镜像视觉反馈联合改良强制性运动治疗对脑卒中偏瘫患者上肢功能的疗效观察

doi:10.3969/j.issn.1000-8535.2017.05.005

摘要/Abstract

摘要： 目的观察镜像视觉反馈和改良强制性运动治疗对脑卒中偏瘫患者上肢功能的影响。方法前瞻性纳入2013年12月—2016年10月在我院收治的、临床资料完整的脑卒中偏瘫患者117例,随机将患者分4组:A组30例,B组29例,C组28例和D组30例,所有患者均接受常规综合康复治疗,连续治疗4周。在常规综合康复治疗的基础上,B组和C组分别增加镜像视觉反馈训练和改良强制性运动治疗,D组则同时另加镜像视觉反馈和改良强制性运动治疗。主要观察指标包括治疗前、后的Fugl-Meyer量表(FMA)、上肢功能测试(upper extremity function test, UEFT)和改良Barthel指数(MBI)的评分。结果 4组患者治疗后的FMA、UEFT和MBI评分分别为:A组(26.37±3.44)、(43.30±3.46)、(56.27±4.76),B组(29.17±2.82)、(45.41±3.40)、(58.72±4.48),C组(29.46±3.16)、(45.71±2.37)、(58.82±3.89),D组(31.93±2.74)、(48.83±3.57)、(62.17±4.51),与治疗前组内相比,配对t检验显示差异有统计学意义(P＜0.05);单因素方差分析发现,D组明显优于A、B、C 3组,差异有统计学意义(P＜0.05);B、C 2组均优于A组,差异有统计学意义(P＜0.05);B、C 2组间比较,差异无统计学意义(P＞0.05)。结论在常规综合康复训练基础上,单独联合镜像视觉反馈或改良强制性运动治疗均能改善脑卒中偏瘫患者上肢运动功能和日常生活自理能力,但同时联合应用两种疗法,疗效更佳。

关键词: 镜像视觉反馈, 改良强制性运动, 脑卒中, 偏瘫, 上肢运动功能

Abstract: Objective To investigate the effects of mirror visual feedback (MVF) and modified constraint-induced movement therapy (mCIMT) on upper extremity function in post-stroke hemiplegics. Methods 117 patients with hemiplegia post-stroke were collected prospectively from December 2013 to October 2016, and randomly divided into the following four groups: group A (n=30), group B (n=29), group C (n=28) and group D (n=30). All patients were trained with conventional comprehensive rehabilitation therapy for four weeks, while the group B and group C were respectively trained with MVF and mCIMT based on conventional comprehensive rehabilitation therapy. Finally, the group D was simultaneously trained with MVF and mCIMT. The investigation duration was set as four weeks for all groups. The Fugl-Meyer Assessment (FMA) score, Upper Extremity Function Test (UEFT) score, and Modified Barthel Index (MBI) score were used as main index of clinical effects. Results After treatment, the scores of FMA, UEFT and MBI were respectively (26.37±3.44),(43.30±3.46),(56.27±4.76) in group A, (29.17±2.82), (45.41±3.40), (58.72±4.48) in group B, (29.46±3.16), (45.71±2.37), (58.82±3.89) in group C, (31.93±2.74), (48.83±3.57), (62.17±4.51) in group D.Comparing with the scores before treatment, the paired-sample t test showed that there were significant differences (P<0.05). The single factor variance test showed that the scores of the group D were significant better than those scores in group A, group B and group C (P<0.05); furthermore the scores of the group B and group C were significant better than the group A (P<0.05). However, there were no difference at those scores between the group B and group C (P＞0.05). Conclusion Based on conventional comprehensive rehabilitation, single combined with MVF or mCIMT may significantly improve the function of upper limb and activities of daily living (ADL) in post-stroke patients with hemiplegia. However, simultaneous combined with MVF and mCIMT will be more effective than the single one.

Key words: Mirror visual feedback, Modified constraint-induced movement therapy, Stroke, Hemiplegia, Upper limb function

刘文权, 曾德良, 梁宇健, 胡庆中. 镜像视觉反馈联合改良强制性运动治疗对脑卒中偏瘫患者上肢功能的疗效观察[J]. 广州医药, 2017, 48(5): 19-23.

