华西医学

华西医学

基于“闭环康复”的数字化镜像疗法对脑卒中患者上肢功能恢复的影响

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目的 探究基于“闭环康复”的数字化镜像疗法(mirror therapy,MT)对脑卒中患者上肢功能恢复的影响。 方法 2017 年 12 月—2018 年 4 月纳入脑卒中患者 90 例,随机分配到数字化镜像干预组(MG 组)和常规干预组(CG 组),每组各 45 例。MG 组患者先接受基于数字化镜像治疗设备的 MT 训练 60 min,随后再接受 30 min 手功能康复治疗,形成“闭环康复”;CG 组患者分别接受运动疗法、作业治疗以及手功能康复治疗各 30 min(共 90 min)。所有患者均接受 1 次/d、5 d/周、共计 4 周的干预。于治疗前、治疗 4 周后分别采用 Fugl-Meyer 上肢评分(Fulg-Meyer Assessment Upper Limb Subscalee,FMA_UL)评价上肢运动功能,改良巴氏指数(Modified Barthel Index,MBI)评价日常生活活动能力以及改良 Ashworth(Modified Ashworth Scale,MAS)评价腕屈/伸肌肌张力。 结果 研究过程中,5 例患者(MG 组 3 例,CG 组 2 例)未完成干预,最终 85 例患者完成研究。MG 组和 CG 组患者治疗前 FMA_UL 评分分别为(25.86±17.41)、(21.71±15.60)分,MBI 评分分别为(66.62±21.73)、(59.14±21.58)分;治疗 4 周后 FMA_UL 评分分别为(33.43±17.08)、(26.48±16.47)分,MBI 评分分别为(84.62±15.06)、(71.10±19.95)分。治疗 4 周后,两组患者 FMA_UL 评分及 MBI 评分均较治疗前明显提高(P<0.05),且 MG 组评分高于 CG 组(P<0.05)。两组 MAS 评分在治疗前后差异均无统计学意义(P>0.05)。 结论 基于“闭环康复”的数字化 MT 能够改善脑卒中患者上肢功能及日常生活能力,并且优于常规治疗方法。

Objective To explore the effect of " closed-loop rehabilitation”-based digital mirror therapy (MT) on the recovery of upper limb function after stroke. Methods Between December 2017 and April 2018, 90 stroke patients were recruited and randomly assigned to digital MT group (MG) or conventional group (CG), with 45 in each group. Patients in MG received digital MT for 60 minutes and subsequent hand function rehabilitation for 30 minutes, which was a " closed-loop rehabilitation”; moreover, patients in CG received therapeutic exercises, occupational therapy, and hand function rehabilitation for 30 minutes separately (totally 90 minutes). Both interventions were daily provided, 5 days per week and lasting for 4 weeks. Clinical assessments were provided before and after the interventions, including the Fugl-Meyer Assessment Upper Limb (FAM_UL) for motor function evaluation, the Modified Barthel Index (MBI) for the activities of daily life (ADL) evaluation, and the Modified Ashworth Scale (MAS) for the spasticity of wrist extensor/flexor. Results Five patients did not complete the study (3 in MG and 2 in CG), so there were totally 85 subjects analysed in the end. After 4-week interventions, significant improvements of FMA_UL scores (Pre: MG, 25.86±17.41; CG, 21.71±15.60. Post: MG, 33.43±17.08; CG, 26.48±16.47) and MBI scores (Pre: MG, 66.62±21.73; CG, 59.14±21.58. Post: MG, 84.62±15.06; CG, 71.10±19.95) were found in both groups; moreover, higher scores of FMA_UL and MBI were investigated in MG comparing with CG after interventions. However, there were no significantly differences in MAS. Conclusions The " closed-loop rehabilitation”-based digital MT can improve the motor function of upper limb and the ability of ADL in patients with stroke. Moreover, it is more effective than conventional treatments.

关键词: 闭环康复; 镜像疗法; 上肢; 脑卒中

Key words: Closed-loop rehabilitation; Mirror therapy; Upper limb; Stroke

引用本文: 丁力, 荣积峰, 崔晓, 田婧, 邵芃, 王鹤玮, 陈树耿, 余庐婴, 贾杰. 基于“闭环康复”的数字化镜像疗法对脑卒中患者上肢功能恢复的影响. 华西医学, 2018, 33(10): 1232-1237. doi: 10.7507/1002-0179.201805135 复制

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