Nghiên cứu hiệu quả kết hợp điện châm với tập xe đạp motomed viva 2 trong phục hồi chức năng vận động ở bệnh nhân liệt nửa người sau nhồi máu não TT tieng anh

28 64 0
Nghiên cứu hiệu quả kết hợp điện châm với tập xe đạp motomed viva 2 trong phục hồi chức năng vận động ở bệnh nhân liệt nửa người sau nhồi máu não TT tieng anh

Đang tải... (xem toàn văn)

Tài liệu hạn chế xem trước, để xem đầy đủ mời bạn chọn Tải xuống

Thông tin tài liệu

1 PROBLEM INTRODUCTION Brain stroke (BS) is the second leading cause of death in the world and the leading cause of adult disability In Vietnam, the level of recovery after the acute phase is less than 20%, mainly due to paralysis, which makes it impossible to walk as well as the ability to perform daily activities Thus, more than 80% of patients need rehabilitation after the acute phase Rehabilitation for motor patients by electro-acupuncture is one of the most effective methods of rehabilitation after stroke, easy to apply and less expensive Physiotherapy is one of the most important techniques in rehabilitation Assistive and supportive exercise tools are one of the indispensable parts to create a comprehensive recovery result in rehabilitation In particular, the exercise bicycle is a supportive exercise tool that meets most forms of exercise to achieve the goals of therapeutic movement and the goal of rehabilitation after stroke Exercise bicycle is a simple device, easy to use, is used at home, in many rehabilitation facilities and can exercise for long-term after stroke The goal of the thesis: Evaluate the motor functional rehabilitation with the treatment using electro-acupuncture in combination with exercises on Motomed viva bicycle for hemiplegia patients after acute phase of ischaemic stroke Evaluate a number of factors affecting the rehabilitation for patients with hemiplegia after stroke with the treatment using electro-acupuncture in combination exercise bicycles THE PRACTICAL APPLICATION AND CONTRIBUTION OF THE THESIS Brain stroke is the leading cause of multiple disabilities in adults, hemiplegia is one of the main disabilities affecting the quality of life of patients Researching for easy and cost-effective solutions to reduce the level of paralysis is essential, consistent with the rehabilitation of motor functions after brain stroke to improve the life quality of patients The thesis proposes a method for rehabilitation of motor function after ischaemic stroke by combining electro-acupuncture of traditional medicine with rehabilitation method as a highly effective tool to support zmovement The research is inherited and applies new techniques suitable to the practical situation The research results have confirmed the effect of occupational rehabilitation after ischaemic stroke of two combined clinical and subclinical methods The research is based on adding a new option, a new intervention method for physicians and patients, which is feasible and widely applicable THE STRUCTURE OF THE THESIS The thesis consists of 126 pages: 02 pages for problem introduction, 39 pages for overview, 19 pages for subjects and research methods, 32 pages for research results, 31 pages for discussion, 02 pages for conclusion, and 01 page for recommendation The thesis has 138 references (45 Vietnamese, 88 English, 05 Chinese), 50 tables, 05 charts, 14 pictures, 06 diagrams and appendices Chapter 1: OVERVIEW 1.1 Ischaemic stroke in modern medicine 1.1.1 The definition of brain stroke and ischaemic stroke stroke Brain stroke is a sudden occurrence of neurological dysfunction, usually localized rather than diffuse, persists for more than 24 hours or causes death within 24 hours, determined by vascular origin and not by injury Currently, modern technology is applied in diagnosis and treatment A new definition: Transient Ischemic Attack is a shortterm neurological dysfunction due to cerebral ischemia or retina, with clinical symptoms usually lasting below hour without the evidence of critical brain stroke A ischaemic stroke occurs when a brain blood vessel is blocked Areas irrigated by un-nourished vessels will be destroyed 1.1.2 Rehabilitation of ischaemic stroke patients after acute phase After the acute phase of ischaemic stroke, there are many complex disorders in which hemiplegia greatly affects the quality of life It is necessary to apply many methods and techniques at the same time to make the recovery faster and more complete Rehabilitation measures include strengthening paralysis muscle strength by passive, active, resistance-based exercises, enhanced functional activities and control of secondary injuries Exercise aids are important, including exercise bicycles, which help improve motor function more quickly and comprehensively 1.2 Ischaemic stroke in