踝关节智能牵伸对脊髓损伤患者下肢痉挛效果的随机对照试验

doi:10.3969/j.issn.1006-9771.2024.10.009

Abstract

Abstract:

Objective To observe the effect of intelligent flexible ankle stretching training on lower extremity spasm in patients with spinal cord injury.

Methods From June, 2021 to May, 2024, 28 patients with spinal cord injury were randomly divided into control group (n = 14) and experimental group (n = 14). Both groups received conventional rehabilitation treatment. On this basis, the control group received manual extension treatment, and the experimental group received intelligent flexible ankle stretching system training, for eight weeks. The modified Ashworth Scale (MAS), ankle dorsiflexion angle, Clinical Spasticity Index (CSI), max root mean square (RMS_max) of surface electromyography of gastrocnemius medial head and vibration perception threshold (VPT) of great toe were compared.

Results After treatment, MAS (χ² = 10.378, P = 0.035), ankle dorsiflexion angle (Z = -3.306, P < 0.001), CSI (t = 4.101, P = 0.001) and RMS_max of gastrocnemius medial head (Z = -3.296, P < 0.001) improved in the experimental group, while MAS (χ² = 11.418, P = 0.022), ankle dorsiflexion angle (Z = -1.986, P = 0.047) and RMS_max of gastrocnemius medial head (Z = -2.297, P = 0.021) were better in the experimental group than in the control group. Although VPT was improved after treatment, no significant difference was found within and beteen groups (P > 0.05).

Conclusion The intelligent flexible ankle stretching training could improve the lower limb muscle spasticity in patients with spinal cord injury, and may be benefit for foot proprioception.

Key words: spinal cord injury, lower limb rehabilitation robot, spasm, randomized controlled trial

CLC Number:

R651.2

GAO Mingming, YUN Xiaoping, ZHAO Shuyu, XIN Ran, SONG Guiyun, ZHAO Yang. Rehabilitation effect of intelligent ankle stretching on lower extremity spasm in patients with spinal cord injury: a randomized controlled trial[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(10): 1187-1192.

Figures/Tables 6

Table 1

Table 2

Table 3

Table 4

Comparison of CSI between two groups pre- and post-treatment"

组别	n	测试	$x - ± s$	t值	P值
对照组	14	前测	12.86±2.28	1.665	0.120
		后测	12.29±2.46
试验组	14	前测	12.86±1.83	4.101	0.001
		后测	11.21±2.94
治疗前两组均值差			0.00±2.25	0.000	1.000
治疗后两组均值差			-1.07±3.81	-1.045	0.306

