| 摘要: |
| ［摘要］ 目的 观察神经肌肉激活（Neurac）技术联合经颅磁刺激（TMS）前庭反射治疗脑卒中后偏瘫的疗效。方法 招募2022年1月至2023年8月首都医科大学附属北京康复医院收治的脑卒中后偏瘫患者123例，采用随机数字表法将其分为Neurac技术组（N组）、TMS前庭反射组（T组）和联合组，每组41例。所有患者均接受常规康复训练，在此基础上，N组接受Neurac技术治疗，T组接受TMS前庭反射治疗，联合组接受Neurac技术联合TMS前庭反射治疗，连续治疗4周。比较三组治疗前后躯干稳定性、行走功能、表面肌电图指标［肱二头肌、肱三头肌的均方根值（RMS）］、下肢肌力情况、上下肢运动能力［Fugl-Meyer运动功能评估（FMA）量表评分］、躯体平衡功能［脑卒中患者姿势控制量表（PASS）评分、Brunel平衡评估（BBA）量表评分］及生活质量［脑卒中专门化生活质量量表（SS-QOL）评分］。结果 治疗前，三组躯干稳定性指标比较差异无统计学意义（P>0.05）。治疗后，三组在睁眼时和闭眼时躯体的摆动长度、摆动面积、平均速度均较治疗前显著降低（P<0.05），且联合组指标水平显著低于T组和N组（P<0.05），T组指标水平显著低于N组（P<0.05）。治疗前，三组屈肘和伸肘时肱二头肌RMS、肱三头肌RMS、下肢肌力情况、上下肢FMA量表评分、BBA量表评分和PASS评分比较差异无统计学意义（P>0.05）。治疗后，三组屈肘和伸肘时肱二头肌RMS、肱三头肌RMS、上下肢FMA量表评分、BBA量表评分、PASS评分均较治疗前显著升高（P<0.05），且联合组指标水平较N组、T组更高（P<0.05），但N组和T组比较差异无统计学意义（P>0.05）。治疗后，三组下肢肌力情况均较治疗前显著改善（P<0.05），且联合组改善情况显著优于N组和T组（P<0.05）。联合组治疗后SS-QOL的自理能力、活动能力、体能、社会角色维度评分显著高于N组和T组（P<0.05），但N组和T组比较差异无统计学意义（P>0.05）。结论 Neurac技术联合TMS前庭反射治疗脑卒中后偏瘫，可增强患者上下肢肌力，改善躯体稳定性及平衡能力，增强行走能力，提高生活质量。 |
| 关键词: 脑卒中后偏瘫 神经肌肉激技术 经颅磁刺激前庭反射 下肢肌力 躯干稳定性 行走功能 |
| DOI：10.3969/j.issn.1674-3806.2025.02.10 |
| 分类号:R 493 |
| 基金项目:北京市科技计划项目（编号：Z210102740516081） |
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| Observation on the efficacy of Neurac technique combined with TMS of vestibular reflex in treatment of post-stroke hemiplegia |
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WU Dan, GUO Boyuan, HUANG Yan, JIA Nan, GAO Chang, LI Shuang, ZHANG Xiaoying
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Department of Occupational Therapy, Rehabilitation Diagnosis and Treatment Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing 100043, China
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| Abstract: |
| ［Abstract］ Objective To observe the efficacy of neuromuscular activation(Neurac) technique combined with transcranial magnetic stimulation(TMS) of vestibular reflex in treatment of post-stroke hemiplegia. Methods A total of 123 patients with post-stroke hemiplegia who were admitted to Beijing Rehabilitation Hospital Affiliated to Capital Medical University from January 2022 to August 2023 were recruited. The patients were randomly divided into Neurac technique group(N group), TMS of vestibular reflex group(T group), and combined treatment group, with 41 cases in each group. All the patients received conventional rehabilitation training. On this basis, N group received treatment of Neurac technique, and T group received treatment of TMS of vestibular reflex, and the combined treatment group received a combined treatment of Neurac technique and TMS of vestibular reflex, and all the groups were treated continuously for 4 weeks. The trunk stability, walking function, surface electromyography indicators［root mean square(RMS) values of biceps brachii and triceps brachii］, lower limb muscle strength, upper and lower limb motor ability［Fugl-Meyer Assessment(FMA) scale scores］, body balance function［ Postural Assessment Scale for Stroke(PASS) scores, Brunel Balance Scale(BBA) scores］ and quality of life［Stroke-Specific Quality of Life Scale(SS-QOL) scores］ were compared among the three groups before and after treatment. Results Before treatment, there were no statistically significant differences in the trunk stability indicators among the three groups(P>0.05). After treatment, the swing length, swing area, and average speed of the body in the three groups were significantly reduced when the eyes were open and closed compared with those before treatment(P<0.05), and the levels of the indicators in the combined treatment group were significantly lower than those in T group and N group(P<0.05), and the levels of the indicators in T group were significantly lower than those in N group(P<0.05). Before treatment, there were no statistically significant differences in RMS values of biceps brachii and triceps brachii at the state of elbow flexion and extension, lower limb muscle strength, FMA scores of upper and lower limbs, BBA scores, and PASS scores among the three groups(P>0.05). After treatment, the RMS values of biceps brachii and triceps brachii at the state of elbow flexion and extension, FMA scores of upper and lower limbs, BBA scores, and PASS scores in the three groups were significantly elevated compared with those before treatment(P<0.05), and the levels of the indicators in the combined treatment group were higher than those in N group and T group(P<0.05). However, there were no significant differences between N group and T group(P>0.05). After treatment, the lower limb muscle strength in the three groups improved significantly compared with that before treatment(P<0.05), and the improvement in the combined treatment group was significantly better than that in N group and T group(P<0.05). After treatment, the self-care ability, activity ability, physical ability, and social role dimension scores of SS-QOL in the combined treatment group were significantly higher than those in N group and T group(P<0.05), but there were no statistically significant differences between N group and T group(P>0.05). Conclusion Neurac technique combined with TMS of vestibular reflex can enhance the muscle strength of the upper and lower limbs of the patients, improve their physical stability and balance ability, enhance their walking ability in the treatment of post-stroke hemiplegia, and improve their quality of life. |
| Key words: Post-stroke hemiplegia Neuromuscular activation(Neurac) technique Transcranial magnetic stimulation(TMS) of vestibular reflex Lower limb muscle strength Trunk stability Walking function |