traditional medicine * Concept and the cause Windstroke disease appeared more than 2000 years in the Noi kinh book, also known as other names: Thien phong, thien kho, thien than bat dung, phuc kich In " Kim quy yeu luoc" also stated the disease Windstroke, and it is used till now After acute stage with symptoms of prominent hemiplegia, it is classified as half-disabled The cause of windstroke: commonly with the elderly, impaired heart, liver and kidney activity causing negative phenomena, sputum, internal wind to cause seizures, coma The cause is often combined internal and external qi *Rehabilitation movement after the acute phase After the acute phase of windstroke, there are still severe sequelae and pathological properties, including empty symtom and full symtom Principles must simultaneously treat the template; improve the righteous temperament, increase physicality and eliminate evil spirits; fostering kidneys, qi, blood, balancing the organs to eliminate evil wind The treatment of hemiplegia due to windstroke with the nonpharmacologic recovery phase in which electro-acupuncture has been applied has many good results In addition to electroacupuncture, other methods are widely applied such as pharmacoacupuncture, acupressure massage In addition, patients need combination therapy of modern medicine to control functional factors and combination of exercises for rehabilitation 1.3 Treatment with electro-acupuncture 1.3.1 Outline The purpose of acupuncture is to regulate qi; to bring the imbalance of yin and yang of viscera and bowels, meridian and collateral back to balance state; to open the circulation of the qi In the empty symtom, it is necessary tonification to increase the qi In the full symtom, use the dispertion to reduce the qi of that part Previously, after the acupuncture is completed, twist the needle to perform the complementary tonification and dispertion, this makes qi not fast, not strong, uneven, hurting patients, and it takes a lot of effort and time Electro-acupuncture with two tonification and dispertion frequencies, regular and constant stimulating electric pulses have the effect of fast, strong qi recovery without pain 1.3.2 Affection mechanism of electro-acupuncture Acupuncture is a stimulus that causes a new reflex pulse to inhibit and break the pathological reflex pulse There are many unified views and many studies indicate the mechanism of neurological and humoral effects with three types of body reactions: local reactions, sectional reactions, systemic reactions From the traditional medicine point of view, the negative balance of yin and yang leads to the occurrence of disease Acupuncture works to balance yin and yang, raising the righteous temperament, expelling the evil wind Depending on the nature of the disease, use acupuncture or moxibusion, tonification or dispertion Ailments arose to disturb the normal functioning of the meridian and collateral system, acupuncture regulates the function of them If the viscera and bowels is sick, there will be changes in the corresponding pathology of the meridian, using the points on the meridian to correct the function of those organs 1.4 Methods of using exercise bicycles with resistance 1.4.1 Exercise bicycle structure A exercise bicycle is a device that has the same structure as a bicycle with adjustable resistance, some devices have a structure for the upper limb Devices often have straps or gloves to hold to the pedal There are two types of vehicles depending on the seat position and the pivot: straight bikes and tilt bikes Nowadays, there are many electric-powered devices that are capable of passive exercise, usually in the form of an inclined bicycle, so that patients can practice from the early stages after a stroke when the signs of survival have stabilized 1.4.2 The effectiveness of training bike exercises Exercise on bicycle has the effect of increasing muscle strength, joint range, increasing coordination and balancing ability of people with hemiplegia The paralyzed party has straps fixed to the device Passive training equipment helps patients to practice from the early stages of the disease when the signs of survival have stabilized Early movement helps to mentally faster, the half of the healthy side is not weakened, stimulating motor movement reflexes of the paralyzed person Early movement also helps to eat and sleep better, quickly improve the body, get used to and adapt to the sitting, standing postures, preventing secondary injuries Thus, exercising with bicycles can be used as passive exercise, assisted active exercise, active exercise and increased resistance Cycling in the lower limbs is done by most of the muscle groups and joints of the lower limbs, which are most effective in the muscles