智能镜像手套任务导向性训练联合低频重复经颅磁刺激对脑卒中患者手功能效果的随机对照试验

doi:10.3969/j.issn.1006-9771.2024.07.012

《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (7): 831-838.doi: 10.3969/j.issn.1006-9771.2024.07.012

智能镜像手套任务导向性训练联合低频重复经颅磁刺激对脑卒中患者手功能效果的随机对照试验

陈晨, 孟兆祥, 杨康, 张敏杰, 左亚南, 王奎, 张熙斌, 全逸峰, 金星()

苏北人民医院康复医学科，江苏扬州市 225001

收稿日期:2024-03-11 修回日期:2024-05-13 出版日期:2024-07-25 发布日期:2024-08-07
通讯作者: 金星，E-mail： 7853190@qq.com
作者简介:陈晨(1996-)，女，汉族，江苏淮安市人，硕士研究生，初级治疗师，主要研究方向：神经康复。
基金资助:
扬州市科技计划项目(YZ2022099)

Effect of intelligent mirror glove task-oriented training combined with low-frequency repetitive transcranial magnetic stimulation on hand function in patients with stroke: a randomized controlled trial

CHEN Chen, MENG Zhaoxiang, YANG Kang, ZHANG Minjie, ZUO Ya'nan, WANG Kui, ZHANG Xibin, QUAN Yifeng, JIN Xing()

Department of Rehabilitation Medicine, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, China

Received:2024-03-11 Revised:2024-05-13 Published:2024-07-25 Online:2024-08-07
Contact: JIN Xing, E-mail: 7853190@qq.com
Supported by:
Yangzhou Science and Technology Plan(YZ2022099)

摘要/Abstract

摘要：

目的观察智能镜像手套任务导向性训练联合低频重复经颅磁刺激(rTMS)对脑卒中患者手功能恢复的效果。
方法 2022年10月1日至2023年6月30日，选择苏北人民医院脑卒中患者136例，随机分为对照组、镜像组、rTMS组和联合组，每组34例。各组均给予常规康复治疗，镜像组增加智能镜像手套任务导向性训练治疗，rTMS组增加低频rTMS治疗，联合组增加智能镜像手套任务导向性训练与低频rTMS治疗，共4周。比较治疗前后Fugl-Meyer评定量表上肢部分(FMA-UE)评分、Wolf运动功能测定量表(WMFT)评分和前臂伸肌群、屈肌群表面肌电均方根值(RMS)患侧/健侧比值；比较rTMS组和联合组治疗前后经颅磁刺激运动诱发电位(MEP)的差异。
结果对照组4例、镜像组7例、rTMS组5例、联合组6例脱落。4组FMA-UE、WMFT评分和前臂伸肌、屈肌群RMS比的组内效应(F > 996.656, P < 0.001)、组间效应(F > 20.333, P < 0.001)和交互效应(F > 72.796, P < 0.001)均显著，且联合组最优。治疗后，rTMS组和联合组MEP的振幅均增加(|t| > 3.842, P < 0.05)，联合组明显高于rTMS组(t = -3.060, P < 0.01)。
结论智能镜像手套任务导向性训练联合低频rTMS可有效促进脑卒中患者手功能恢复。

关键词: 脑卒中, 智能镜像手套, 任务导向性训练, 重复经颅磁刺激, 手功能, 随机对照试验

Abstract:

