Effectiveness Of Blood Flow Restriction Combined With Exercise Training On Physical Function And Walking Function In Patients With Stroke

Inability to walk or difficulty walking is one of the most devastating aftereffects of stroke.With the increasing prevalence and morbidity,more and more stroke patients need systematic rehabilitation training to restore their physical functions and gait.Blood flow restricted combined with exercise training(BFR-ET),a new exercise technique,has been shown to have a significant effect on skeletal muscles.Achieving the same effect as high-load and longtime exercise training through the low-load and shorttime exercise training.Research showed that muscle hypertrophy,muscle fiber thickening,muscle mass,volume and strength increasing after BFR-ET.At the same time,BFR-ET not only targeted at limb muscle groups with limited blood flow,but also improved muscle capacity in unrestricted muscle groups.Therefore,compared with traditional exercise training,BFR-ET may be potential to improve physical functions and gait in stroke patients by improving overall muscle capacity.Therefore,this study added BFR-ET to traditional rehabilitation training therapy,so that patients can get better training effects.Objective: To analyze the effects of BFR-ET on lower limb function and gait in stroke patients,to explore the effectiveness of BFR-ET on lower limb function and gait in stroke patients,and to discuss the possibility of its physiological mechanism.Methods: 34 stroke patients hospitalized from September 2021 to June 2022 were randomly selected and divided into BFR combined exercise training group(BFR-ET)(experimental group)and exercise training group(ET)(control group).Based on daily routine rehabilitation,the experimental group received BFR-ET and the control group received exercise training twice a day.Some scales were performed in both groups at before,during and after treatment(20 days)including Brunnstrom staging,muscle strength(Manual Muscle Testing,MMT),muscle tone(Modified Ashworth Scale,MAS),active range of motion(AROM),Fugl-Meyer Assessment Lower Extremities(FMA-LE),Time-up and Go Test(TUGT),and Modified Barthel index(MBI).The gait analysis system was used to evaluate gait only before and after training.Results: 1)Physical function comparison: there were different between the two groups in hip flexor strength(P = 0.027)and hip abduction strength(P = 0.012)before training;after training,the improvements of three and six sets of muscle strength were discovered respectively in the control group and experimental group at three time points within the group.Only hip abduction muscle strength(P = 0.048)was different between groups.In two groups,the changes of six sets of AROM were observed.Only ankle plantar flexion(P = 0.014)was significant in AROM after training.Before training,FMA-LE scores of subjects in the two groups were different between the two groups(P = 0.037),and FMA-LE scores of subjects in the control group(P < 0.001)and the experimental group(P < 0.001)were different within the group.2)Comparison of walking function: Compared to pre-training,the TUGT scores were different in the control group(P < 0.001)and the experimental group(P < 0.001)after 20-day training.The results showed discrepancy of walking speed of the contralateral side(P = 0.001)and the change of walking speed of the contralateral side(P = 0.031)between the two groups.The differences were detected about the support and phase period between the contralateral side and the ipsilateral side at pre-training(P = 0.024;P = 0.007)and post-training(P = 0.004;P = 0.001).After training,the differences were observed about hip flexion comparison between the contralateral and the ipsilateral side in the control group(P = 0.001)and the experimental group(P = 0.013).There were discrepancies between contralateral and ipsilateral knee flexion in the control group(P = 0.01)and the experimental group(P= 0.002).there were distinctions about in metatarsal flexion of the contralateral and ipsilateral ankle in the control group(P = 0.017)and the experimental group(P =0.04).Conclusions: 1)Blood flow restriction combined with exercise training is a safe and effective combination therapy,which can improve muscle strength,active range of motion and the comprehensive score of motor function(Fugl-Meyer Rating Scale-lower extremity)and promote the improvement of physical function in stroke patients.2)Blood flow restriction combined with exercise training can coordinate the walking speed and supporting phase of the contralateral and ipsilateral side of stroke patients,as well as the knee angle during walking to improve the walking symmetry of stroke patients.3)Based on improving the muscle function of stroke patients as the starting point,BFR-ET can promote the improvement of their physical function,increase the movement control ability of stroke patients,promote their walking symmetry and stability.