绳带辅助本体感觉神经肌肉促进技术训练联合绳带辅助脑机接口训练对脑卒中偏瘫上肢康复效果的随机对照试验

doi:10.3969/j.issn.1006-9771.2024.08.013

《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (8): 972-978.doi: 10.3969/j.issn.1006-9771.2024.08.013

绳带辅助本体感觉神经肌肉促进技术训练联合绳带辅助脑机接口训练对脑卒中偏瘫上肢康复效果的随机对照试验

梁天佳, 龙耀斌(), 陆丽燕, 周金英, 黄福才, 黄林鹏, 邬映超, 龙耀翔, 韦小翠, 柳忠

广西医科大学第二附属医院康复医学科，广西南宁市 530007

收稿日期:2024-04-17 出版日期:2024-08-25 发布日期:2024-09-11
通讯作者: 龙耀斌(1974-)，男，壮族，广西南宁市人，博士，主任医师，主要研究方向：神经康复、肌骨康复、儿童康复。E-mail： long232316@163.com
作者简介:梁天佳(1975-)，男，壮族，广西南宁市人，硕士，主任医师，主要研究方向：神经康复、肌骨康复、老年康复。
基金资助:
广西壮族自治区医疗卫生适宜技术开发与推广应用项目(S2019010);广西壮族自治区医疗卫生适宜技术开发与推广应用项目(S2020017);广西壮族自治区卫生健康委员会自筹经费科研课题(Z20190377);广西壮族自治区卫生健康委员会自筹经费科研课题(Z-A20220647);广西壮族自治区医疗卫生重点学科建设项目([2022]4号)

Effect of rope-assisted proprioceptive neuromuscular facilitation combined with rope-assisted brain-computer interface training on upper limb function in stroke patients with hemiplegia: a randomized controlled trial

LIANG Tianjia, LONG Yaobin(), LU Liyan, ZHOU Jinying, HUANG Fucai, HUANG Linpeng, WU Yingchao, LONG Yaoxiang, WEI Xiaocui, LIU Zhong

Department of Rehabilitation Medicine, the Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530007, China

Received:2024-04-17 Published:2024-08-25 Online:2024-09-11
Supported by:
Guangxi Medical and Health Appropriate Technology Development, Promotion and Application Project(S2019010);Guangxi Medical and Health Appropriate Technology Development, Promotion and Application Project(S2020017);Guangxi Health Commission Self-fund Project(Z20190377);Guangxi Health Commission Self-fund Project(Z-A20220647);Guangxi Key Medical and Health Discipline Construction(No. [2022]4)

摘要/Abstract

摘要：

目的探讨绳带辅助本体感觉神经肌肉促进技术(PNF)训练联合绳带辅助脑机接口(BCI)训练在脑卒中偏瘫患者上肢康复中的应用效果。

方法 2022年3月至2023年2月，选取广西医科大学第二附属医院脑卒中偏瘫住院患者96例，随机分为常规组(n = 32)、PNF组(n = 32)和联合组(n = 32)。各组均给予常规康复治疗，常规组给予上肢PNF训练，PNF组给予上肢绳带辅助PNF训练，联合组给予上肢绳带辅助PNF训练和上肢绳带辅助BCI训练，共4周。治疗前后，分别采用偏瘫上肢功能测试-香港版(FTHUE-HK)、Fugl-Meyer上肢功能评定(FMA-UE)和改良Barthel指数(MBI)进行评估。

结果各组FTHUE-HK评分、MBI评分的组内效应(F > 341.219, P < 0.001)、组间效应(F > 21.705, P < 0.001)和交互效应(F > 3.171, P < 0.05)均显著；FMA-UE评分的组内效应(F = 520.472, P < 0.001)和组间效应(F = 41.939, P < 0.001)显著，交互效应不显著(P > 0.05)。治疗后，各项指标均为联合组最优(P < 0.05)。

结论绳带辅助PNF训练联合绳带辅助脑机BCI训练能进一步促进脑卒中偏瘫上肢运动功能障碍患者的恢复，提高其日常生活能力。

关键词: 脑卒中, 上肢, 绳带疗法, 本体感觉神经肌肉促进技术, 脑机接口, 康复, 随机对照试验

Abstract:

Objective To investigate the effect of combination of rope-assisted proprioceptive neuromuscular facilitation (PNF) training and rope-assisted brain-computer interface (BCI) training on upper limb function in stroke patients with hemiplegia.

Methods From March, 2022 to February, 2023, 96 inpatients with stroke hemiplegia from the Second Affiliated Hospital of Guangxi Medical University were randomly divided into conventional group (n = 32), PNF group (n = 32) and combined group (n = 32). All the groups received routine rehabilitation treatment. The conventional group received upper limb PNF training, the PNF group received upper limb rope-assisted PNF training, and the combined group received both upper limb rope-assisted PNF training and upper limb rope-assisted BCI training, for four weeks. They were assessed with Functiongal Test for the Hemiplegic Upper Extremity-Hong Kong version (FTHUE-HK), Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and modified Barthel Index (MBI) before and after treatment.