Objective To explore the effect of task-oriented training of intelligent mirror gloves combined with low-frequency repetitive transcranial magnetic stimulation (rTMS) on hand function recovery in stroke patients.
Methods From October 1st, 2022 to June 30th, 2023, 136 stroke patients in Northern Jiangsu People's Hospital were randomly divided into control group, mirror group, rTMS group and combination group, with 34 patients in each group. All the groups received routine rehabilitation treatment. In addition, the mirror group received task-oriented training of intelligent mirror gloves, rTMS group received low-frequency rTMS, and the combination group received task-oriented training combined with low-frequency rTMS, for four weeks. The Fugl-Meyer Assessment-Upper Extremities (FMA-UE) score, Wolf Motor Function Test (WMFT) score, and surface electromyographic root mean square (RMS) of forearm extensor and flexor muscle groups on the affected/healthy side before and after treatment were compared. And the differences of transcranial magnetic stimulation-motor-evoked potentials (MEP) between rTMS group and combination group before and after treatment were also compared.
Results Four cases in the control group, seven in the mirror group, five in rTMS group and six in the combination group dropped off. The intra-group effect (F > 996.656, P < 0.001), inter-group effect (F > 20.333, P < 0.001) and interaction effect (F > 72.796, P < 0.001) were significant in the scores of FMA-UE and WMFT, and the RMS ratio of forearm extensor and flexor muscle groups among four groups, in which the combination group was the best. After treatment, the amplitude of MEP increased in rTMS group and combination group (|t| > 3.842, P < 0.05), and was higher in the combination group than in rTMS group (t = -3.060, P < 0.01).
Conclusion The task-oriented training of intelligent mirror gloves combined with low-frequency rTMS could effectively promote the recovery of hand function in stroke patients.

Key words: stroke, intelligent mirror gloves, task-oriented training, repetitive transcranial magnetic stimulation, hand function, randomized controlled trial

中图分类号:

R743.3

陈晨, 孟兆祥, 杨康, 张敏杰, 左亚南, 王奎, 张熙斌, 全逸峰, 金星. 智能镜像手套任务导向性训练联合低频重复经颅磁刺激对脑卒中患者手功能效果的随机对照试验[J]. 《中国康复理论与实践》, 2024, 30(7): 831-838.

CHEN Chen, MENG Zhaoxiang, YANG Kang, ZHANG Minjie, ZUO Ya'nan, WANG Kui, ZHANG Xibin, QUAN Yifeng, JIN Xing. Effect of intelligent mirror glove task-oriented training combined with low-frequency repetitive transcranial magnetic stimulation on hand function in patients with stroke: a randomized controlled trial[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(7): 831-838.

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组别	n	性别(男/女)/n	年龄/岁	病程/d	病变性质(缺血/出血)/n	偏瘫侧(左/右)/n
对照组	30	20/10	64.75±9.09	23.75±5.55	26/4	20/10
镜像组	27	20/7	59.22±15.39	23.26±12.46	25/2	21/6
rTMS组	29	22/7	55.17±13.51	26.83±7.51	29/0	22/7
联合组	28	25/3	63.56±9.74	24.43±10.69	28/0	22/6
χ²/F值		4.230	1.209	0.367	7.334	1.396
P值		0.238	0.315	0.777	0.062	0.706

变量	组别	治疗前		治疗后
变量	组别	均值	标准差	均值	标准差
FMA-UE	对照组	9.5	3.42	17.56	3.03
	镜像组	10.13	3.24	22.94	4.75
	rTMS组	9.46	1.72	30.92	2.96
	联合组	10.25	3.79	32.62	4.09
WMFT	对照组	7.19	4.35	17.01	2.99
	镜像组	8.00	4.93	21.30	3.81
	rTMS组	7.36	3.53	28.18	2.93
	联合组	7.25	4.12	37.75	4.04
伸肌群RMS比/%	对照组	2.04	1.20	14.33	3.48
	镜像组	3.70	2.81	21.82	7.50
	rTMS组	4.10	3.02	26.53	6.62
	联合组	4.39	3.12	41.74	7.21
屈肌群RMS比/%	对照组	5.51	2.91	18.90	4.98
	镜像组	8.80	5.07	32.34	7.03
	rTMS组	8.75	5.05	43.78	7.84
	联合组	7.99	6.69	58.08	11.63

