| Background:In today’s society, with rapid economic development and continuous rising of people’s living level, the incidence of cerebrovascular disease has become higher and higher. The cerebrovascular disease has become one of the most common diseases in old people life and health. Along with the advance of disease prevention and control work, the cerebrovascular disease mortality decline gradually, but at the same time also brought a sharp rise in the number of cerebrovascular disease handicap. In China, as a big developing country with a population of 1.4 billion, the incidence of cerebrovascular disease in our country countryside occupies the world first and the city ranks third so it is particularly important to get the best rehabilitation of cerebrovascular disease. Shoulder hand syndrome as a common complication of cerebrovascular disease, brought great physical pain and psychological distress to the patient with cerebral apoplexy. How to make early diagnose and get seasonable treatment of shoulder hand syndrome is an increasingly important problem for both the physician and the patient.Objective:Shoulder hand syndrome refers to in the recovery period in patients with cerebrovascular disease with side hand suddenly edema, pain and suffering from pain in the shoulder, and make the limited hand movement function. Shoulder hand syndrome is a common secondary complication of cerebrovascular diseases, the domestic and foreign research shows that the probability of acute cerebrovascular disease with shoulder hand syndrome range from 12.5% to 70.0%.It generally occurs in 3 days after the onset and for 6 months after the latest. The shoulder hand syndrome brings serious obstacles to the patient with cerebrovascular disease. with poor treatment will cause deformation of the hands and fingers, and even loss of hand function in patients. Recently, focused ultrasound is used in the clinical treatment of chronic soft tissue injuries and curative effect have been achieved, but there is little application of low intensity focused ultrasound treatment on shoulder hand syndrome after stroke, this experiment was designed to get application of rehabilitation exercise and low intensity focused ultrasound for the treatment of shoulder hand syndrome after stroke, and to explore impact of the low intensity focused ultrasound on shoulder hand syndrome after stroke.Methods:Choose conforms to the standard of 28 patients with cerebral apoplexy and divided into control group and experimental group randomly wih14 cases in each group. The experimental group and control group were given the basis therapy of kinesitherapy, occupational therapy, transcranial magnetic stimulation. The experimental group was given low intensity focused ultrasound treatment as additional treatment. The specific method is:the experimental group was given low intensity focused ultrasound treatment, set the output power range from 0 to5 w is adjustable, deep subcutaneous 0.5-5.0 cm, pulse frequency of 1 KHZ. twice a day, every time lasted 15 minutes,6 days per week, for 4 weeks. The control group at the same time was given false low intensity focused ultrasound treatment, the output power was kept on 0W.Rehabilitation training for 2 groups before and after treatment of 4 weeks and 4 weeks after the end of follow-up, visual analog pain score method (visual analogue scale, VAS), the upper limb Fugl-Meyer rating method (upper extremity component of Fugl-Meyer Assessment (FMA-UE)), Arm Action investigation and Test table (Action Research Arm Test, ARAT) and modified Ashworth rating scale (modified Ashworth scale, MAS) to evaluate the limb and spasm of pain, function, limb swelling degree was evaluated by water immersion method.Results:1. The comparison from the initial evaluation shows that there was no significant difference between LIFU group and control group (p>0.05).2. The two groups of patients before treatment and after treatment of 4 weeks and 4 weeks follow-up after treatment of VAS score respectively is,7.16±1.42,5.64±1.50, 4.71±1.63 of control group and 7.26±1.35,3.52±1.52,2.06±0.78 of LIFU group. The changes of results between groups show that Low intensity focused ultrasound can significantly reduce the limb pain of the people with shoulder hand syndrome. The hand swelling degree respectively is control group 23.93±5.42,19.26±4.83,15.27±4.82; LIFU group 24.13±4.76,13.11±4.75,7.82±3.82. The changes of results between groups show that Low intensity focused ultrasound can significantly reduce the hand swelling degree.3. The FMA-p score collected before treatment, treatment for 4 weeks and 4 weeks follow-up after the treatment respectively was 11.8±2.89,20.1±4.33,21.1±3.82 of control group and 12.2±3.02,24.4±3.73,25.7±3.72 of LIFU group. The results show that LIFU can Promote shoulder hand syndrome proximal limb functional recovery. The FMA-d score collected before treatment,treatment for 4 weeks and 4 weeks follow-up after the treatment respectively was 5.53±1.77,9.1±2.33,14.31±2.92 of control group and5.03± 1.91,13.5±3.37,18.8±3.22of LIFU group. The results show that the LIFU treatment can improve the distal upper extremity function in patients with shoulder hand syndrome.4. The ARAT score collected before treatment, treatment for 4 weeks and 4 weeks follow-up after the treatment respectively was 17.1±4.28,21.7±2.39,24.5±2.92 of control group and 16.3±5.59,26.3±3.37,30.7±2.24 of LIFU group. The results show that the LIFU treatment can improve hand function in patients with shoulder hand syndrome.5. The MAS score of wrist collected before treatment, treatment for 4 weeks and 4 weeks follow-up after the treatment respectively was1.53±0.92,1.80±0.68,1.71±0.47 of control group and 1.40±0.91,1.50±0.52,1.67±0.65 of LIFU group. By statistical data analysis shows that LIFU treatment in patients with shoulder hand syndrome had no effect on wrist muscle tone.6. The MAS score of elbow collected before treatment, treatment for 4 weeks and 4 weeks follow-up after the treatment respectively was 1.53±0.91,1.53±0.92, 1.57±0.51 of control group and 1.40±0.83,1.36±0.63,1.33±0.49 of LIFU group. By statistical data analysis shows that LIFU treatment in patients with shoulder hand syndrome had no effect on elbow muscle tone.Conclusion:After rehabilitation training, two groups of patients, suffering shoulder hand syndrome after stroke hemiplegia, have significantly improved the function of their arm and hand movements. The effect of LIFU group was obviously better than control group. After the rehabilitation training the activity function of the upper extremity in patients was significantly better than the before, which shows that the rehabilitation training can effectively promote the concurrent shoulder hand syndrome after stroke hemiplegia patients’ limb movement function recovery, to improve the quality of life. LIFU group in the improvement of lateral upper limb pain, swelling degree, hand function of upper extremities and hand function were superior to control group in the assessment of rehabilitation and all those show that low intensity focused ultrasound combined with rehabilitation training is better than simple rehabilitation training in the process of the treatment of shoulder hand syndrome. |
PDF Full Text Request