科研之友
微信
新浪微博
Facebook
分享链接
摘要
Background： Shoulder subluxation is a major complication of stroke-induced hemiplegia with high incidence.Among various treatments,EMG biofeedback (EMGBF) has a definite effect.However,in many studies,the stimulation site and direction of motion are not uniform.Objective： To explore the effect of EMGBF on post-stroke shoulder subluxation with different stimulus parts and directions of movement.Methods： A total of 267 patients with post-stroke shoulder subluxation were selected from the Affiliated Hospital of Southwest Medical University from May 2017 to May 2018.They were randomly and equally divided into the flexion group,abduction group and extension group.Subluxation degree detected by finger palpation was classified into gradeⅠ,Ⅱ and Ⅲ.On the basis of routine treatment,all groups were treated with EMGBF.The electrodes were placed in the deltoid muscle anterior bundle,the middle bundle and the posterior bundle,and guidance was given to the patients to perform flexion,abduction and extension movements.Measurements of the electromyographic score (iEMG) before treatment and at the end of the 3rd,6th,9th weeks of treatment,and the scores of Fugl-Meyer upper limb motor function assessment,VAS score,Barthel index,Stroke Specific Quality of Life Scale (SSQOLS) score,interval between the affected acromion and the humeral head (AHI) and the distance between the apex of the bilateral scapula before treatment and at the end of the 9th weeks of treatment were performed.Results： GradeⅠ,Ⅱ and Ⅲ subluxation patients in three groups showed similar pretreatment iEMG and iEMG at the 3rd week of treatment (P>0.05),but significantly different iEMG at the 6th and 9th weeks of treatment (P<0.05),and they obtained significant improvements in iEMG after treatment (P<0.05).Fugl-Meyer assessment score,VAS score,Barthel index,SSQOLS score,AHI and distance between the apex of the bilateral scapula were similar in gradeⅠ,Ⅱ and Ⅲ subluxation patients in three groups at baseline(P>0.05).At the end of 9-week treatment,extension group(all patients with different degree of subluxation) showed higher Fugl-Meyer assessment score and lower VAS score than other two groups (P<0.05).GradeⅠandⅡsubluxation patients in abduction group showed higher Fugl-Meyer assessment score than those in flexion group (P<0.05).GradeⅠ,Ⅱ and Ⅲ subluxation patients in abduction group showed higher Barthel index than those of other two groups(P<0.05).GradeⅠ,Ⅱ and Ⅲ subluxation patients in both flexion group and abduction group showed lower AHI than those in extension group (P<0.05).GradeⅠ,Ⅱsubluxation patients in abduction group showed lower AHI than those in flexion group (P<0.05).GradeⅠ,Ⅱ and Ⅲ subluxation patients in extension group showed less distance between the apex of the bilateral scapula compared with other two groups (P<0.05).When the treatment ended,gradeⅠ,Ⅱ and Ⅲ subluxation patients in all groups showed improved Fugl-Meyer assessment score,Barthel index,SSQOLS score,decreased VAS score,and AHI,as well as greater distance between the apex of the bilateral scapula compared with baseline (P<0.05).Conclusion： The stimulation and abduction of the middle bundle of deltoid muscle are superior to other two schemes in EMGBF.The improvement of the muscle strength of the core bundle can improve the dislocation of shoulder joint,alleviate pain and improve the quality of life.At the same time,it provides a reference for the development of follow-up standardized treatment plan.
- 单位
