卒中偏瘫患者的研究较少。本研究旨在探讨 WBV 联合 ESWT 对脑卒中患者患侧下肢痉挛和步态功能的影响。
2020 年 3 月至 2021 年 3 月，50 例脑卒中偏瘫患者在长沙市第一医院康复医学科接受治疗，将其分为对照组和联合组，每组 25 例。两组均进行常规治疗，对照组在常规治疗基础上进行 ESWT 和假 WBV，联合组在常规治疗后进行 ESWT 和 WBV。治疗前和治疗 4 周后，采用改良 Ashworth 量表（MAS）、下肢 Fugl-Meyer 运动评估（FMA-LE）部分、Berg 平衡量表（BBS）和三维步态分析参数（髋关节和膝关节屈伸峰值）及运动学参数（速度、步频和步长）和时空参数（速度、步频和步长）评估两组患者的下肢痉挛和步态功能。
治疗 4 周后，两组 MAS 评分均低于治疗前（均<0.05），联合组评分低于对照组（均<0.001）；BBS 和 FMA-LE 评分均高于治疗前（均<0.05），联合组评分高于对照组（均<0.001）；对照组患者的步行速度、步频和步长均高于治疗前（均<0.05），髋关节和膝关节屈伸峰值无明显差异（均<0.05）；联合组髋关节屈伸峰值、膝关节屈伸峰值、步速、步频和步长均高于治疗前（均<0.05），且高于对照组（均<0.05 或<0.001）。
WBV 联合 ESWT 可改善脑卒中偏瘫患者患侧下肢痉挛和运动功能、平衡和步态。
