关键词:

脑卒中, 本体感觉神经肌肉促进技术, 针灸, 肢体功能障碍, 步态时空, 运动学特征

Abstract:

Objective　To explore the curative effect of acupuncture and moxibustion combined with proprioceptive neuromuscular facilitation (PNF) for patients with limb dysfunction after stroke. Methods　Ninety-eight patients with limb dysfunction after stroke admitted to Liaocheng Third People's Hospital from January 2022 to January 2023 were selected for the randomized controlled trial. They were divided into a single group and an experimental group by the random number table method, with 49 patients in each group. There were 30 males and 19 females in the single group; they were (62.67±6.71) years old. There were 29 males and 20 females in the experimental group; they were (63.75±6.76) years old. The single group were treated with PNF, and the experimental group with PNF, acupuncture, and moxibustion. The total clinical response rates and related scores [Berg Balance Scale (BBS), Neurological Deficit Scale (NIHSS), Modified Barthel Index (MBI), and Functional Comprehensive Assessment Scale (FCA)], limb function [Free Hand Muscle Strength Scale (MMT) and Fugl Meyer Motor Function Score (FMA)], and gait spatiotemporal parameters (stride speed, stride length, stride frequency, affected side swing phase, affected side support phase, and bilateral support phase level), and kinematic parameters [peak joint torque (hip, knee, and ankle) and maximum flexion and extension angle (hip and knee)] before and after the treatment were compared between the two groups. t and χ² tests were applied. Results　The total clinical effective rate after the treatment of the experimental group was higher than that of the single group [95.92% (47/49) vs. 79.59% (39/49)], with a statistical difference (χ²=4.653; P=0.031). The scores of FCA, MBI, BBS, and NIHSS in the experimental group were (65.19±4.23), (73.82±8.56), (43.18±3.45), and (3.15±1.17); the scores in the single group were (61.86±5.35), (66.79±5.98), (34.59±2.80), and (5.27±2.38); there were statistical differences between the two groups (t=3.418, 4.713, 13.533, and 5.596; all P<0.05). After the treatment, the scores of upper and lower limb FAM and MMT in the experimental group were higher than those in the single group [(55.79±6.55) vs. (49.65±5.25), (27.06±3.67) vs. (24.68±3.35), and (4.07±0.62) vs. (3.46±0.87)], with statistical differences (t=5.120, 3.353, and 3.997; all P<0.05). After the treatment, the stride frequency, stride length, stride speed, and affected side swing phase level in the experimental group were higher than those in the single group [(107.76±10.96) steps/min vs. (95.19±9.25) steps/min, (40.67±6.48) cm vs. (36.50±5.71) cm, (0.63±0.13) m/s vs. (0.45±0.11) m/s, and (42.84±6.01)% vs. (39.76±5.24)%]; the levels of the affected side support phase and bilateral support phase in the experimental group were lower than those in the single group [(57.21±5.01)% vs. (61.89±5.06)% and (31.16±6.11)% vs. (37.46±7.06)%]; there were statistical differences (t=6.135, 3.380, 7.399, 2.704, 4.601, and 4.723; all P<0.05). After the treatment, the peak torque of hip joint, the maximum flexion and extension angle of hip joint, the peak torque of knee joint, the maximum flexion and extension angle of knee joint, and the peak torque of ankle joint in the experimental group were bigger than those in the single group [(0.64±0.13) Nm vs. (0.55±0.11) Nm, (34.35±7.09)° vs. (29.64±6.71)°, (1.59±0.32) Nm vs. (1.37±0.31) Nm, (49.46±8.02)° vs. (42.98±7.61)°, and (1.59±0.27) Nm vs. (1.45±0.24) Nm], with statistical differences (t=3.700, 3.378, 3.457, 4.103, and 2.713; all P<0.05). Conclusion　Acupuncture and moxibustion + PNF for patients with limb dysfunction after stroke can improve the curative effect and their limb muscle strength, balance ability, motor function, walking ability, nerve injury, and quality of life.

Key words:

Stroke, Proprioception neuromuscular facilitation technology, Acupuncture and moxibustion, Limb dysfunction, Gait spatiotemporal,  , Kinematics characteristics