变量		平方和	自由度	均方	F值	P值
FMA-UE	组内	7918.339	1	7918.339	1566.204	< 0.001
	组间	1206.813	3	402.271	20.303	< 0.001
	组内×组间	1104.117	3	368.039	72.796	< 0.001
WMFT	组内	8343.516	1	8343.516	1024.803	< 0.001
	组间	1965.711	3	655.237	26.165	< 0.001
	组内×组间	2066.651	3	688.884	84.613	< 0.001
伸肌群RMS比	组内	11865.650	1	11865.650	996.656	< 0.001
	组间	4051.778	3	1350.593	29.029	< 0.001
	组内×组间	2573.227	3	857.742	72.046	< 0.001
屈肌群RMS比	组内	22585.961	1	22585.961	1063.093	< 0.001
	组间	7598.295	3	2532.765	29.675	< 0.001
	组内×组间	5714.070	3	1904.690	89.651	< 0.001

变量	组别	组别	平均值差	P值	95%CI
变量	组别	组别	平均值差	P值	上限	下限
FMA-UE	对照组	镜像组	-3.000	0.009	-5.228	-0.772
	对照组	rTMS组	-7.906	< 0.001	-10.135	-5.678
	对照组	联合组	3.000	0.009	0.772	5.228
	镜像组	rTMS组	6.666	< 0.001	4.308	9.014
	镜像组	联合组	3.661	0.003	1.308	6.014
	rTMS组	联合组	-1.245	0.294	-3.599	1.108
WMFT	对照组	镜像组	-2.558	0.030	-4.865	-0.252
	对照组	rTMS组	-6.156	0.001	-9.548	-2.764
	对照组	联合组	-10.406	< 0.001	-12.911	-7.901
	镜像组	rTMS组	-3.598	0.031	-6.846	-0.350
	镜像组	联合组	-7.848	< 0.001	-10.155	-5.541
	rTMS组	联合组	-4.250	0.015	-7.642	-0.858
伸肌群RMS比	对照组	镜像组	-4.582	0.005	-7.726	-1.438
	对照组	rTMS组	-7.135	0.003	-11.759	-2.512
	对照组	联合组	-15.384	< 0.001	-18.799	-11.970
	镜像组	rTMS组	-2.554	0.253	-6.981	1.874
	镜像组	联合组	-10.803	< 0.001	-13.947	-7.658
	rTMS组	联合组	-8.249	0.001	-12.872	-3.625
屈肌群RMS比	对照组	镜像组	-8.868	< 0.001	-13.126	-4.609
	对照组	rTMS组	-14.560	< 0.001	-20.823	-8.298
	对照组	联合组	-21.328	< 0.001	-25.953	-16.703
	镜像组	rTMS组	-5.693	0.062	-11.689	0.304
	镜像组	联合组	-12.460	< 0.001	-16.719	-8.202
	rTMS组	联合组	-6.768	0.035	-13.030	-0.505

组别	n	测试	$\bar{x}±s$	t值	P值
rTMS组	29	前测	21.95±1.03	-0.461	0.664
		后测	22.10±1.30
联合组	28	前测	21.53±2.92	0.430	0.673
		后测	21.28±3.02
治疗前两组均值差			0.42±0.23	0.340	0.737
治疗后两组均值差			0.82±0.44	0.633	0.534

智能镜像手套任务导向性训练联合低频重复经颅磁刺激对脑卒中患者手功能效果的随机对照试验

Effect of intelligent mirror glove task-oriented training combined with low-frequency repetitive transcranial magnetic stimulation on hand function in patients with stroke: a randomized controlled trial

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组别	n	测试	$\bar{x}±s$	t值	P值
rTMS组	29	前测	162.67±65.06	-3.842	0.012
		后测	274.67±88.76
联合组	28	前测	160.06±61.40	-12.288	< 0.001
		后测	377.63±63.86
治疗前两组均值差			19.83±12.60	0.087	0.931
治疗后两组均值差			-102.96±33.65	-3.060	0.006

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