that create the extension of the knees and hip, so that the hip, knee and ankle joints are exercised There are four main muscle groups involved: knee extension, hip extension, knee flexion, hip flexion In addition, the muscle group plantarflexion and dorsiflexion are also involved in cycling For the upper limb, the biking is primarily due to flexes, extensors of elbows and shoulders The participating muscle groups are the elbows flexion and elbows extension, shoulders flexion and shoulders abduction In addition, there is the participation of crank muscles in the shoulder flexion, large back muscles and large round muscles in shoulder extension, upper spine muscles in shoulder abduction Chapter 2: SUBJECTS AND RESEARCH METHOD 2.1 Research subjects 2.1.1 Criteria for selecting patients 120 patients were diagnosed after acute phase of ischaemic stroke (ICD10-2014) Patients aged from 18 years old and above, regardless of gender, occupation, First time of ischaemic stroke, stable treatment of cardiovascular, respiratory, neurological disorders after acute phase, hemiplegia people, mentally alert to cooperate with physicians (Mini - mental state examination test ≥ 20 points), agreed and voluntarily participated in research Hemiplegic patients due to ischaemic stroke region of perfusion of the mid cerebral artery, determined clinically and subclinically according to the World Health Organization's diagnostic criteria Patients who have been treated with acute phase stabilize their vital signs at specialized hospitals The acute phase is difficult to determine the duration depending on the patient's condition, minimum of days The patients were then examined according to traditional medicine through eight notions, four ways of examination to divid into: full and empty symtom 2.1.2 Criteria for excluding patients Patients with cardiopathy, cerebrovascular malformation, pulmonary embolism, chronic lung disease, arthropathy, blood pathology, postoperative, postpartum, pregnant women, accompanied by diseases: Tuberculosis , mental disorders, HIV/AIDS Patients who not cooperate with the study, not participate in sufficient time for treatment, patients who are being treated have more severe and life-threatening symptoms 2.2 Research facilities 2.2.1 Electro-acupuncture Acupuncture needles: Types of stainless steel acupuncture needles made by Vietnam, with lengths from 6cm to 20 cm M8 ac electro-acupuncture produced by Vietnam National Hospital of Acupunture Aseptic alcohol-free cotton wool, clip without pin, bean tray, stethoscope, blood pressure, shock-proof box with full of medicine 2.2.2 Exercise bicycle Exercise bicycles are of Reck, Germany, model Motomed viva 2, produced in 2015 A bicycle has separate hand and foot 10 training modes, using the standard program Passive exercise with the help of motor, maximum speed of 60 rpm Active set without resistance and active set with resistance, adjust the resistance level from to 20 2.2.3 Electromyography recorder Electromyography motors were recorded by Neuropack, manufactured by Medilec-Synergy, UK, at the electromyography room of Vietnam National Hospital of Acupunture 2.3 Research Methods Methods of clinical intervention were controlled, compared before and after treatment, compared with the control group Qualified patients were divided according to pairing method (similar in age and gender) into two groups: - Study group: 60 patients treated with electroacupuncture and exercise bicycle - Control group: 60 patients treated only with electroacupuncture 2.4 Research targets Examined and assessed: upon admission, after 30 days of treatments 2.4.1 Motor function evaluation We assessed the stretching of the muscles in the knee extension, the dorsiflexion, the elbow flexion, and shoulder abduction Mechanical gradation according to the British Medical Research Council, consisting of degrees from to Assessment measure: Good: increase ≥ levels, Fair: increase level, Poor: no increase 14 Comment: the level of good (increased> levels) the research group was higher than the control group at all evaluation agencies with statistical significance Table 3.3 Change the average score on the scale of before and after treatment Research group (n=60); ± SD Before After (1) (2) Group Index Rankin 3,80±0,40 p Control group (n=60); ± SD Before After (3) (4) 2,17±0,91 3,87±0,34 2,75±0,77 < 0,001 Barthel

Ngày đăng: 20/02/2020, 06:13

Từ khóa liên quan

Mục lục

  • THE PRACTICAL APPLICATION AND CONTRIBUTION OF THE THESIS

  • THE STRUCTURE OF THE THESIS

    • 1.1.2. Rehabilitation of ischaemic stroke patients after acute phase

    • 1.4. Methods of using exercise bicycles with resistance

    • CONCLUSIONS

Tài liệu cùng người dùng

  • Đang cập nhật ...

Tài liệu liên quan