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

Thus, more than80% of patients need rehabilitation after the acute phase.Rehabilitation for motor patients by electro-acupuncture is one of the most effective methods of rehabilitation a

PROBLEM INTRODUCTION

Brain stroke (BS) is the second leading cause of death inthe 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 aswell as the ability to perform daily activities Thus, more than80% 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 inrehabilitation Assistive and supportive exercise tools are one ofthe indispensable parts to create a comprehensive recoveryresult in rehabilitation In particular, the exercise bicycle is asupportive exercise tool that meets most forms of exercise toachieve the goals of therapeutic movement and the goal ofrehabilitation after stroke Exercise bicycle is a simple device,easy to use, is used at home, in many rehabilitation facilities andcan exercise for long-term after stroke

The goal of the thesis:

1 Evaluate the motor functional rehabilitation with the treatment using electro-acupuncture in combination with exercises on Motomed viva 2 bicycle for hemiplegia patients after acute phase of ischaemic stroke.

2 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 inadults, 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 therehabilitation of motor functions after brain stroke to improve the lifequality of patients

The thesis proposes a method for rehabilitation of motorfunction after ischaemic stroke by combining electro-acupuncture oftraditional medicine with rehabilitation method as a highly effectivetool to support zmovement The research is inherited and applies newtechniques suitable to the practical situation The research resultshave confirmed the effect of occupational rehabilitation afterischaemic stroke of two combined clinical and subclinical methods.The research is based on adding a new option, a new interventionmethod for physicians and patients, which is feasible and widelyapplicable

THE STRUCTURE OF THE THESIS

The thesis consists of 126 pages: 02 pages for problemintroduction, 39 pages for overview, 19 pages for subjects andresearch methods, 32 pages for research results, 31 pages fordiscussion, 02 pages for conclusion, and 01 page forrecommendation The thesis has 138 references (45 Vietnamese, 88English, 05 Chinese), 50 tables, 05 charts, 14 pictures, 06 diagramsand 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 neurologicaldysfunction, usually localized rather than diffuse, persists formore than 24 hours or causes death within 24 hours, determined

by vascular origin and not by injury

Currently, modern technology is applied in diagnosis andtreatment A new definition: Transient Ischemic Attack is a short-term neurological dysfunction due to cerebral ischemia or retina,with clinical symptoms usually lasting below 1 hour without theevidence of critical brain stroke

A ischaemic stroke occurs when a brain blood vessel isblocked Areas irrigated by un-nourished vessels will bedestroyed

1.1.2 Rehabilitation of ischaemic stroke patients after acute phase

After the acute phase of ischaemic stroke, there are manycomplex disorders in which hemiplegia greatly affects the quality

of life It is necessary to apply many methods and techniques atthe same time to make the recovery faster and more complete.Rehabilitation measures include strengthening paralysis musclestrength by passive, active, resistance-based exercises, enhancedfunctional activities and control of secondary injuries Exerciseaids are important, including exercise bicycles, which helpimprove 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 theNoi kinh book, also known as other names: Thien phong, thienkho, thien than bat dung, phuc kich In " Kim quy yeu luoc" alsostated the disease Windstroke, and it is used till now After acutestage with symptoms of prominent hemiplegia, it is classified ashalf-disabled

The cause of windstroke: commonly with the elderly,impaired heart, liver and kidney activity causing negativephenomena, sputum, internal wind to cause seizures, coma Thecause is often combined internal and external qi

*Rehabilitation movement after the acute phase

After the acute phase of windstroke, there are still severesequelae and pathological properties, including empty symtom andfull symtom Principles must simultaneously treat the template;improve the righteous temperament, increase physicality andeliminate evil spirits; fostering kidneys, qi, blood, balancing theorgans to eliminate evil wind

