| Objective: With the development of modern science and technology and medical science,the mortality rate of stroke is decreasing year by year,leading to an increase in the number of survivors with various motor and cognitive impairments.In the functional recovery of hemiplegic limbs in stroke patients,it was found that the functional recovery of the upper limbs is more difficult than that of the lower limbs,which seriously affects the daily life of patients and makes it difficult for them to return to their families and society.On the basis of routine treatment,this study attempts to combine functional electrical stimulation(FES)with bilateral arm training with rhythmic auditory cueing(BATRAC)for the recovery of upper limb motor function in patients with subacute hemiplegia after stroke.The aim is to explore the feasibility and effectiveness of combining FES and BATRAC rhythms at the same frequency in improving the motor function of the upper limb and hand(Brunnstrom staging in stages I-II)with severe hemiplegia,And the intervention cycle that combines treatment to produce good results provides a new treatment strategy for the rehabilitation of upper limb motor function in severe hemiplegia during the subacute phase of stroke.Methods: In this study,45 stroke patients who met the inclusion criteria in the occupational therapy department of Shaanxi Rehabilitation Hospital from March 2022 to August 2022 were selected as research objects and randomly divided into 3 groups:conventional treatment group(n=15),conventional + FES group(n=15),and conventional + FES + BATRAC group(n=15).All three groups received routine rehabilitation training.At the same time,the conventional + FES group was treated with conventional dose of FES(treatment parameters: frequency 0.8Hz,pulse width 200 us,intensity 10-30 m A(tolerance as the degree),stimulation duration: intermittent time 1:1).In the BATRAC group,rhythmic auditory stimulation was performed on both upper limbs on the basis of FES.All the three groups were given rehabilitation treatment program once a day,5 times a week for 4 consecutive weeks.The following assessments were made before treatment,2 weeks after treatment,and 4 weeks after treatment: AROM and muscle strength tests,Brunnstrom upper limb and hand(BRS-A/H)stage,Fugl-Meyer Upper limb and wrist portion(FMA-UE/WH)score and modified Barbi index were statistically analyzed.Results:(1)FMA-UE/WH score,carpal dorsal-Arom/muscle strength: Before intervention,there was no significant difference in the scores of four indexes among the three groups(p>0.05).After 2 weeks of intervention,there was a significant difference between conventional + FES + BATRAC group and conventional treatment group(P < 0.05),and the conventional + FES + BATRAC group was higher than the conventional treatment group.There was no statistical significance between conventional + FES + BATRAC group and conventional + FES group,or between conventional + FES group and conventional treatment group(p>0.05).After 4 weeks of intervention,there were significant differences between the conventional + FES +BATRAC group and the conventional treatment group(P < 0.05),and the conventional + FES + BATRAC group was higher than the conventional treatment group.There was statistical significance between the conventional + FES + BATRAC group and the conventional + FES group(P < 0.05),and the conventional + FES +BATRAC group was higher than the conventional + FES group.However,there was no significant difference between conventional + FES group and conventional treatment group(p>0.05).Compared with before intervention,after 2 weeks of intervention,the four indexes of the three groups were increased and had significant differences(P < 0.05);Compared with 2 weeks after intervention,the scores of 3 groups after 4 weeks of intervention were increased and had significant differences(P< 0.05).(2)BRS-A/H rating: Before intervention,there was no significant difference in BRS-A/H rating among the three groups(p>0.05).After 2 weeks of intervention,there was no significant difference in BRS-A/H rating among the three groups(P >0.05).After 4 weeks of intervention,there was a significant difference between the conventional + FES + BATRAC group and the conventional treatment group(P <0.05),and the BRS-A rating of the conventional + FES + BATRAC group was higher than the conventional treatment group.Although there was no significant difference between conventional + FES + BATRAC group and conventional + FES group,and between conventional + FES + BATRAC group and conventional treatment group(p>0.05),the BRS-A/H rating of conventional + FES + BATRAC group was higher than that of conventional + FES group,and the BRS-A rating of conventional + FES +BATRAC group was higher than that of conventional treatment group.Compared with before intervention,BRS-A/H rating of conventional treatment group and conventional + FES group was improved after 2 weeks of intervention,but there was no statistical significance(P > 0.05).The BRS-A/H rating of the conventional + FES+ BATRAC group was significantly improved after 2 weeks of intervention(P < 0.05).Compared with 2 weeks after intervention,BRS-A/H rating of 3 groups after 4 weeks of intervention was improved and there were significant differences(P < 0.05).(3)MBI score: There was no significant difference among the three groups before intervention(p>0.05).Compared with before intervention,the MBI scores of the three groups after 2 weeks of intervention were all improved and had significant difference(P<0.05);Compared with 2 weeks after intervention,the MBI scores of the three groups after 4 weeks of intervention were improved and had significant difference(P<0.05).Conclusion:(1)It is feasible and effective that 4-week FES combined with BATRAC rehabilitation treatment scheme is used to improve the motor function of upper limbs(Brunnstrom stage is in stage Ⅰ-Ⅱ)with severe hemiplegia after subacute stroke.(2)On the basis of conventional treatment,the treatment of FES combined with BATRAC is better than FES alone in the recovery of upper limb motor function in patients with subacute stroke,and the effect of 4 weeks is better than 2 weeks,especially in the BRS-A/H grading.However,longer intervention cycles may be needed to improve daily living ability of severely hemiplegic upper limbs in subacute stroke patients to produce greater benefits. |
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