目的探讨运动想象疗法对脑卒中患者运动功能康复的疗效。方法2015年5月至2016年10月,40例脑卒中偏瘫患者随机分为对照组(常规康复疗法)和运动想象组(运动想象+常规康复疗法),每组20例。治疗前及治疗6周后,分别采用Fugl-Meyer评定量表(FMA)、改良Barthel指数(MBI)进行评定,采用磁共振弥散张量成像(DTI)测量患者各向异性分数(FA)。结果治疗后,两组患者FMA评分、MBI评分均较治疗前显著提高(t>5.088, P<0.001),运动想象组优于对照组(t>2.124, P<0.05)。治疗前,两组病灶侧FA均较对侧明显减小(t>3.892, P<0.01),两组间无显著性差异(t<1.144, P>0.05);治疗后,运动想象组有较多患者(5/5 vs. 2/4) FA升高。结论运动想象疗法能促进脑卒中恢复期患者运动功能及日常生活活动能力恢复,对受损白质纤维的恢复可能有帮助。
ObjectiveTo explore the effect of motor imagery on motor recovery in hemiplegic patients after stroke. MethodsFrom May, 2015 to October, 2016, 40 hemiplegic patients after stroke were randomly divided into control group (accepted routine rehabilitation, n=20) and motor imagery group (accepted motor imagery and routine rehabilitation, n=20). They were assessed with Fugl-Meyer Assessment (FMA), modified Barthel Index (MBI) before and six weeks after treatment. Fractional anisotropy (FA) of the focus was measured with diffusion tensor imaging (DTI). ResultsThe scores of FMA and MBI improved in both groups after treatment (t>5.088, P<0.001), and improved more in the motor imagery group than in the control group (t>2.124, P<0.05). The FA reduced in the focus compared with the same site of unaffected side in both groups before treatment (t>3.892, P<0.01), and there was no significant difference between two groups (t<1.144, P>0.05). FA increased in more patients of the motor imagery group (5/5) than in the control group (2/4). ConclusionMotor imagery can promote the recovery of motor function and activities of daily living in stroke patients, and may help the recovery of fibers in white matter.
[1] Wang W, Jiang B, Sun H, et al. Prevalence, incidence and mortality of stroke in China: Results from a Nationwide Population-Based Survey of 480,687 adults [J]. Circulation, 2017, 135(8): 759-771.
[2] Zhao XF, Du Y, Liu PG, et al. Acupuncture for stroke: evidence of effectiveness, safety, and cost from systematic reviews [J]. Top Stroke Rehabil, 2012, 19(3): 226-233.
[3] Valiengo L, Casati R, Bolognini N, et al. Transcranial direct current stimulation for the treatment of post-stroke depression in aphasic patients: a case series [J]. Neurocase, 2016, 22(2): 225-228.
[4] Saposnik G, Levin M. Virtual reality in stroke rehabilitation: a meta-analysis and implications for clinicians [J]. Stroke, 2011, 42(5): 1380-1386.
[5] Høyer E, Jahnsen R, Stanghelle JK, et al. Body weight supported treadmill training versus traditional training in patients dependent on walking assistance after stroke: a randomized controlled trial [J]. Disabil Rehabil, 2012, 34(3): 210-219.
[6] Nikhil S. Motor imagery after stroke: where next? [J]. Imag Med, 2012, 4(1): 129-136.
[7] Porro CA, Francescato MP, Cettolo V, et al. Primary motor and sensory cortex activation during motor performance and motor imagery: a functional magnetic resonance imaging study [J]. J Neurosci, 1996, 16: 7688-7698.
[8] Dettmers C, Benz M, Liepert J, et al. Motor imagery in stroke patients, or plegic patients with spinal cord or peripheral diseases [J]. Acta Neurol Scand, 2012, 126(4): 238-247.
[9] Yeo SS, Seo JP, Kwon YH, et al. Precommissural fornix in the human brain: a diffusion tensor tractography study [J]. Yonsei Med J, 2013, 54(2): 315-320.
[10] Zijta FM, Froeling M, Nederveen AJ, et al. Diffusion tensor imaging and fiber tractography for the visualization of the female pelvic floor [J]. Clin Anat, 2013, 26(1): 110-114.
[11] Huseyinsinoglu BE, Ozdincler AR, Krespi Y. Bobath concept versus constraint-induced movement therapy to improve arm functional recovery instrokepatients: a randomized controlled trial [J]. Clin Rehabil, 2012, 26(8): 705-715.
[12] Pereira S, Mehta S, Lobo L, et al. Functional electrical stimulation for improving gait in persons with chronic stroke [J]. Top Stroke Rehabil, 2012, 19(6): 491-498.
[13] Langhammer B, Stanghelle JK. Can physiotherapy after stroke based on the Bobath concept result in improved quality of movement compared to the motor relearning programme [J]. Physiother Res Int, 2011, 16(2): 69-80.
[14] Kho AY, Liu KP, Chung RC. Meta-analysis on the effect of mental imagery on motorrecovery of the hemiplegic upper extremity function [J]. Aust Occup Ther J, 2014, 61(2): 38-48.
[15] Hong IK, Choi JB, Lee JH. Cortical changes after mental imagery training combined with electromyography-triggered electrical stimulation in patients with chronic stroke [J]. Stroke, 2012, 43(9): 2506-2509.
[16] Brunelli S, Morone G, Iosa M, et al. Efficacy of progressive muscle relaxation, mental imagery, and phantom exercise training on phantom limb: a randomized controlled trial [J]. Arch Phys Med Rehabil, 2015, 96(2): 181-187.
[17] Berger CC, Ehrsson HH. The fusion of mental imagery and sensation in the temporal association cortex [J]. J Neurosci, 2014, 34(41): 13684-13692.
[18] Torunn A, Julie B, Dahle LA, et al. Stroke patients do not need to be inactive in the first two-weeks after stroke: results from a stroke unit focused on early rehabilitation [J]. Int J Stroke, 2012, 7(1): 25-31.
[19] Svendsen ML, Ehlers LH, Ingeman A, et al. Higher stroke unit volume associated with improved quality of early stroke care and reduced length of stay [J]. Stroke, 2012, 43(11): 3041-3045.
[20] Song J, Nair VA, Young BM, et al. DTI?measures track and predict motor function outcomes in?stroke?rehabilitation utilizing BCI technology [J]. Front Hum Neurosci, 2015, 9: 195.
[21] Aja-Fernandez S, Alberola-Lopez C, Westin CF. Noise and signal estimation in magnitude MRI and Rician distributed images: a LMMSE approach [J]. IEEE Trans Image Process, 2008, 17(8): 1383-1398.
[22] Assemlal HE, Tschumperle D, Brun L, et al. Recent advances in diffusion MRI modeling: angular and radial reconstruction [J]. Med Image Anal, 2011, 15(4): 369-396.
[23] Durrleman S, Fillard P, Pennec X, et al. Registration, atlas estimation and variability analysis of white matter fiber bundles modeled as currents [J]. Neuroimage, 2011, 55(3): 1073-1090.
[24] Seo Y. Effects of different field strengths, gradient directions, and acquisitions on fractional anisotropy in diffusiontensor imaging: A tract-based spatial statistics study [J]. Concept Magnetic Resonance Part B, 2013, 43B(1): 41-48.