The treatment of hemiplegia due to windstroke with the pharmacologic recovery phase in which electro-acupuncture hasbeen applied has many good results In addition to electro-acupuncture, other methods are widely applied such as pharmaco-acupuncture, acupressure massage In addition, patients needcombination therapy of modern medicine to control functionalfactors and combination of exercises for rehabilitation

non-1.3 Treatment with electro-acupuncture

1.3.1 Outline

The purpose of acupuncture is to regulate qi; to bring theimbalance of yin and yang of viscera and bowels, meridian andcollateral back to balance state; to open the circulation of the qi Inthe empty symtom, it is necessary tonification to increase the qi Inthe full symtom, use the dispertion to reduce the qi of that part.Previously, after the acupuncture is completed, twist the needle toperform the complementary tonification and dispertion, this makes

qi not fast, not strong, uneven, hurting patients, and it takes a lot ofeffort and time Electro-acupuncture with two tonification anddispertion frequencies, regular and constant stimulating electricpulses 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 toinhibit and break the pathological reflex pulse There are manyunified views and many studies indicate the mechanism ofneurological and humoral effects with three types of body

reactions: local reactions, sectional reactions, systemic reactions.

From the traditional medicine point of view, the negativebalance of yin and yang leads to the occurrence of disease.Acupuncture works to balance yin and yang, raising the righteoustemperament, expelling the evil wind Depending on the nature ofthe disease, use acupuncture or moxibusion, tonification ordispertion Ailments arose to disturb the normal functioning of themeridian 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 onthe 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 astructure 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 arecapable of passive exercise, usually in the form of an inclined bicycle, so thatpatients 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 musclestrength, joint range, increasing coordination and balancing ability

of people with hemiplegia The paralyzed party has straps fixed tothe device Passive training equipment helps patients to practicefrom the early stages of the disease when the signs of survival havestabilized Early movement helps to mentally faster, the half of thehealthy side is not weakened, stimulating motor movement reflexes

of the paralyzed person Early movement also helps to eat and sleepbetter, quickly improve the body, get used to and adapt to thesitting, standing postures, preventing secondary injuries Thus,exercising with bicycles can be used as passive exercise, assistedactive exercise, active exercise and increased resistance

Cycling in the lower limbs is done by most of the musclegroups and joints of the lower limbs, which are most effective in themuscles that create the extension of the knees and hip, so that thehip, knee and ankle joints are exercised There are four main musclegroups involved: knee extension, hip extension, knee flexion, hipflexion In addition, the muscle group plantarflexion anddorsiflexion are also involved in cycling.

For the upper limb, the biking is primarily due to flexes,extensors of elbows and shoulders The participating musclegroups are the elbows flexion and elbows extension, shouldersflexion and shoulders abduction In addition, there is theparticipation of crank muscles in the shoulder flexion, large backmuscles and large round muscles in shoulder extension, upperspine 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 ofischaemic stroke (ICD10-2014) Patients aged from 18 years oldand above, regardless of gender, occupation, First time ofischaemic stroke, stable treatment of cardiovascular, respiratory,neurological disorders after acute phase, hemiplegia people,mentally alert to cooperate with physicians (Mini - mental stateexamination test ≥ 20 points), agreed and voluntarilyparticipated in research

Hemiplegic patients due to ischaemic stroke region ofperfusion of the mid cerebral artery, determined clinically and

subclinically according to the World Health Organization'sdiagnostic criteria Patients who have been treated with acutephase stabilize their vital signs at specialized hospitals The acutephase is difficult to determine the duration depending on thepatient's condition, minimum of 7 days.

The patients were then examined according to traditionalmedicine through eight notions, four ways of examination todivid into: full and empty symtom

2.1.2 Criteria for excluding patients

Patients with cardiopathy, cerebrovascular malformation,pulmonary embolism, chronic lung disease, arthropathy, bloodpathology, postoperative, postpartum, pregnant women,accompanied by diseases: Tuberculosis , mental disorders, HIV/AIDS Patients who do not cooperate with the study, do notparticipate in sufficient time for treatment, patients who arebeing treated have more severe and life-threatening symptoms

2.2 Research facilities

2.2.1 Electro-acupuncture

Acupuncture needles: Types of stainless steel acupunctureneedles made by Vietnam, with lengths from 6cm to 20 cm M8 acelectro-acupuncture produced by Vietnam National Hospital ofAcupunture Aseptic alcohol-free cotton wool, clip without pin, beantray, stethoscope, blood pressure, shock-proof box with full ofmedicine

2.2.2 Exercise bicycle

Exercise bicycles are of Reck, Germany, model Motomedviva 2, produced in 2015 A bicycle has 2 separate hand and foot

training modes, using the standard program Passive exercisewith the help of motor, maximum speed of 60 rpm Active setwithout resistance and active set with resistance, adjust theresistance level from 1 to 20.