LIU Wenquan, ZENG Deliang, LIANG Yujian, HU Qingzhong. Clinical investigation of mirror visual feedback combined with modified constraint-induced movement therapy on upper extremity function in patients with post-stroke hemiplegia[J]. Guangzhou Medical Journal, 2017, 48(5): 19-23.

参考文献

[1] 王丽菊,陈立早,欧艺,等.镜像视觉反馈和肌电生物反馈对脑卒中偏瘫患者上肢功能的影响[J]. 中国康复理论与实践,2015,21(2):202-206.
[2] BRAVI L, STOYKOV M E. New directions in occupational therapy: implementation of the task- oriented approach in conjunction with cortical stimulation after stroke [J]. Top Stroke Rehabil,2007,14(6): 68-73.
[3] 丁力,贾杰.“镜像疗法”作为一种康复治疗技术的新进展[J]. 中国康复医学杂志,2015,30(5):509-511.
[4] 何宗颖.改良强制性运动疗法对脑卒中偏瘫患者上肢功能及日常生活能力的影响[D]. 郑州:郑州大学,2013.
[5] 中华神经内科学会,中华神经外科学会.各类脑血管疾病的诊断要点[J]. 中华神经科杂志,1996,29(6):379-381.
[6] 刘文权,徐武华,吴婉霞,等.运动想象及肌电生物反馈治疗对卒中患者上肢运动功能的影响[J]. 广东医学,2012,33(22):3418-3420.
[7] 王维,马跃文,杨巍,等.镜像疗法对脑卒中偏瘫患者上肢功能和手功能的影响[J]. 大连医科大学学报,2013,35(6):600-602.
[8] 刘永平,王文清,程子辉,等.改良和传统强制性运动疗法对脑卒中偏瘫患者上肢运动功能疗效的临床观察[J]. 临床和实验医学杂志,2011,10(6):404-406.
[9] GLADSTONE D J, DANELLS C J, BLACK S E. The Fugl-meyer assessment of motor recovery after stroke: a critical review of its measurement properties [J]. Neurorehabil Neural Repair, 2002, 16(3):232-240.
[10] 王玉龙.康复功能评定学[M]. 北京:人民卫生出版社, 2012:358-359.
[11] 李奎成,唐丹,刘晓艳,等.国内Barthel指数和改良Barthel指数应用的回顾性研究[J]. 中国康复医学杂志,2009,24(8):737-740.
[12] CALMELS C, HOLMES P, JARRY G, et al. Variability of EEG synchronization prior to and during observation and execution of a sequential finger movement[J]. Hum Brain Mapp, 2006,27(3):251-266.
[13] GARRY M I, LOFTUS A, SUMMERS J J. Mirror, mirror on the wall: viewing a mirror reflection of unilateral hand movements facilitates ipsilateral M1 excitability[J]. Exp Brain Res, 2005,163(1):118-122.
[14] RIZZOLATTI G, FABBRI-DESTRO M, CATTANEO L. Mirror neurons and their clinical relevance[J]. Nat Clin Pract Neurol, 2009, 5(1):24-34.
[15] GARRISON K A, WINSTEIN C J, AZIZ-ZADEH L. The mirror neuron system: a neural substrate for methods in stroke rehabilitation[J]. Neurorehabil Neural Repair, 2010,24(5):404-412.
[16] THIEME H, MEHRHOLZ J, POHL M, et al. Mirror therapy for improving motor function after stroke[J]. Cochrane Database Syst Rev, 2012(3):8449.
[17] POLLOCK A, FARMER S E, BRADY M C, et al. Interventions for improving upper limb function after stroke[J]. Cochrane Database Syst Rev, 2014(11):10820.
[18] 李贺,闫兆宏,李贞兰.强制性使用运动疗法用于脑卒中康复的影像学研究进展[J]. 中国康复医学杂志,2012,27(8):783-786.
[19] LIEPERT J, MILTNER W H, BAUDER H, et al. Motor cortex plasticity during constraint-induced movement therapy in stroke patients[J]. Neurosci Lett, 1998, 250(1):5-8.
[20] 杨雷,朱洁,王传杰,等.强制性运动疗法结合电刺激对偏瘫患者上肢功能的作用[J]. 中国康复医学杂志,2015,30(3):285-286.