| Spinal cord injury(SCI)disrupts the communication between the brain and the parts of the body dominated by the spinal cord below the injured segment.It is a disease of the central nervous system that can cause paralysis and dysfunction of multiple physiological systems and seriously threaten human health.Epidemiological investigation shows that the incidence of spinal cord injury is increasing year by year,and the most common factors are traffic accidents and falling.In addition,most patients with spinal cord injury present long-term paralysis and are prone to various complications,resulting in high disability rate and mortality.Electrical stimulation is a safe and effective physiotherapy method in spinal cord injury rehabilitation.Studies have shown that electrical stimulation of different parts of spinal cord injury patients has certain rehabilitation effects,which can activate neural pathways and promote the regeneration of nerve axons.However,at present,single site electrical stimulation is mostly used in the treatment plan,and studies believe that combined electrical stimulation is better than the treatment effect of single site,but there are few relevant studies and the stimulation method has certain limitations.Objectives:To observe the effects of 8-week associative electrical stimulation on sensory function,motor function,functional independence and related blood biochemical indexes in patients with incomplete spinal cord injury,and to explore the related mechanism of its treatment.The conclusion of this study can provide a new therapeutic plan and theoretical basis for the rehabilitation of patients with incomplete spinal cord injury.Methods:30 patients with incomplete spinal cord injury from the Rehabilitation Department of Tianjin Hospital who met the inclusion criteria were selected.However,due to the influence of novel Coronavirus and patients' own complications during the study,3patients voluntarily withdrew from the experiment.Therefore,a total of 27 patients completed the experiment before and after the intervention.Eleven patients with cervical spinal cord injury and 16 patients with thoracolunbar spinal cord injury,aged49.30±9.31 years,were randomly divided into two groups: experimental group(n=14)and control group(n=13).The experimental group received combined electrical stimulation,and the control group received conventional jiji electroacupuncture.The subjects received combined electrical stimulation/jiji electroacupuncture 5 times a week,30 minutes each time.The intervention lasted for 8 weeks.Sensory function was assessed by ASIA sensory score.The ASIA Exercise Scale was used to assess motor function,and the muscle strength related indicators(RMS,i EMG)of the major key muscles of lower extremities(rectus femoris,medial femoris,lateral femoris,tibialis anterior and gastrocnemius)were measured by the surface electromyography test system Bio Neuro Infiniti(Canada).Functional independence scale and spinal cord independence assessment(3rd edition)were used to assess functional independence of patients.Observe the changes of blood biochemical indexes(superoxide dismutase,interleukin-6)to explore the related mechanisms.The patients were tested and evaluated before and after intervention.Statistical methods:SPSS23.00 software was used for statistical analysis and t test was used for measurement data conforming to normal distribution.Wilcoxon rank sum test was used for measurement data that did not conform to normal distribution.Chi-square test or Fisher's exact test were used for counting data,repeated measurement data were analyzed by two-factor variance analysis method,if P < 0.05 indicates a statistical difference.Results:1.Changes in functional independence between the experimental group and the control group before and after intervention: after 8 weeks of intervention,intra-group comparison: Compared with before intervention,the functional independence scale increased from 55.86±6.39 points after treatment to 67.93±10.39 points after intervention in the experimental group,and from 55.00±7.98 points to 59.54±9.32 points after intervention in the control group,both groups had statistical differences(P < 0.05);The score of spinal cord independence assessment(3rd edition)in the experimental group increased from 28.07±7.94 points after treatment to 41.93±10.03 points after intervention,and the difference was statistically significant(P < 0.05),the difference was relatively small in the control group before and after treatment,and there was no statistical difference(P < 0.05).Inter-group comparison: there were no significant differences in the scores of functional independence Scale and Spinal Independence Scale(3rd edition)between the experimental group and the control group before intervention(P > 0.05),the scores of the experimental group were better than those of the control group after intervention,with statistical difference(P< 0.05).2.Comparison of sensory function between the experimental group and the control group before and after intervention: after 8 weeks of intervention,intra-group comparison showed: Compared with before intervention,the experimental group increased from 141.86±30.70 points to 160.64±21.35 points after treatment,and the control group increased from 133.31±30.95 points to 137.23±29.26 points after intervention.The difference was significant in the experimental group from the 4th week.In the control group,the difference was significant from the 6th week(P< 0.05).Comparison between groups: there was no significant difference in ASIA sensory function score between the experimental group and the control group before treatment(P >0.05),after 6 weeks of intervention,the sensory function score of ASIA in the experimental group was superior to that in the control group,with statistical difference(P < 0.05).3.After 8 weeks of intervention,intra-group comparison showed that: The ASIA motor function score of the experimental group increased from 56.71±10.34 points to65.93±13.64 points after intervention,and the difference was significant in the experimental group from the 4th week,while the difference in the control group was relatively small before and after treatment,and there was no statistical difference all the time(P > 0.05);There was no significant change in surface EMG values during passive exercise in both groups compared with before intervention(P > 0.05),the surface electromyography(RMS,i EMG)of the lower extremity key muscles in the experimental group were significantly higher than those before intervention(P < 0.05),except for tibialis anterior muscle RMS,gastrocnemius muscle RMS and i EMG,the other indexes in the control group were significantly increased(P < 0.05).Comparison between groups: there was no significant difference in each index between the experimental group and the control group before intervention(P > 0.05),after 8 weeks of intervention,there was no significant difference between the i EMG group and the control group except the value of surface EMG during passive exercise and active exercise(P > 0.05),ASIA motor function score and other key lower limb muscle surface EMG indexes in the experimental group were better than those in the control group,with significant difference(P < 0.05).4.Comparison of blood biochemical indexes between the experimental group and the control group before and after intervention: The level of superoxide dismutase in the experimental group increased from 141.90±17.29 U/ m L to 158.41±17.68U/ml after treatment,and that in the control group increased from 134.19±14.53 U/ m L to145.09±14.80 U/ml after intervention.There were statistically significant differences before and after treatment(P < 0.05),interleukin 6 level in the experimental group decreased from 5.22(4.15,7.06)pg/ml to 2.24(1.79,3.46)pg/ml after treatment,The control group decreased from 4.22(3.21,6.45)pg/ml to 2.99(2.23,4.01)pg/ml after intervention,and there was statistical difference between the two groups before and after treatment(P < 0.05).Comparison between groups: there were no statistically significant differences in superoxide dismutase and interleukin 6 levels between the experimental group and the control group before treatment(P > 0.05),the level of superoxide dismutase in the experimental group was higher than that in the control group,and the difference was statistically significant(P < 0.05),and there was no significant difference in interleukin 6 levels between the experimental group and the control group after intervention(P > 0.05).Conclusions:1.8 weeks of combined electrical stimulation and jiaji electroacupuncture can improve the sensory and motor functions of patients with incomplete spinal cord injury,improve the functional independence of patients,alleviate secondary injury by improving antioxidant capacity,reduce chronic inflammation,and promote functional recovery.3.The therapeutic effect of 8-week combined electrical stimulation on patients with incomplete spinal cord injury was better than that of jiji electroacupuncture,and there were no adverse events during the treatment process,so it can be used as a rehabilitation method for incomplete spinal cord injury. |
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