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目的观察基于Bobath理念的膝关节运动控制训练对脑卒中后痉挛性偏瘫患者的下肢运动功能及平衡功能恢复的临床疗效。方法选取脑卒中后偏瘫下肢痉挛状态的患者68例,随机分为对照组和观察组,每组各34例,对照组采用常规康复治疗方法,观察组在常规运动疗法的基础上运用Bobath理念框架下进行膝关节运动控制强化训练。分别于治疗前以及治疗4周后对2组患者Holden步行功能分类、肌张力(改良Ashworth分级)评定、下肢简化Fugl-Meyer运动量表(FMA)以及Berg平衡量表(BBS)变化进行对比分析。结果经过4周治疗后2组患者Holden、FMA及BBS的评分比治疗前均有明显提高,经统计学分析差异有统计学意义(P<0.01),且观察组评分也明显优于对照组(P<0.05);2组下肢改良Ashworth评分比治疗前显著降低(P<0.01),且观察组也明显低于对照组(P<0.05)。结论对于步行功能障碍的脑卒中后下肢痉挛的患者,采用基于Bobath理念的膝关节运动控制训练能够有效抑制下肢肌张力,增强膝关节的稳定性,改善脑卒中患者平衡功能及下肢运动功能,促进患者恢复,且临床疗效明显优于常规康复训练。
Objective To observe the clinical effect of knee movement control training based on Bobath concept on motor function and balance function recovery of stroke patients with post-stroke spastic hemiplegia. Methods Sixty-eight patients with post-stroke hemiplegia lower extremity spasticity were randomly divided into control group and observation group, 34 cases in each group. The control group received routine rehabilitation therapy. The observation group used Bobath’s concept of frame of mind Under knee exercise control intensive training. Holden walking function classification, muscle tone (modified Ashworth grade), lower limb simplified Fugl-Meyer motion scale (FMA) and Berg balance scale (BBS) were compared before and after treatment for 4 weeks. Results After 4 weeks of treatment, Holden, FMA and BBS scores of two groups were significantly higher than those before treatment, the difference was statistically significant (P <0.01), and the score of the observation group was also significantly better than the control group P <0.05). The modified Ashworth score of lower extremity in two groups was significantly lower than that before treatment (P <0.01), and the observation group was also significantly lower than the control group (P <0.05). Conclusions In patients with post-stroke lower extremity spasticity due to walking dysfunction, knee movement control training based on Bobath concept can effectively suppress the muscle tension of lower extremity, enhance the stability of knee joint, improve the balance function and lower extremity motor function of stroke patients, and promote Patients recovered, and the clinical efficacy was significantly better than the conventional rehabilitation training.