智能镜像手套任务导向性训练联合低频重复经颅磁刺激对脑卒中患者手功能效果的随机对照试验

doi:10.3969/j.issn.1006-9771.2024.07.012

Abstract

Abstract:

Objective To explore the effect of task-oriented training of intelligent mirror gloves combined with low-frequency repetitive transcranial magnetic stimulation (rTMS) on hand function recovery in stroke patients.
Methods From October 1st, 2022 to June 30th, 2023, 136 stroke patients in Northern Jiangsu People's Hospital were randomly divided into control group, mirror group, rTMS group and combination group, with 34 patients in each group. All the groups received routine rehabilitation treatment. In addition, the mirror group received task-oriented training of intelligent mirror gloves, rTMS group received low-frequency rTMS, and the combination group received task-oriented training combined with low-frequency rTMS, for four weeks. The Fugl-Meyer Assessment-Upper Extremities (FMA-UE) score, Wolf Motor Function Test (WMFT) score, and surface electromyographic root mean square (RMS) of forearm extensor and flexor muscle groups on the affected/healthy side before and after treatment were compared. And the differences of transcranial magnetic stimulation-motor-evoked potentials (MEP) between rTMS group and combination group before and after treatment were also compared.
Results Four cases in the control group, seven in the mirror group, five in rTMS group and six in the combination group dropped off. The intra-group effect (F > 996.656, P < 0.001), inter-group effect (F > 20.333, P < 0.001) and interaction effect (F > 72.796, P < 0.001) were significant in the scores of FMA-UE and WMFT, and the RMS ratio of forearm extensor and flexor muscle groups among four groups, in which the combination group was the best. After treatment, the amplitude of MEP increased in rTMS group and combination group (|t| > 3.842, P < 0.05), and was higher in the combination group than in rTMS group (t = -3.060, P < 0.01).
Conclusion The task-oriented training of intelligent mirror gloves combined with low-frequency rTMS could effectively promote the recovery of hand function in stroke patients.

Key words: stroke, intelligent mirror gloves, task-oriented training, repetitive transcranial magnetic stimulation, hand function, randomized controlled trial

CLC Number:

R743.3

CHEN Chen, MENG Zhaoxiang, YANG Kang, ZHANG Minjie, ZUO Ya'nan, WANG Kui, ZHANG Xibin, QUAN Yifeng, JIN Xing. Effect of intelligent mirror glove task-oriented training combined with low-frequency repetitive transcranial magnetic stimulation on hand function in patients with stroke: a randomized controlled trial[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(7): 831-838.

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References 26

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组别	n	性别(男/女)/n	年龄/岁	病程/d	病变性质(缺血/出血)/n	偏瘫侧(左/右)/n
对照组	30	20/10	64.75±9.09	23.75±5.55	26/4	20/10
镜像组	27	20/7	59.22±15.39	23.26±12.46	25/2	21/6
rTMS组	29	22/7	55.17±13.51	26.83±7.51	29/0	22/7
联合组	28	25/3	63.56±9.74	24.43±10.69	28/0	22/6
χ²/F值		4.230	1.209	0.367	7.334	1.396
P值		0.238	0.315	0.777	0.062	0.706

变量	组别	治疗前		治疗后
变量	组别	均值	标准差	均值	标准差
FMA-UE	对照组	9.5	3.42	17.56	3.03
	镜像组	10.13	3.24	22.94	4.75
	rTMS组	9.46	1.72	30.92	2.96
	联合组	10.25	3.79	32.62	4.09
WMFT	对照组	7.19	4.35	17.01	2.99
	镜像组	8.00	4.93	21.30	3.81
	rTMS组	7.36	3.53	28.18	2.93
	联合组	7.25	4.12	37.75	4.04
伸肌群RMS比/%	对照组	2.04	1.20	14.33	3.48
	镜像组	3.70	2.81	21.82	7.50
	rTMS组	4.10	3.02	26.53	6.62
	联合组	4.39	3.12	41.74	7.21
屈肌群RMS比/%	对照组	5.51	2.91	18.90	4.98
	镜像组	8.80	5.07	32.34	7.03
	rTMS组	8.75	5.05	43.78	7.84
	联合组	7.99	6.69	58.08	11.63