Qualified patients were divided according to pairingmethod (similar in age and gender) into two groups:

- Study group: 60 patients treated with acupuncture and exercise bicycle

- Control group: 60 patients treated only with electro-acupuncture

electro-2.4 Research targets

Examined and assessed: upon admission, after 30 days oftreatments

2.4.1 Motor function evaluation

We assessed the stretching of the muscles in the kneeextension, the dorsiflexion, the elbow flexion, and shoulderabduction Mechanical gradation according to the British MedicalResearch Council, consisting of 6 degrees from 0 to 5

Assessment measure: Good: increase ≥ 2 levels, Fair: increase 1level, Poor: no increase

2.4.2 Assess the level of reduced ability and disability according to the Modified Rankin Scale

The scale has 7 levels of disability from 0 to 6: Good:switch ≥ 2 degrees, Fair: transfer 1 degree, Poor: noimprovement or worse

2.4.3 Assess the independence of daily activities on the Barthel scale

The scale has 10 contents, total score of 100, level assessment:Independent: 80-100 points, need support: 30-75 points, Dependent: 0-

2.4.5 Assess the level of motor rehabilitation by electromyography

Electromyography recording in 4 muscles: quadricepsfemoris, tibialis anterior, delta, biceps brachii Each muscle isdefined with two indices: Motor unit frequency (MUP).Amplitude of motor unit (µV)

2.4.6 Assess muscle stiffness using the modified Ashworth scale

Evaluate muscle groups: the knee extension, thedorsiflexion, the elbow flexion, and shoulder abduction How to

determine: No muscle spasms: below 1+, Muscle spasms: From1+ degrees Assess progress: Good: no increase or decrease, Fair:increase 1 degree, Poor: increase from 2 degrees or above.

Chapter 3: RESEARCH RESULTS 3.1 Evaluate the rehabilitation of motor function after

treament using electro-acupuncture in combination with exercise bicycle

Table 3.1 Average evaluation of muscle force before and after treatment

Group

Muscle

Research group(n=60)

´

X ± SD

Control group (n=60)

Control group(n=60); X ´ ± SD pknee

dorsiflexion 2,15±0,95 1,27±0,61 < 0,001shoulder

abduction 2,08±1,08 1,25±0,86 < 0,001elbow

Comments: The muscularity in all muscle groups after treatment in both

groups increased compared to before treatment, p <0.001 The meanmuscle level after treatment in the research group was higher than thecontrol group, p <0.001

Table 3.2 Assess the average increase in muscle force

Comment: muscle level increase before and after treatment all four

muscle groups in the study group were statistically significant higher thanthe control group

Figure 3.1 Good degree of muscle elevation after treatment of the two

groups

Comment: the level of good (increased> 2 levels) the research group was

higher than the control group at all evaluation agencies with statisticalsignificance

Table 3.3 Change the average score on the scale of before and after

treatment

Group

Index

Research group (n=60); X ´ ± SD

Control group(n=60); X ´ ± SD P2-4Before

(1) After(2) Before (3) After(4)Rankin 3,80±0,40 2,17±0,91 3,87±0,34 2,75±0,77 <0,001

Comment: Post-treatment indexes were improved compared to

before treatment, p <0.001 in both groups After treatment, theresearch group's indicators improved better than the control group, p

´

X ± SD

Control groupn=60

´

X ± SD

pRankin 1,63±0,82 1,12±0,61 < 0,001Barthel 49,17±11,83 34,92±8,46 < 0,001Orgogozo 43,58±12,76 31,58±9,50 < 0,001