基于镜像神经元理论的动作观察疗法联合低频重复经颅磁刺激对脑卒中后单侧空间忽略的效果

doi:10.3969/j.issn.1006-9771.2026.07.004

《中国康复理论与实践》 ›› 2026, Vol. 32 ›› Issue (7): 768-775.doi: 10.3969/j.issn.1006-9771.2026.07.004

• 专题脑卒中并发症康复 • 上一篇下一篇

基于镜像神经元理论的动作观察疗法联合低频重复经颅磁刺激对脑卒中后单侧空间忽略的效果

张费¹, 傅博勋¹(), 沈慧¹, 陈进²

¹ 宿迁市中西医结合医院康复医学科，江苏宿迁市 223800
² 江苏医药职业学院康复医学院，江苏盐城市 224000

收稿日期:2025-09-19 修回日期:2026-04-01 接受日期:2026-04-28 出版日期:2026-07-25 发布日期:2026-07-30
通讯作者: 傅博勋，E-mail： fuboxun0723@163.com
作者简介:张费(1990-)，女，汉，江苏宿迁市人，主管技师，主要研究方向：神经康复、失语症和认知障碍康复。
基金资助:
2022年度江苏医药职业学院校外教学基地科研发展项目(20229130)

Effect of action observation therapy based on mirror neuron system combined with low-frequency repetitive transcranial magnetic stimulation on post-stroke unilateral spatial neglect

Zhang Fei¹, Fu Boxun¹(), Shen Hui¹, Chen Jin²

¹ Department of Rehabilitation Medicine, Suqian Integrated Traditional Chinese and Western Medicine Hospital, Suqian, Jiangsu 223800, China
² Rehabilitation Medicine College of Jiangsu Medical Vocational College, Yancheng, Jiangsu 224000, China

Received:2025-09-19 Revised:2026-04-01 Accepted:2026-04-28 Published:2026-07-25 Online:2026-07-30
Contact: Fu Boxun, E-mail: fuboxun0723@163.com
Supported by:
Jiangsu Medical Vocational College Off-campus Teaching Base Research and Development Project(20229130)

摘要/Abstract

摘要：

目的探讨基于镜像神经元理论的动作观察疗法(AOT)联合低频重复经颅磁刺激(rTMS)对脑卒中后单侧空间忽略的效果。

方法选取2023年1月至2024年3月宿迁市中西医结合医院收治的脑卒中后单侧空间忽略患者108例，随机分为AOT组、rTMS组和联合组，各36例。3组均接受常规治疗，AOT组加用AOT，rTMS组加用rTMS，联合组加用AOT和rTMS，共4周。治疗前后采用蒙特利尔认知评估量表(MoCA)、Fugl-Meyer评定量表(FMA)、改良Barthel指数(MBI)、中国行为性忽略测试-常规测验(CBIT-C)和中国行为性忽略测试-行为测验(CBIT-B)进行评定，并检测患侧N20潜伏期和振幅。

结果 3组各脱落3例。干预后，MoCA、FMA、MBI、CBIT-C评分及N20潜伏期和振幅的时间主效应(F > 77.096, P < 0.001)、组别主效应(F > 5.119, P < 0.01)和交互效应(F > 3.320, P < 0.05)均显著。CBIT-B评分的时间主效应(F = 367.430, P < 0.001)和组别主效应(F = 4.995, P = 0.008)均显著。干预后，联合组MoCA、FMA、MBI、CBIT-B、CBIT-C评分及N20振幅均高于AOT组和rTMS组，N20潜伏期均低于AOT组和rTMS组(P < 0.05)。

结论 AOT联合rTMS可进一步改善脑卒中后单侧空间忽略患者的认知功能、运动功能、日常生活活动能力和空间忽略程度，可能与神经传导功能改善有关。

关键词: 脑卒中, 动作观察疗法, 低频重复经颅磁刺激, 单侧空间忽略

Abstract:

Objective To evaluate the effect of action observation therapy (AOT) combined with low-frequency repetitive transcranial magnetic stimulation (rTMS) on post-stroke unilateral spatial neglect.

