| Cerebrovascular accident is a common disease in China,including intracerebral hemorrhage and cerebral infarction.Cerebral infarction mostly occurred in people over 60 years old,while intracerebral hemorrhage mostly occurred in people under 60.The causes of such disease include vascular wall lesions,heart disease and hemodynamic changes,blood component and blood rheology changes and other causes.After the accident,few patients can recover to live on their own,and most patients will suffer from symptoms such as cognitive dysfunction,allolalia,dysmnesia,sensory dysfunction and dyskinesia.Most of the patients after stroke have one or more of the above functional deficiencies,so their quality of life become very poor and it is difficult for them to return to the social society.Therefore,it is necessarily urgent to carry out rehabilitation training after stroke,which has potential to improve the patients’ residual function and self-care ability,thus reducing the burden of family members.The recovery of lower limb function is undoubtedly the greatest incentive for patients as walking is the most urgent ability for patients.In clinics,motor imagery therapy,as a new rehabilitation treatment method,has been paid more and more attentions.Its simple operation and remarkable effect have been recognized by the therapists and patients.Objective:To investigate the role of motor imagery therapy combined with electromyography biofeedback in the recovery of lower limb function in patients with hemiplegia after stroke.Methods:90 stroke patients with hemiplegia were randomly divided into three groups : control group(A)(n=30 cases),biofeedback group(B)(n=30 cases)and combined-treatment group(C)(n=30 cases).All patients received routine rehabilitation training.Group A received sham electromyography biofeedback therapy and motor imagery therapy.Group B received electromyography biofeedback therapy and sham motor imagery therapy,while group C received motor imagery therapy and electromyography biofeedback therapy.Patient’s recovery level was assessed by Brunnstrom grading(lower limb),Fugl-Meyer Assessment(FMA),Modified Barthel index(MBI),Berg Balance Scale(BBS)and Functional Ambulation Category(FAC)before and after 4 weeks treatment.In addition,10 patients were randomly selected from each group by drawing lots before and after the treatment with SPECT to observe the changes of blood perfusion.Results:Brunnstrom grading situation(lower limb): before treatment,in the control group,the cases about Ⅰ to Ⅵ level of lower limb were 8,12,7,3,0,0 respectively;In the biofeedback group,the cases about Ⅰ to Ⅵ level of lower limb were 14 8,8,0,0,0 respectively;In addition,in the combined-treatment group,the cases about Ⅰ to Ⅵ level of lower limb were12,4,9,5,0,0 respectively.After 4 weeks of treatment,in the control group,the cases about Ⅰ to Ⅵ level of lower limb were 4,11,9,5,1,0 respectively;In the biofeedback group,the cases about Ⅰ to Ⅵ level of lower limb were 3,4,5,10,8,0 respectively;In addition,in the combined-treatment group,the cases about Ⅰ to Ⅵ level of lower limb were 0,2,3,7,18,0 respectively.FAC: before treatment,in the control group,the cases about 0 to 5 level of walking ability were 16,13,1,0,0,0 respectively.In the biofeedback group,the cases about 0 to 5 level of walking ability were 17,9,4,0,0,0,0 respectively;In addition,in the combined-treatment group,the cases about 0 to 5 level of walking ability were 15,11,4,0,0,0 respectively.After 4 weeks of treatment,in the control group,the cases about 0 to 5 level of walking ability were 9,14,7,0,0,0 respectively.In the biofeedback group,the cases about 0 to 5 level of walking ability were 4,8,12,6,0,0 respectively,people in the feedback group.In addition,in the combined-treatment group,the cases about 0 to 5 level of walking ability were 0,3,9,12,6,0 respectively.FMA: after 4 weeks of treatment,the control group increased from the initial 9.93 ± 2.56 points to 13.13 ± 3.63 points,the biofeedback group increased from the initial 10.70 ± 2.76 points to 15.30 ± 3.56 points,the combined-treatment group increased from the initial 9.80 ± 3.21 points to 22.33 ± 4.04 points.Berg balance score: after 4 weeks of treatment,the control group increased from the initial 18.90 ± 5.18 points to 23.40 ± 6.59 points,the biofeedback group increased from the initial 19.63 ± 5.86 points to 27.73 ± 6.83 points,the combined-treatment group from the initial 18.20 ± 5.92 points increased to 32.77 ± 7.19 points.MBI: after 4 weeks of treatment,the control group increased from the initial 23.57 ± 7.40 points to 27.23 ± 6.32 points,the biofeedback group increased from the initial 25.97 ± 7.57 points to 33.43 ± 9.22 points,the combined-treatment group from the initial 25.47 ± 7.57 points to 41.37 ± 9.50 points.SPECT results: after 4 weeks of treatment,in the control group,6 patients had no changes,3 patients had filling changes,and 1 patient had significant filling change.In the biofeedback group,4 patients had no changes,5 patients with filling changes,1 patient with significant filling change.In the combined-treatment group,1 patient had no change,2 patients with filling changes,and 7 patients with significant filling changes.There were no significant differences in Brunnstrom grading situation(lower limb),walking ability classification and FMA,BBS,MBI scores in the three groups before treatment(P>0.05).Comparison between groups after treatment,all the indicators of the biofeedback group was better than the control group(P<0.05),and the combined-treatment group was better than the other two groups(P<0.05).Comparison within each group,all the indicators have been significantly improved(P<0.05).Similarly,the lesion filling rate of patients in the three groups was improved compared with that before treatment.There was no significant difference in the lesion filling rate between the biofeedback group and the control group(P>0.05).The lesion filling rate of the combined treatment group was also significantly different from that of the control group and biofeedback group(P<0.05).Conclusions:1.The results of this study showed that after 4 weeks of treatment,the Brunnstrom grading,Holden walking ability grading,Berg balance ability scoring,FMA and MBI scoring in the combined treatment group were significantly better than those in the control group and biofeedback group.This suggests that motor imagery therapy combined with electromyography biofeedback is more effective in improving lower limb function in patients with hemiplegia.2.The results of this study showed that after 4 weeks of treatment,the cerebral blood perfusion in the lesion area was improved compared with that before treatment,and the improvement degree of the combined treatment group was more significant,which was consistent with the recovery degree of limb function. |
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