摘要
目的探讨励-协夫曼大运动疗法(LSVT-BIG)联合重复经颅磁刺激(rTMS)对帕金森病(PD)患者平衡及步行功能的影响。方法选取2020年1月至2021年2月在浙江医院康复治疗中心就诊的PD患者60例作为研究对象。采用随机数字表法分为对照组、LSVT-BIG组和联合组,每组20例。3组患者均予常规药物治疗,对照组在rTMS伪刺激后进行常规康复训练,LSVT-BIG组在rTMS伪刺激后进行LSVT-BIG训练,联合组在rTMS治疗后进行LSVT-BIG训练。于训练前和训练4周后,分别采用Tecnobody平衡测试仪评估姿势稳定性以及基于数字视频和图像处理技术进行步态参数分析,同时采用活动平衡信心(ABC)量表评估患者活动时维持平衡的信心程度。结果训练前,3组患者睁眼和闭眼状态下运动轨迹面积、运动轨迹周长、稳定极限、ABC量表评分、跨步周期、跨步长和步速比较差异均无统计学意义(均P>0.05)。训练后,3组患者睁眼和闭眼状态下运动轨迹面积和运动轨迹周长均低于训练前,稳定极限、ABC量表评分、跨步长和步速均高于训练前,跨步周期均短于训练前,差异均有统计学意义(均P<0.05)。联合组患者睁眼和闭眼状态下运动轨迹面积、运动轨迹周长均低于其他两组,稳定极限、ABC量表评分、跨步长和步速均高于其他两组,跨步周期均短于其他两组,差异均有统计学意义(均P<0.05)。LSVT-BIG组患者睁眼和闭眼状态下运动轨迹面积、运动轨迹周长均低于对照组,稳定极限和ABC量表评分、跨步长和步速均高于对照组,跨步周期均短于对照组,差异均有统计学意义(均P<0.05)。结论LSVT-BIG联合rTMS能有效改善PD患者平衡和步行功能,增强平衡信心,较单一LSVT-BIG训练效果更好,该联合治疗方案值得在临床推广使用。
Objective To explore the clinical efficacy of Lee Silverman voice treatment-BIG(LSVT-BIG)combined with repetitive transcranial magnetic stimulation(rTMS)for balance and walking function in patients with Parkinson's disease(PD).Methods Sixty PD patients who visited the Rehabilitation Treatment Centre of Zhejiang Hospital from January 2020 to February 2021 were enrolled in this study.The patients were randomly divided into three groups with 20 cases in each group,all patients were given conventional drug therapy.Patients in control group received routine rehabilitation training after rTMS pseudo-stimulation,patients in LSVT-BIG group received LSVT-BIG training after rTMS pseudo-stimulation,while patients in combination group received LSVT-BIG training after rTMS treatment.Before and after 4 weeks of training,the postural stability was evaluated with Tecnobody balance tester and the gait parameters were analyzed based on digital video and image processing techniques;the degree of confidence in maintaining balance during activities was assessed with activities-specific balance confidence(ABC)scores.Results Before training,there were no significant differences in dynamic and static balance parameters,gait parameters and ABC scores among three groups(all P>0.05).After 4 weeks of training,the track area and circumference of motion with open and closed eyes in 3 groups were significantly decreased(all P<0.05),and stability limit and ABC scores were significantly increased compared with those before treatment(both P<0.05);and the stride period was shorter(P<0.05),stride length and stride speed were significantly increased compared with those before treatment(both P<0.05).The improvement of above parameters in LSVT-BIG group was more marked than that in control group,while the parameters of combination group was better than those of other two groups(all P<0.05).Conclusion LSVT-BIG combined with rTMS can effectively improve balance control and walking function and enhance balance confidence in PD patients,which is better than LSVT-BIG alone.
作者
张伟伟
黄墩兵
尹梦
廖兴
全俊
奚陈平
ZHANG Weiwei;HUANG Dunbing;YIN Meng;LIAO Xing;QUAN Jun;XI Chenping(Rehabilitation Treatment Centre,Zhejiang Hospital,Hangzhou 310013,China;不详)
出处
《浙江医学》
CAS
2022年第20期2194-2199,共6页
Zhejiang Medical Journal
基金
浙江省中医药优秀青年人才基金项目(2022ZQ004)。
关键词
励-协夫曼大运动疗法
帕金森病
重复经颅磁刺激
平衡功能
步行功能
Lee Silverman voice treatment-BIG
Parkinson's disease
Repetitive transcranial magnetic stimulation
Balance function Walking function