Methods A total of 108 patients with post-stroke unilateral spatial neglect admitted to Suqian Integrated Traditional Chinese and Western Medicine Hospital from January, 2023 to March, 2024 were enrolled. The patients were randomly allocated to AOT group, rTMS group and combined group with 36 patients in each group. All the groups received conventional treatment. The AOT group additionally received AOT, the rTMS group additionally received rTMS, and the combined group received both AOT and rTMS, for four weeks. Before and after treatment, the patients were assessed using the Montreal Cognitive Assessment (MoCA), Fugl-Meyer Assessment (FMA), modified Barthel Index (MBI), Chinese Behavioural Inattention Test-conventional test (CBIT-C) and CBIT-behavioural test (CBIT-B). The latency and amplitude of the N20 potential on the affected side were also measured.

Results Three patients dropped out from each group. After intervention, significant main effects of time (F > 77.096, P< 0.001) and group (F > 5.119, P< 0.01) and significant time-by-group interaction effects (F > 3.320, P< 0.05)were observed in the MoCA, FMA, MBI, and CBIT-C scores. For the CBIT-B score, the main effects of time (F = 367.430, P < 0.001) and group (F = 4.995, P = 0.008) were significant. After intervention, MoCA, FMA, MBI, CBIT-C and CBIT-B scores, and N20 amplitude and latency were better in the combined group than in the AOT and rTMS groups (P < 0.05).

Conclusion The combination of AOT and rTMS may further ameliorate cognitive function, motor function, activities of daily living, and the degree of spatial neglect in post-stroke patients with unilateral spatial neglect, potentially attributable to improved nerve conduction function.

Key words: stroke, action observation therapy, low-frequency repetitive transcranial magnetic stimulation, unilateral spatial neglect

中图分类号:

R743.3

张费, 傅博勋, 沈慧, 陈进. 基于镜像神经元理论的动作观察疗法联合低频重复经颅磁刺激对脑卒中后单侧空间忽略的效果[J]. 《中国康复理论与实践》, 2026, 32(7): 768-775.

Zhang Fei, Fu Boxun, Shen Hui, Chen Jin. Effect of action observation therapy based on mirror neuron system combined with low-frequency repetitive transcranial magnetic stimulation on post-stroke unilateral spatial neglect[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(7): 768-775.

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组别	n	性别(男/女)/n	年龄/岁	脑卒中类型(脑梗死/脑出血)/n	偏瘫侧(左/右)/n
AOT组	36	26/10	58.82±10.36	27/9	21/15
rTMS组	36	24/12	59.55±10.01	25/11	16/20
联合组	36	28/8	56.64±11.52	29/7	19/17
χ²/F值		1.108	0.728	1.409	0.971
P值		0.575	0.485	0.494	0.616

项目	组别	n	治疗前		治疗后
项目	组别	n	均值	标准差	均值	标准差
MoCA	AOT组	33	21.39	2.14	23.03	2.32
	rTMS组	33	21.82	2.21	23.45	2.43
	联合组	33	21.41	2.28	24.82	2.51
FMA	AOT组	33	54.27	6.08	66.12	7.75
	rTMS组	33	53.91	5.83	65.76	7.94
	联合组	33	56.12	6.04	74.61	8.22
MBI	AOT组	33	42.48	6.39	54.67	13.06
	rTMS组	33	40.55	6.14	53.79	12.94
	联合组	33	39.73	6.71	64.52	15.93
CBIT-C	AOT组	33	88.36	11.12	100.12	12.08
	rTMS组	33	90.48	10.07	101.82	12.83
	联合组	33	87.45	11.58	111.58	13.46
CBIT-B	AOT组	33	46.48	8.03	67.12	7.24
	rTMS组	33	48.67	8.85	65.91	6.98
	联合组	33	45.73	7.86	71.48	7.61
潜伏期/ms	AOT组	33	24.92	2.54	22.27	2.33
	rTMS组	33	25.84	2.65	21.48	2.26
	联合组	33	26.15	2.71	19.17	2.02
振幅/μV	AOT组	33	1.01	0.33	1.86	0.58
	rTMS组	33	1.03	0.32	1.75	0.49
	联合组	33	0.97	0.21	2.19	0.42