Table 4

Table 5

Table 6

References 25

[1]	恽晓平. 脑性瘫痪儿童康复评定[M]. 北京: 北京出版社, 2018: 111.
[2]	SKOOG B, JAKOBSSON K E. Prevalence of spasticity and below-level neuropathic pain related to spinal cord injury level and damage to the lower spinal segments[J]. J Rehabil Med Clin Commun, 2020, 3: 1000039.
[3]	BILLINGTON Z J, HENKE A M, GATER D R J. Spasticity management after spinal cord injury: the here and now[J]. J Pers Med, 2022, 12(5): 808.
[4]	卢利萍, 桑德春, 季淑凤. 下肢康复机器人LR2训练对偏瘫患者下肢肌痉挛和ADL能力改善的疗效观察[J]. 中国康复医学杂志, 2018, 33(1): 45-49.
	LU L P, SANG D C, JI S F. A study on the antispasticity effect and ADL of leg rehabilitation robot (LR2) in the hemiplegia patients[J]. Chin J Rehabil Med, 2018, 33(1): 45-49.
[5]	FRANCISCO G E, WISSEL J, PLATZ T, et al. Post-stroke spasticity[M]// PLATZ T. Clinical pathways in stroke rehabilitation. Evidence-based clinical practice recommendations, Cham, Switzerland: WFNR-Springer, 2021.
[6]	GUNNARSSON S, LEMMING D, ALEHAGEN S, et al. Dosing patterns in treatment of disabling spasticity with intrathecal Baclofen[J]. Rehabil Nurs, 2021, 46(6): 315-322.
[7]	SKOOG B, HEDMAN B. Intrathecal Baclofen dosage for long-term treatment of patients with spasticity due to traumatic spinal cord injuries or multiple sclerosis[J]. Ann Rehabil Med, 2019, 43(5): 555-561. doi: 10.5535/arm.2019.43.5.555 pmid: 31693845
[8]	PALAZÓN-GARCÍA R, ALCOBENDAS-MAESTRO M, ESCLARIN-DE R A, et al. Treatment of spasticity in spinal cord injury with Botulinum toxin[J]. J Spinal Cord Med, 2019, 42(3): 281-287.
[9]	FELIX B D, QUAN X S. Effectiveness of intelligent control strategies in robot-assisted rehabilitation: a systematic review[J]. IEEE Trans Neural Syst Rehabil Eng, 2024, 32: 1828-1840.
[10]	杨绯, 潘钰, 吴琼, 等. 踝扭伤后关节生物力学和本体感觉变化特征及相关性[J]. 中国康复理论与实践, 2019, 25(12): 1365-1369.
	YANG F, PAN Y, WU Q, et al. Biomechanics characteristics and its correlation with proprioception of ankle post sprain[J]. Chin J Rehabil Theory Pract, 2019, 25(12): 1365‐1369.
[11]	REN Y, WU Y N, YANG C Y, et al. Developing a wearable ankle rehabilitation robotic device for in-bed acute stroke rehabilitation[J]. IEEE Trans Neural Syst Rehabil Eng, 2017, 25(6): 589-596.
[12]	ZHAI X X, WU Q, LI X, et al. Effects of robot-aided rehabilitation on the ankle joint properties and balance function in stroke survivors: a randomized controlled trial[J]. Front Neurol, 2021, 12: 719305.
[13]	翟晓雪, 潘钰, 吴琼, 等. 踝关节智能牵伸训练对偏瘫患者踝关节生物力学特性及其运动功能和日常生活活动能力的影响[J]. 中华物理医学与康复杂志, 2021, 43(1): 25-29.
	ZHAI X X, PAN Y, WU Q, et al. Ankle stretching can improve stroke survivors′ ankle biomechanics, balance, walking and ability in the activities of daily living[J]. Chin J Phys Med Rehabil, 2021, 43(1): 25-29.
[14]	LIN P J, ZHAI X, LI W, et al. A transferable deep learning prognosis model for predicting stroke patients' recovery in different rehabilitation trainings[J]. IEEE J Biomed Health Inform, 2022, 26(12): 6003-6011.
[15]	KIRSHBLUM S C, BURNS S P, BIERING-SORENSEN F, et al. International Standards for Neurological Classification of Spinal Cord Injury (revised 2011)[J]. J Spinal Cord Med, 2011, 34(6): 535-546. doi: 10.1179/204577211X13207446293695 pmid: 22330108
[16]	恽晓平. 康复疗法评定学[M]. 2版. 北京: 华夏出版社, 2014: 205.
[17]	GAO M M, YUN X P, ZHANG T. VSA-3000: A quantitative vibration sensation testing device for patients with central nervous system injury[J]. Front Neurol, 2020, 11: 936. doi: 10.3389/fneur.2020.00936 pmid: 33013633
[18]	夏晓昧, 蒋孝翠, 赵秦, 等. 序贯应用全身振动训练和下肢康复机器人训练对不完全性脊髓损伤患者下肢功能的影响[J]. 江苏医药, 2022, 48(8): 801-804.
	XIA X M, JIANG X C, ZHAO Q, et al. Effect of sequential application of whole-body vibration training and lower limb rehabilitation robot training on function of lower limbs in patients with incomplete spinal cord injury[J]. Jiangsu Med J, 2022, 48(8): 801-804.
[19]	CALABRÒ R S, BILLERI L, CIAPPINA F, et al. Toward improving functional recovery in spinal cord injury using robotics: a pilot study focusing on ankle rehabilitation[J]. Expert Rev Med Devices, 2022, 19(1): 83-95.
[20]	SHAKTI D, DAS R, KUMAR N, et al. Development of robotic rehabilitation device for spasticity treatment of acute spinal cord injury patients[J]. IETE J Res, 2021, 69(8): 5044-5051.
[21]	PILKAR R, MOMENI K, RAMAMNUJAM A, et al. Use of surface EMG in clinical rehabilitation of individuals with SCI: barriers and future considerations[J]. Front Neurol, 2020, 11: 578559.
[22]	LI J, SU K, MEI J, et al. Using surface electromyography to evaluate the efficacy of governor vessel electroacupuncture in poststroke lower limb spasticity: study protocol for a randomized controlled parallel trial[J]. Evid Based Complement Alternat Med, 2021, 2021: 5511031.
[23]	LI S, LUO X, ZHANG S, et al. Evaluation of multilevel surgeries in children with spastic cerebral palsy based on surface electromyography[J]. Front Neurosci, 2021, 15: 680645.
[24]	BALBINOT G, JONER W M, LI G, et al. The use of surface EMG in neurorehabilitation following traumatic spinal cord injury: a scoping review[J]. Clin Neurophysiol, 2022, 138: 61-73. doi: 10.1016/j.clinph.2022.02.028 pmid: 35364465
[25]	LEE Y, CHEN K, REN Y, et al. Robot-guided ankle sensorimotor rehabilitation of patients with multiple sclerosis[J]. Mult Scler Relat Disord, 2017, 11: 65-70.

