心理旋转试验在脑卒中患者运动表象能力评估中的应用

doi:10.3969/j.issn.1006-9771.2020.07.015

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (7): 813-819.doi: 10.3969/j.issn.1006-9771.2020.07.015

心理旋转试验在脑卒中患者运动表象能力评估中的应用

王鹤玮¹,王云龙²,陆小锋³,赵思淇³,王传凯⁴,丁力¹,陈树耿¹,王莹莹⁵,王建晖²,贾杰¹()

1.复旦大学附属华山医院,上海市 200040
2.河南大学附属南石医院康复医学科,河南南阳市 473000
3.上海大学通信与信息工程学院,上海市 200072
4.上海市静安区中心医院,上海市 200040
5.复旦大学公共卫生学院流行病学教研室,上海市 200032

收稿日期:2019-02-13 修回日期:2019-07-17 出版日期:2020-07-25 发布日期:2020-07-24
通讯作者: 贾杰 E-mail:shannonjj@126.com
作者简介:王鹤玮(1993-),男,汉族,江苏南京市人,博士研究生,主要研究方向：中枢神经系统损伤后上肢与手功能的康复。|贾杰,女,教授,博士生导师。
基金资助:
国家重点研发计划项目(2018YFC2002301);上海市卫生和计划生育委员会科研课题面上项目(201540197);上海市科委科研计划项目(16441905302)

Application of Mental Rotation Test in Motor Imagery Ability Assessment for Stroke Patients

WANG He-wei¹,WANG Yun-long²,LU Xiao-feng³,ZHAO Si-qi³,WANG Chuan-kai⁴,DING Li¹,CHEN Shu-geng¹,WANG Ying-ying⁵,WANG Jian-hui²,JIA Jie¹()

1. Huashan Hospital, Fudan University, Shanghai 200040, China
2. Department of Rehabilitation Medicine, Nanshi Hospital Affiliated to Henan University, Nanyang, Henan 473000, China
3. School of Communication & Information Engineering, Shanghai University, Shanghai 200072, China
4. Central Hospital of Jing'an District, Shanghai 200040, China
5. Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China

Received:2019-02-13 Revised:2019-07-17 Published:2020-07-25 Online:2020-07-24
Contact: JIA Jie E-mail:shannonjj@126.com
Supported by:
National Key R & D Program of China(2018YFC2002301);Shanghai Commission for Health and Family Research Planning(201540197);Shanghai Science and Technology Commission Scientific Research Program(16441905302)

摘要/Abstract

摘要：

目的研究脑卒中患者面对不同图案时的反应策略和影响心理旋转试验结果的主要因素。方法 2018年5月至10月,15例脑卒中患者和15例年龄、性别和教育程度匹配的健康受试者接受基于标准软件程序的心理旋转试验,视觉刺激包括手背、手心、汉字和字母4种图案,记录反应时和正确率。采用蒙特利尔认知功能评估量表(MoCA)评定所有受试者,采用Fugl-Meyer评定量表上肢部分(FMA-UE)评定脑卒中患者。结果在手背、手心和字母测试中,脑卒中患者的正确率低于健康对照(F > 7.027, P < 0.05)。在所有测试中,脑卒中患者的反应时均显著长于健康对照( F > 14.827, P < 0.001);在手背和手心测试中,反应时随旋转角度的主效应非常高度显著( F > 7.747, P < 0.001),0°时最短。所有受试者的MoCA评分与反应时呈负相关( r < -0.375, P < 0.05),脑卒中患者FMA-UE评分与除字母测试之外的反应时呈负相关( r < -0.581, P < 0.05)。结论不同的刺激图案可影响心理旋转试验的处理策略和结果。脑卒中患者的运动表象能力较健康人有所减弱,但基本模式相对保留。

关键词: 脑卒中, 心理旋转试验, 运动表象, 视觉刺激, 评定

Abstract:

Objective To study the judgment strategies of stroke patients facing different visual stimulus and the main factors affecting the mental rotation test results. Methods From May to October, 2018, 15 stroke patients and 15 age-sex-education-matched healthy controls accepted standard software-based mental rotation tests with four kinds of visual stimulus: hand back, hand palm, Chinese characters and alphabets. Reaction time and response accuracy were recorded. All the subjects were assessed with Montreal Cognitive Assessment (MoCA), and the patients were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE) additionally. Results When hand back, hand palm and alphabets worked as visual stimulus, the response accuracy was less in the patients than in the controls (F > 7.027, P < 0.05). For all the tests, the reaction time was more in the patients than in the controls ( F > 14.827, P < 0.001). The main effect of rotation angle was significant to reaction time when picture of hands as visual stimulus ( F > 7.747, P < 0.001), while it was the least at 0°. The MoCA scores negatively correlated with reaction time in both groups ( r < -0.375, P < 0.05), as well as the FMA-UE scores in the patients ( r < -0.581, P < 0.05). Conclusion Different types of visual stimulus may affect the judgment strategies and results of mental rotation test. Motor imagery ability is impaired for stroke patients, however, the basic reaction model maintains somehow.