Results The intra-group effect (F > 341.219, P < 0.001), inter-group effect (F > 21.705, P < 0.001) and interaction effect (F > 3.171, P < 0.05) were significant in the scores of FTHUE-HK and MBI. The intra-group effect (F =520.472, P < 0.001) and inter-group effect (F = 41.939, P < 0.001) were significant in the scores of FMA-UE, and the interaction effect was not (P > 0.05). After treatment, the FTHUE-HK, FMA-UE and MBI scores were the best in the combined group (P < 0.05).

Conclusions The combination of rope-assisted PNF training with rope-assisted BCI device training could further improve the motor function of the upper limbs in stroke patients with hemiplegia, and enhance their activities of daily living.

Key words: stroke, upper limb, rope therapy, proprioceptive neuromuscular facilitation, brain-computer interface, rehabilitation, randomized controlled trial

中图分类号:

R743.3

梁天佳, 龙耀斌, 陆丽燕, 周金英, 黄福才, 黄林鹏, 邬映超, 龙耀翔, 韦小翠, 柳忠. 绳带辅助本体感觉神经肌肉促进技术训练联合绳带辅助脑机接口训练对脑卒中偏瘫上肢康复效果的随机对照试验[J]. 《中国康复理论与实践》, 2024, 30(8): 972-978.

LIANG Tianjia, LONG Yaobin, LU Liyan, ZHOU Jinying, HUANG Fucai, HUANG Linpeng, WU Yingchao, LONG Yaoxiang, WEI Xiaocui, LIU Zhong. Effect of rope-assisted proprioceptive neuromuscular facilitation combined with rope-assisted brain-computer interface training on upper limb function in stroke patients with hemiplegia: a randomized controlled trial[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(8): 972-978.

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组别	n	性别(男/女)/n	年龄/岁	卒中类型(梗死/出血)/n	病程/d	偏瘫侧/(左/右)/n
常规组	32	20/12	58.33±5.87	22/10	21.01±7.21	12/20
PNF组	32	19/13	56.41±4.98	20/12	20.17±6.95	14/18
联合组	32	21/11	57.06±6.04	21/11	23.42±7.15	10/22
χ²/F值		0.267	0.956	0.277	1.805	1.067
P值		0.875	0.388	0.871	0.170	0.587

变量	组别	n	治疗前		治疗后
变量	组别	n	均值	标准差	均值	标准差
FTHUE-HK	常规组	32	2.01	0.65	2.48	0.76
	PNF组	32	2.12	0.81	2.95	0.75
	联合组	32	2.16	0.69	3.35	0.78
FMA-UE	常规组	32	19.32	4.52	22.51	5.33
	PNF组	32	18.95	4.91	25.86	5.64
	联合组	32	19.10	5.02	28.74	5.85
MBI	常规组	32	33.87	6.92	38.25	8.36
	PNF组	32	32.69	7.48	42.67	8.12
	联合组	32	34.05	7.35	47.52	8.95

变量		平方和	自由度	均方	F值	P值
FTHUE-HK	组内	32.505	1	32.505	341.219	< 0.001
	组间	4.135	2	2.068	21.705	< 0.001
	组内×组间	8.573	2	4.286	4.750	0.011
FMA-UE	组内	2073.755	1	2073.755	520.472	< 0.001
	组间	334.198	2	167.099	41.939	< 0.001
	组内×组间	288.010	2	144.005	2.851	0.063
MBI	组内	4134.797	1	4134.797	510.450	< 0.001
	组间	668.375	2	334.187	41.256	< 0.001
	组内×组间	735.542	2	367.771	3.171	0.047

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
FTHUE-HK	常规组	PNF组	-0.110	0.551	-0.477	0.257
	常规组	联合组	-0.150	0.374	-0.485	0.185
	PNF组	联合组	-0.040	0.832	-0.416	0.336
FMA-UE	常规组	PNF组	0.370	0.755	-1.988	2.728
	常规组	联合组	0.220	0.854	-2.167	2.607
	PNF组	联合组	-0.150	0.904	-2.631	2.331
MBI	常规组	PNF组	1.180	0.515	-2.421	4.781
	常规组	联合组	-0.180	0.920	-3.747	3.387
	PNF组	联合组	-1.360	0.466	-5.066	2.346

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
FTHUE- HK	常规组	PNF组	-0.470	0.015	-0.847	-0.093
FTHUE- HK	常规组	联合组	-0.870	< 0.001	-1.255	-0.485
	PNF组	联合组	-0.400	0.041	-0.782	-0.018
FMA-UE	常规组	PNF组	-3.350	0.017	-6.092	-0.608
	常规组	联合组	-6.230	< 0.001	-9.027	-3.433
	PNF组	联合组	-2.880	0.049	-5.752	-0.008
MBI	常规组	PNF组	-4.420	0.036	-8.538	-0.302
	常规组	联合组	-9.270	< 0.001	-13.598	-4.942
	PNF组	联合组	-4.850	0.027	-9.120	-0.580

绳带辅助本体感觉神经肌肉促进技术训练联合绳带辅助脑机接口训练对脑卒中偏瘫上肢康复效果的随机对照试验

Effect of rope-assisted proprioceptive neuromuscular facilitation combined with rope-assisted brain-computer interface training on upper limb function in stroke patients with hemiplegia: a randomized controlled trial

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