组别	n	性别 (男/女)/n	损伤类型 (完全性/不完全性)/n	损伤节段 (颈段/胸段/腰段)/n	年龄/岁	病程/月
对照组	14	12/2	2/12	10/4/0	34.36±11.47	5.25 (3.88, 7.63)
试验组	14	9/5	3/11	5/8/1	39.07±16.02	7.50 (3.00, 27.38)
χ²/t/Z值		1.714	0.243	4.000	0.895	-0.690
P值		0.190	0.622	0.135	0.379	0.490

组别	n	测试	M(Q_L, Q_U)	Z值	P值
对照组	14	前测	17.90(7.18, 87.33)	-0.594	0.552
		后测	17.45(8.40, 39.05)
试验组	14	前测	19.30(10.00, 54.93)	-1.334	0.182
		后测	12.15(9.10, 130.00)
治疗前两组差值			0.00 (-8.48, 8.85)	-0.300	0.769
治疗后两组差值			-0.25 (-14.43, 27.80)	-0.416	0.701

Rehabilitation effect of intelligent ankle stretching on lower extremity spasm in patients with spinal cord injury: a randomized controlled trial

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组别	n	测试	0级	1级	1⁺级	2级	3级	χ²值	P值
对照组	14	前测	0	3	9	0	2	0.202	0.904
		后测	0	4	8	0	2
试验组	14	前测	0	3	7	1	3	10.378	0.035
		后测	2	7	2	3	0
治疗前两组差值			0	0	2	1	1	1.450	0.694
治疗后两组差值			2	3	6	3	2	11.418	0.022

组别	n	测试	M(Q_L, Q_U)	Z值	P值
对照组	14	前测	95.00 (90.00, 103.50)	-0.118	0.906
		后测	94.00 (90.75, 100.75)
试验组	14	前测	104.50 (94.50, 111.25)	-3.306	< 0.001
		后测	90.00 (80.00, 95.50)
治疗前两组差值			2.50 (-0.75, 12.75)	-0.799	0.424
治疗后两组差值			-6.50 (-16.00, 0.50)	-1.986	0.047

组别	n	测试	M(Q_L, Q_U)	Z值	P值
对照组	14	前测	54.20 (36.63, 72.60)	-1.476	0.140
		后测	59.65 (45.00, 73.38)
试验组	14	前测	82.40 (32.45, 107.50)	-3.296	< 0.001
		后测	25.40 (14.48, 63.18)
治疗前两组差值			11.50 (-16.18, 50.60)	-1.011	0.329
治疗后两组差值			-29.80 (-53.38, -8.13)	-2.297	0.021

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