功能性電刺激在臨床上的應用一個案報告

Clinical Applications of Functional Electrical Stimulation－Three-case Reports

張梅蘭(Mei-Lan Chang) ； 徐道昌(Tao-Chang Hsu)

《物理治療學會雜誌》 12卷 (1987/11) Pp. 91-100

https://doi.org/10.29617/JPT.198711.0013

摘要

功能性電刺激利用電來刺激周邊神經健全之麻痺肌肉，是一種以外在方式控制肌肉收縮以達成具有功能和目的活動的治療法。電刺激使肌力增強的理論基礎曾有寇斯(Yadov M. Kots)提出解釋。他認爲正常肌肉自主性收縮的只有60%~70%的運動單元參與，而電刺激可達90%。此外，電流參數、治療計劃、肌肉狀況也是重要的影響因素。文中提出三個個案包括中風、背椎側彎、小兒麻痺在臨床上應用功能性電刺激之療效評估，同時利用Cybex Ⅱ(上標 +)測試肌力，以求客觀。中風個案於治療後，痙攣程度顯著下降，背屈及遺迹蹠屈之肌力從無法測試增至4Nm與9Nm。其患側與健側之差比值：背屈爲60%，蹠屈爲53%，背椎側彎個案於治療42次後，角度由45°矯正至35°，達到成功治療的標準；至於小兒麻痺患者，用電刺激其肌腱轉移及病弱的肌肉纖維，肌力沒有明顯進步，但功能上卻有顯著的進步。總之，功能性電刺激在臨床上不失爲一有效的治療方法，但對於個案之選擇、評估方法之改進以及進一步完善之研究都是值得再繼續努力的方向。

並列摘要

Functional electrical stimulation is the external control of innervated, but paretic or paralytic muscles by electrical stimulation of the corresponding intact peripheral nerves, to achieve functional and purposeful movement. According to Kots' theory maximum voluntary muscular contraction only recruits 60-70% of the motor units while electrical stimulation recurits up to 90%. Electrical parameter, treatment program and muscle condition are all important factors affecting the muscle strength increase. Three cases, diagnosed as stroke, scoliosis and poliomyelitis, were treated with functional electrical stimulation and evaluated by Cybex Ⅱ(superscript +) isokinetic dynomometer. After 46 treatments, the spasticity of the affected lower extremity of the stroke patient was markably lower, the maximum torques of dorsiflexion and plantarfiexion improved to 4 Nm and 9 Nm respectively, and torque deficits to 60% and 53% respectively. After 42 treatments of functional electrical stimulation and scoliosis exercise, the scoliosis curve decreased from 45° to 35°. Functional electrical stimulation applied to the transferred tendon and weak quadriceps muscle of the poliomyelitis case did not increase strength very much, but did improve gait pattern and walking tolerance. To sum up, these experiences show the potential value of functional electrical stimulation as a treatment modality not only for increasing muscle strength but also for decreasing spasticity. Since the kind of results in each case were different and the objective evaluator Cybex Ⅱ(superscript +) isokinetic machine was not so sensitive, further research is needed.

並列關鍵字

Functional electrical Stimulation ； Scoliosis ； Stroke ； Poliomyelitis