变量		平方和	自由度	均方	F值	P值
MoCA	组内	414.383	1	414.383	77.096	< 0.001
	组间	65.018	2	32.509	6.048	0.003
	组内×组间	91.741	2	45.871	8.534	< 0.001
FMA	组内	9646.639	1	9646.639	194.155	< 0.001
	组间	508.685	2	254.343	5.119	0.007
	组内×组间	1304.894	2	652.447	13.132	< 0.001
MBI	组内	13871.266	1	13871.266	116.349	< 0.001
	组间	1612.958	2	806.479	6.764	0.001
	组内×组间	860.828	2	430.414	3.610	0.029
CBIT-C	组内	12268.701	1	12268.701	86.515	< 0.001
	组间	1742.276	2	871.138	6.143	0.003
	组内×组间	941.533	2	470.766	3.320	0.038
CBIT-B	组内	22268.273	1	22268.273	367.430	< 0.001
	组间	605.507	2	302.754	4.995	0.008
	组内×组间	115.002	2	57.501	0.949	0.389
潜伏期/ms	组内	1076.461	1	1076.461	182.270	< 0.001
	组间	156.956	2	78.478	13.288	< 0.001
	组内×组间	41.326	2	20.663	3.499	0.032
振幅/μV	组内	42.813	1	42.813	254.761	< 0.001
	组间	2.221	2	1.110	6.608	0.002
	组内×组间	1.301	2	0.651	3.872	0.023

变量	组别		平均值差	P值	95%CI
变量	组别		平均值差	P值	下限	上限
MoCA	AOT组	rTMS组	-0.420	0.365	-1.316	0.476
	AOT组	联合组	-1.790	0.002	-2.686	-0.894
	rTMS组	联合组	-1.370	0.012	-2.266	-0.474
FMA	AOT组	rTMS组	0.360	0.789	-2.245	2.965
	AOT组	联合组	-8.490	< 0.001	-11.095	-5.885
	rTMS组	联合组	-8.850	< 0.001	-11.455	-6.245
MBI	AOT组	rTMS组	0.880	0.623	-2.645	4.405
	AOT组	联合组	-9.850	0.002	-15.265	-4.435
	rTMS组	联合组	-10.730	0.001	-16.145	-5.315
CBIT-C	AOT组	rTMS组	-1.700	0.456	-6.178	2.778
	AOT组	联合组	-11.460	< 0.001	-15.938	-6.982
	rTMS组	联合组	-9.760	0.002	-14.238	-5.282
CBIT-B	AOT组	rTMS组	1.210	0.342	-1.289	3.709
	AOT组	联合组	-4.360	0.001	-6.859	-1.861
	rTMS组	联合组	-5.570	< 0.001	-8.069	-3.071
潜伏期	AOT组	rTMS组	0.790	0.156	-0.301	1.881
	AOT组	联合组	3.100	< 0.001	2.009	4.191
	rTMS组	联合组	2.310	< 0.001	1.219	3.401
振幅	AOT组	rTMS组	0.110	0.234	-0.073	0.293
	AOT组	联合组	-0.330	0.003	-0.513	-0.147
	rTMS组	联合组	-0.440	< 0.001	-0.623	-0.257

基于镜像神经元理论的动作观察疗法联合低频重复经颅磁刺激对脑卒中后单侧空间忽略的效果

Effect of action observation therapy based on mirror neuron system combined with low-frequency repetitive transcranial magnetic stimulation on post-stroke unilateral spatial neglect

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