fes治疗脑卒中的临床应用及其机制讲义燕铁斌.pptVIP

脑卒中后运动控制障碍表现 肌张力异常 肌张力降低 肌张力增高 肢体运动模式异常 协同运动 共同运动 躯体控制障碍 平衡与协调控制障碍 功能性活动障碍 上运动神经元综合症表现 阳性症状(positive symptom) 肌张力增高 腱反射增强 阵挛（重复性牵张反射释放） 屈曲反射释放(病理反射) Babinski 征 协同（共同）运动模式（mass synergy patterns） 阴性症状(negative symptom) 手指的精细动作减少 肌肉无力 运动缓慢 吞咽障碍 选择性活动能力减弱  治疗脑卒中后运动障碍的方法 药物 营养神经，改善微循环 功能训练(functional training，motor control) 运动再学习(motor relearning program) 重复性训练(repetition) 强制性使用(constrain-induced movement) 物理因子治疗 声、光、电、磁等 低频电刺激近几十年来发展比较快 功能性电刺激 Functional electrical stimulation, FES 属于低频电刺激和神经肌肉电刺激（neuromuscular electrical stimulation,NES）范畴 广义 凡是刺激神经肌肉的电刺激都可以称之为NES 狭义 低频脉冲电流（1KHz,1～100Hz） 按照预先设定的程序 刺激结构完整的下运动神经元（一组或多组肌肉） 模拟功能性活动 提高肌肉功能或治疗神经肌肉疾患 （ Sheffler and Chae 2007） 临床随机对照研究 结果 NEW YORK (Reuters Health) - Adding functional electrical stimulation (FES) to standard rehabilitation improves lower extremity function and walking ability in patients with a first acute stroke, new research shows. FES, which has been in use since the 1960s, involves the use of mild electric currents designed to stimulate the muscles. Previous reports have suggested an advantage for electric stimulation therapy over standard rehabilitation, but most studies investigating the issue have not been properly designed, Dr. Christina W. Y. Hui-Chan, from The Hong Kong Polytechnic University, and colleagues note. To address this issue, the researchers assessed the outcomes of 46 patients who were randomly treated with standard rehabilitation alone or in combination with either FES or fake placebo stimulation. Stimulation began a few days after the stroke and was given five days per week for three weeks. The researchers findings appear in the American Heart Associations journal Stroke. Compared with the other two interventions, FES plus standard rehabilitation?improved several measures of lower limb function. As noted, treatment with FES also improved walking ability. After treatment, all patients in the FES group were able to walk and 85 percent returned home. In contrast, the percentage of patien