变量		平方和	自由度	均方	F值	P值
FMA-UE	组内	7918.339	1	7918.339	1566.204	< 0.001
	组间	1206.813	3	402.271	20.303	< 0.001
	组内×组间	1104.117	3	368.039	72.796	< 0.001
WMFT	组内	8343.516	1	8343.516	1024.803	< 0.001
	组间	1965.711	3	655.237	26.165	< 0.001
	组内×组间	2066.651	3	688.884	84.613	< 0.001
伸肌群RMS比	组内	11865.650	1	11865.650	996.656	< 0.001
	组间	4051.778	3	1350.593	29.029	< 0.001
	组内×组间	2573.227	3	857.742	72.046	< 0.001
屈肌群RMS比	组内	22585.961	1	22585.961	1063.093	< 0.001
	组间	7598.295	3	2532.765	29.675	< 0.001
	组内×组间	5714.070	3	1904.690	89.651	< 0.001

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
FMA-UE	对照组	镜像组	-3.000	0.009	-5.228	-0.772
	对照组	rTMS组	-7.906	< 0.001	-10.135	-5.678
	对照组	联合组	3.000	0.009	0.772	5.228
	镜像组	rTMS组	6.666	< 0.001	4.308	9.014
	镜像组	联合组	3.661	0.003	1.308	6.014
	rTMS组	联合组	-1.245	0.294	-3.599	1.108
WMFT	对照组	镜像组	-2.558	0.030	-4.865	-0.252
	对照组	rTMS组	-6.156	0.001	-9.548	-2.764
	对照组	联合组	-10.406	< 0.001	-12.911	-7.901
	镜像组	rTMS组	-3.598	0.031	-6.846	-0.350
	镜像组	联合组	-7.848	< 0.001	-10.155	-5.541
	rTMS组	联合组	-4.250	0.015	-7.642	-0.858
伸肌群RMS比	对照组	镜像组	-4.582	0.005	-7.726	-1.438
	对照组	rTMS组	-7.135	0.003	-11.759	-2.512
	对照组	联合组	-15.384	< 0.001	-18.799	-11.970
	镜像组	rTMS组	-2.554	0.253	-6.981	1.874
	镜像组	联合组	-10.803	< 0.001	-13.947	-7.658
	rTMS组	联合组	-8.249	0.001	-12.872	-3.625
屈肌群RMS比	对照组	镜像组	-8.868	< 0.001	-13.126	-4.609
	对照组	rTMS组	-14.560	< 0.001	-20.823	-8.298
	对照组	联合组	-21.328	< 0.001	-25.953	-16.703
	镜像组	rTMS组	-5.693	0.062	-11.689	0.304
	镜像组	联合组	-12.460	< 0.001	-16.719	-8.202
	rTMS组	联合组	-6.768	0.035	-13.030	-0.505

组别	n	测试	$\bar{x}±s$	t值	P值
rTMS组	29	前测	21.95±1.03	-0.461	0.664
		后测	22.10±1.30
联合组	28	前测	21.53±2.92	0.430	0.673
		后测	21.28±3.02
治疗前两组均值差			0.42±0.23	0.340	0.737
治疗后两组均值差			0.82±0.44	0.633	0.534

Effect of intelligent mirror glove task-oriented training combined with low-frequency repetitive transcranial magnetic stimulation on hand function in patients with stroke: a randomized controlled trial

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组别	n	测试	$\bar{x}±s$	t值	P值
rTMS组	29	前测	162.67±65.06	-3.842	0.012
		后测	274.67±88.76
联合组	28	前测	160.06±61.40	-12.288	< 0.001
		后测	377.63±63.86
治疗前两组均值差			19.83±12.60	0.087	0.931
治疗后两组均值差			-102.96±33.65	-3.060	0.006

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