分级运动表象联合重复经颅磁刺激对脑卒中患者上肢功能的效果

doi:10.3969/j.issn.1006-9771.2023.05.004

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (5): 516-520.doi: 10.3969/j.issn.1006-9771.2023.05.004

• 专题脑卒中肢体功能康复 • 上一篇下一篇

分级运动表象联合重复经颅磁刺激对脑卒中患者上肢功能的效果

贾凡¹, 赵莹¹, 王钊¹, 陈杰², 鲁思涵¹, 张明¹^,²()

1.徐州医科大学附属徐州康复医院，江苏徐州市 221003
2.徐州医科大学徐州临床学院/徐州市中心医院，江苏徐州市 221009

收稿日期:2023-03-13 修回日期:2023-04-21 出版日期:2023-05-25 发布日期:2023-06-19
通讯作者: 张明(1985-)，男，硕士，副教授、副主任治疗师，硕士研究生导师。E-mail：zm1455@163.com
作者简介:贾凡(1999-)，女，汉族，山东菏泽市人，硕士研究生，治疗师，主要研究方向：神经康复。
基金资助:
徐州市医学重点人才项目(XWRCHT20220045)

Effect of graded motor imagery combined with repetitive transcranial magnetic stimulation on upper limb function of stroke patients

JIA Fan¹, ZHAO Ying¹, WANG Zhao¹, CHEN Jie², LU Sihan¹, ZHANG Ming¹^,²()

1. Xuzhou Rehabilitation Hospital, Xuzhou Medical University, Xuzhou, Jiangsu 221003, China
2. Xuzhou Clinical College of Xuzhou Medical University/Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, China

Received:2023-03-13 Revised:2023-04-21 Published:2023-05-25 Online:2023-06-19
Contact: ZHANG Ming, E-mail: zm1455@163.com
Supported by:
Xuzhou Medical Key Talent Project(XWRCHT20220045)

摘要/Abstract

摘要：

目的探讨分级运动表象(GMI)联合重复经颅磁刺激(rTMS)对脑卒中患者上肢功能和日常生活活动能力的影响。

方法 2022年6月至2023年2月，徐州医科大学附属徐州康复医院和徐州市中心医院收治的脑卒中患者45例，随机分为常规组、GMI组和联合组，每组15例。3组均接受常规康复训练，GMI组增加GMI，联合组增加GMI和rTMS，共4周。治疗前后采用Fugl-Meyer评定量表上肢部分(FMA-UE)、上肢动作研究量表(ARAT)、改良Barthel指数(MBI)和香港版偏瘫上肢功能测试(FTHUE-HK)进行评定。

结果治疗后，3组FMA-UE、ARAT、MBI评分及FTHUE-HK分级均较治疗前显著提高(|t| > 9.681, P < 0.001)，联合组最优(F > 13.241, P < 0.001)。

结论 GMI联合rTMS可进一步改善脑卒中患者上肢运动功能，提高日常生活活动能力。

关键词: 脑卒中, 上肢, 运动功能, 经颅磁刺激, 分级运动表象

Abstract:

Objective To explore the effects of graded motor imagery (GMI) combined with repetitive transcranial magnetic stimulation (rTMS) on upper limb function and activities of daily living of stroke patients.

Methods From June, 2022 to February, 2023, 45 stroke patients from Xuzhou Rehabilitation Hospital and Xuzhou Central Hospital were recruited and divided into control group (n = 15), GMI group (n = 15) and combined group (n = 15) randomly. All the groups received conventional rehabilitation, in addition, GMI group received GMI and the combined group received GMI and rTMS, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Action Research Arm Test (ARAT), modified Barthel Index (MBI) and Hong Kong version of Functional Test for the Hemiplegic Upper Extremity (FTHUE-HK) before and after treatment.

Results The scores of FMA-UE, ARAT and MBI, and grades of FTHUE-HK improved in all the groups after treatment (|t| > 9.681, P< 0.001), and all these indexes were the best in the combined group (F > 13.241, P< 0.001).

Conclusion GMI combined with rTMS can further improve the motor function of upper limbs and activities of daily living of stroke patients.

Key words: stroke, upper limb, motor function, transcranial magnetic stimulation, graded motor imagery

中图分类号:

R743.3

贾凡, 赵莹, 王钊, 陈杰, 鲁思涵, 张明. 分级运动表象联合重复经颅磁刺激对脑卒中患者上肢功能的效果[J]. 《中国康复理论与实践》, 2023, 29(5): 516-520.

JIA Fan, ZHAO Ying, WANG Zhao, CHEN Jie, LU Sihan, ZHANG Ming. Effect of graded motor imagery combined with repetitive transcranial magnetic stimulation on upper limb function of stroke patients[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(5): 516-520.

图/表 5

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组别	n	性别(男/女)/n	年龄/岁	病程/d	性质(出血/梗死)/n	偏瘫侧别(左/右)/n
常规组	15	10/5	57.80±12.36	35.67±31.49	4/11	5/10
GMI组	15	7/8	63.13±8.54	34.80±27.35	2/13	7/8
联合组	15	10/5	59.47±6.30	28.80±23.87	2/13	8/7
χ²/F值		1.667	1.263	0.273	1.176	1.260
P值		0.435	0.293	0.763	0.697	0.651

组别	n	治疗前	治疗后	t值	P值
常规组	15	8.27±3.83	16.07±4.11	-10.301	< 0.001
GMI组	15	8.13±4.05	21.73±5.31^a	-15.699	< 0.001
联合组	15	8.36±3.83	27.80±8.24^a,b	-12.504	< 0.001
F值		0.076	13.692
P值		0.927	< 0.001

组别	n	治疗前	治疗后	t值	P值
常规组	15	5.20±3.05	12.27±3.56	-9.812	< 0.001
GMI组	15	5.00±2.39	17.20±5.29^a	-11.597	< 0.001
联合组	15	5.33±2.72	22.20±6.57^a,b	-13.627	< 0.001
F值		0.057	13.241
P值		0.945	< 0.001

组别	n	治疗前	治疗后	t值	P值
常规组	15	52.33±8.85	67.87±7.47	-14.187	< 0.001
GMI组	15	52.87±13.39	75.00±7.89^a	-9.681	< 0.001
联合组	15	55.40±12.99	82.87±7.26^a,b	-12.501	< 0.001
F值		0.283	14.818
P值		0.755	< 0.001

组别	n	治疗前							治疗后							Z值	P值
组别	n	1级	2级	3级	4级	5级	6级	7级	1级	2级	3级	4级	5级	6级	7级	Z值	P值
常规组	15	3	6	6	0	0	0	0	0	3	10	2	0	0	0	-3.317	0.001
GMI组	15	3	7	4	1	0	0	0	0	0	6	6	2	1	0^a	-3.542	< 0.001
联合组	15	2	7	5	1	0	0	0	0	0	2	3	7	3	0^a,b	-3.520	< 0.001
H值		0.234							20.466
P值		0.890							< 0.001

分级运动表象联合重复经颅磁刺激对脑卒中患者上肢功能的效果

Effect of graded motor imagery combined with repetitive transcranial magnetic stimulation on upper limb function of stroke patients

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