Key words: stroke, mental rotation test, motor imagery, visual stimulation, assessment

中图分类号:

R743.3

王鹤玮,王云龙,陆小锋,赵思淇,王传凯,丁力,陈树耿,王莹莹,王建晖,贾杰. 心理旋转试验在脑卒中患者运动表象能力评估中的应用[J]. 《中国康复理论与实践》, 2020, 26(7): 813-819.

WANG He-wei,WANG Yun-long,LU Xiao-feng,ZHAO Si-qi,WANG Chuan-kai,DING Li,CHEN Shu-geng,WANG Ying-ying,WANG Jian-hui,JIA Jie. Application of Mental Rotation Test in Motor Imagery Ability Assessment for Stroke Patients[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(7): 813-819.

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组别	n	性别(男/女, n)	年龄(岁)	受教育年限(年)	病程(d)
对照组	15	8/7	48.73±12.48	10.87±3.76	-
患者组	15	10/5	50.87±11.42	11.27±3.52	110.20±92.71
t值		-	0.488	0.301	-
P值		0.710^a	0.629	0.766	-

组别	n	左	右
对照组	15	95.6±7.1	94.7±4.9
患者组	15	89.0±15.9	82.8±17.4

组别	n	左	右
对照组	15	96.8±4.6	97.1±3.5
患者组	15	91.3±10.9	87.1±12.2

组别	n	正	反
对照组	15	89.5±17.4	87.8±14.5
患者组	15	80.3±22.1	85.2±17.1

组别	n	正	反
对照组	15	92.2±6.2	91.2±12.4
患者组	15	79.8±23.4	80.3±14.7

心理旋转试验在脑卒中患者运动表象能力评估中的应用

Application of Mental Rotation Test in Motor Imagery Ability Assessment for Stroke Patients

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左/右	旋转角度	对照组(n = 15)	患者组(n = 15)
左	0°	1.776±0.327	2.714±1.627
	60°	2.235±0.532	3.818±2.884
	120°	2.962±0.935	5.962±5.363
	180°	3.870±1.303	9.535±8.237
	240°	2.877±0.793	6.158±5.808
	300°	2.256±0.491	3.813±2.906
右	0°	1.707±0.359	2.776±1.716
	60°	2.063±0.436	3.862±3.007
	120°	3.035±1.071	5.917±5.246
	180°	4.295±2.055	9.893±7.29
	240°	3.101±1.379	5.912±5.692
	300°	2.047±0.398	3.888±2.751

左/右	旋转角度	对照组(n = 15)	患者组(n = 15)
左	0°	2.132±0.331	2.840±1.128
	60°	2.377±0.394	3.843±1.889
	120°	3.223±0.962	6.308±4.721
	180°	2.840±0.749	4.434±2.335
	240°	2.520±0.513	3.722±1.603
	300°	2.229±0.347	2.973±1.172
右	0°	2.061±0.374	2.971±1.929
	60°	2.300±0.444	4.187±3.089
	120°	3.931±3.101	5.472±3.784
	180°	2.873±1.027	4.586±3.587
	240°	2.485±0.593	3.875±2.740
	300°	2.170±0.400	3.391±2.192

正/反	旋转角度	对照组(n = 15)	患者组(n = 15)
正	0°	1.653±0.451	2.045±0.618
	60°	1.841±0.549	3.677±2.183
	120°	1.799±0.993	4.526±4.741
	180°	2.589±1.352	3.674±2.954
	240°	1.696±0.650	3.762±4.778
	300°	2.152±0.966	3.775±2.734
反	0°	2.633±1.248	2.735±1.055
	60°	2.668±1.816	4.478±4.776
	120°	2.692±1.131	4.882±5.630
	180°	2.102±1.425	3.166±1.208
	240°	2.095±0.957	4.744±8.003
	300°	1.956±0.790	3.360±2.539

正/反	旋转角度	对照组(n = 15)	患者组(n = 15)
正	0°	1.733±0.602	2.738±1.175
	60°	2.740±1.578	4.981±5.823
	120°	2.128±0.505	5.563±8.597
	180°	1.530±0.447	3.668±4.440
	240°	2.238±0.985	3.792±4.188
	300°	2.199±1.021	4.213±3.835
反	0°	1.810±0.320	4.202±2.719
	60°	2.525±0.714	3.176±1.138
	120°	2.301±0.554	3.493±2.488
	180°	1.948±0.455	3.602±2.621
	240°	2.829±1.125	7.873±17.102
	300°	2.812±1.473	2.914±1.163

功能评定		反应时				正确率
功能评定		手背	手心	汉字	字母	手背	手心	汉字	字母
FMA-UE总分	r	-0.610	-0.581	-0.692	-0.406	0.437	0.345	0.026	0.463
FMA-UE总分	P	0.016	0.023	0.009	0.215	0.104	0.207	0.932	0.130
MoCA总分	r	-0.531	-0.375	-0.517	-0.455	0.351	0.324	0.333	0.461
MoCA总分	P	0.003	0.041	0.006	0.026	0.057	0.080	0.089	0.020
MoCA视空间认知评分	r	-0.569	-0.408	-0.431	-0.438	0.202	0.380	0.340	0.349
MoCA视空间认知评分	P	0.001	0.025	0.025	0.032	0.283	0.038	0.082	0.087

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