重复经颅磁刺激联合镜像疗法对脑卒中偏瘫患者上肢运动功能及神经电生理的效果

doi:10.3969/j.issn.1006-9771.2023.10.012

Abstract

Abstract:

Objective To investigate the effect of 1 Hz repetitive transcranial magnetic stimulation (rTMS) combined with mirror therapy on upper limb motor function and cortical neurophysiological indicators in stroke patients with hemiplegia.
Methods Sixty stroke patients who were admitted to Jinshan Hospital of Fudan University, from October, 2022 to March, 2023 were randomly assigned to control group (n = 15), rTMS group (n = 15), mirror therapy group (n = 15) and combined group (n = 15). All groups received routine medicine and rehabilitation. In addition, the control group received sham rTMS and sham mirror therapy, rTMS group received 1 Hz rTMS and sham mirror therapy, the mirror therapy group received sham rTMS and mirror therapy, and the combined group received 1Hz rTMS combined with mirror therapy, for four weeks. Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and Action Research Arm Test (ARAT) were used to evaluate the motor function of the affected upper limb. The motor-evoked potential (MEP) amplitude and central motor conduction time (CMCT) of the affected cortex were measured using a transcranial magnetic stimulation device.
Results After treatment, the scores of FMA-UE and ARAT, and the amplitude of MEP significantly improved in all groups (|t| > 3.854, P < 0.001), while the CMCT significantly shortened (t > 5.967, P < 0.001). Compared to the control group, rTMS group, the mirror therapy group and the combined group showed more significant improvement in the scores of FMA-UE and ARAT, and the amplitude of MEP, and shorter CMCT (P < 0.05). When compared to rTMS group and the mirror therapy group, the combined group showed more significant improvement the scores of FMA-UE and ARAT, and the amplitude of MEP, and shorter CMCT (P < 0.05). There was significant positive correlation of the scores of FMA-UE and ARAT with the amplitude of MEP, and negative correlation with the CMCT in all groups (R² > 0.804, P < 0.001).
Conclusion The combination of 1 Hz rTMS and mirror therapy contributes to the post-stroke brain functional remodeling and facilitates upper limb motor recovery in stroke patients with hemiplegia.

Key words: stroke, upper limb, motor function, neuroelectrophysiology, repetitive transcranial magnetic stimulation, mirror therapy

CLC Number:

R743.3

CHEN Benmei, JIANG Lixiang, QIU Mulei, WANG Chuanjie, TAO Feng. Effect of repetitive transcranial magnetic stimulation combined with mirror therapy on upper limb motor function and neuroelectrophysiology in stroke patients with hemiplegia[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(10): 1201-1207.

Figures/Tables 6

组别	n	治疗前	治疗后	t值	P值
对照组	15	25.20 $±$ 9.06	29.80±10.15	-9.465	< 0.001
磁刺激组	15	23.73 $±$ 8.70	38.87±9.43^a,b	-11.627	< 0.001
镜像疗法组	15	24.53±8.42	37.60±10.92^a,b	-9.038	< 0.001
联合组	15	24.87±9.27	46.87±11.10^a	-9.973	< 0.001
F值		0.075	6.743
P值		0.973	0.010

组别	n	治疗前	治疗后	t值	P值
对照组	15	18.63 $± 7.99$	22.80±9.04	-7.607	< 0.001
磁刺激组	15	17.63±7.79	30.30±8.01^a,b	-10.526	< 0.001
镜像疗法组	15	18.05±7.95	29.41±9.24^a,b	-8.457	< 0.001
联合组	15	18.21±8.28	37.14±9.13^a	-10.345	< 0.001
F值		0.040	6.561
P值		0.989	0.001

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组别	n	性别/n		年龄/岁	病程/d	卒中类型/n		病变侧/n
组别	n	男	女	年龄/岁	病程/d	脑梗死	脑出血	左侧	右侧
对照组	15	8	7	55.60±7.11	32.53±21.56	10	5	9	6
磁刺激组	15	9	6	59.80±8.29	29.87±20.59	12	3	8	7
镜像疗法组	15	10	5	60.67±8.85	27.20±15.39	9	6	7	8
联合组	15	7	8	57.67±9.83	35.27±20.70	11	4	9	6
χ²/F值		1.357		1.052	0.464	1.587		0.741
P值		0.716		0.377	0.708	0.662		0.864

Effect of repetitive transcranial magnetic stimulation combined with mirror therapy on upper limb motor function and neuroelectrophysiology in stroke patients with hemiplegia

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组别	n	治疗前	治疗后	t值	P值
对照组	15	0.747±0.251	0.890±0.275	-3.854	< 0.001
磁刺激组	15	0.754±0.240	1.120±0.262^a,b	-6.360	< 0.001
镜像疗法组	15	0.749±0.236	1.143±0.317^a,b	-6.456	< 0.001
联合组	15	0.767±0.234	1.397±0.318^a	-6.797	< 0.001
F值		0.021	7.443
P值		0.996	0.001

组别	n	治疗前	治疗后	t值	P值
对照组	15	11.37±1.13	10.89±1.16	6.286	< 0.001
磁刺激组	15	11.81±1.05	10.03±1.04^a,b	10.927	< 0.001
镜像疗法组	15	11.23±1.15	10.09±1.03^a,b	5.967	< 0.001
联合组	15	11.11±1.12	9.27±0.86^a	7.553	< 0.001
F值		1.125	6.185
P值		0.347	0.001

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