Zhongguo cuzhong zazhi (Oct 2022)
脑机接口训练对卒中后感觉障碍患者运动功能恢复的影响：1项探索性研究 Effects of Brain-Computer Interface Training on Motor Function Recovery in Patients with Post-Stroke Sensory Impairment: An Exploratory Study
Abstract
目的 探究脑机接口训练对存在感觉障碍的卒中患者运动功能恢复的影响。 方法 前瞻性招募同时存在上肢感觉和运动功能障碍的卒中受试者，随机分为试验组与对照组。试验组接受每周5 d，每日1次，每次30 min，共4周的基于运动尝试的机器人辅助下的抓握张开脑机接口训练，对照组则进行每周5 d，每日1次，每次30 min，共4周的抓握张开相关任务导向性训练。在干预前后采用Fugl-Meyer上肢运动功能评定量表（Fugl-Meyer assessment upper extremity scale，FMA-UE）、上肢动作研究量表（action research arm test，ARAT）评估患者的上肢运动功能；Fugl-Meyer量表上肢感觉评分评价感觉功能；改良的Ashworth量表（modified Ashworth scale，MAS）评估肌张力；改良Barthel指数（modified Barthel index，MBI）评估日常生活能力。比较2组治疗后较本组治疗前上述指标的改善情况，治疗后2组上述指标的差异以及各指标干预后较干预前的进步情况（干预后分值-干预前分值）。 结果 共纳入12例存在上肢感觉和运动功能障碍的卒中患者，试验组与对照组各6例。试验组[19.00（16.50～42.25）分 vs. 10.00（7.75～23.25）分，P=0.028]、对照组[13.00（10.50～27.50）分 vs. 9.00（8.50～21.00）分，P=0.042]干预后FMA-UE评分均较本组干预前显著改善，此外，试验组患者干预后在ARAT[4.00（3.50～10.50）分 vs. 2.00（1.00～14.00）分，P=0.042]、MBI评分[75.00（58.75～87.50）分 vs. 57.50（50.00～67.50）分，P=0.041]方面也较本组干预前显著改善。干预后2组的比较显示，试验组MBI较对照组提高[75.00（58.75～87.50）分 vs. 45.00（45.00～55.00）分，P=0.023]，余指标差异无统计学意义。另外，比较2组干预后各指标的进步情况，试验组FMA-UE[9.50（6.75～15.25）分 vs. 4.50（3.00～8.25）分，P=0.030]及屈指MAS[-0.50（-1.00～0.00）分 vs. 0.00（0.00～0.50）分，P=0.020]的进步较对照组明显。 结论 对于存在感觉障碍的患者，进行脑机接口干预可促进其运动功能恢复及日常生活能力的提升。 Abstract: Objective To investigate the effects of brain-computer interface (BCI) training on motor function recovery in stroke patients with sensory impairment. Methods The stroke subjects with upper limb sensory and motor function impairment were prospectively enrolled in this study, and all the subjects were randomly divided into experimental group and control group. The experimental group received the robot-assisted graspping and opening brain-computer interface training based on motor attempt, 5 days a week, once a day, 30 minutes each time, for 4 weeks, while the control group received the graspping and opening task-oriented training, 5 days a week, once a day, 30 minutes each time, for 4 weeks. Fugl-Meyer assessment upper extremity scale (FMA-UE) and action research arm test (ARAT) were used to evaluate the upper limb motor function of patients before and after the intervention, and Fugl-Meyer Scale upper limb sensory score was used to evaluate sensory function. The modified Ashworth scale (MAS) was used to evaluate muscle tone. The modified Barthel index (MBI) to evaluate the activity of daily living. The improvement of the above indexes after treatment were compared between the two groups, and the difference of the above indexes after treatment were compared between the two groups. Results A total of 12 eligible stroke patients were included, with 6 cases in each group. The FMA-UE score improved in the experimental group [19.00 (16.50-42.25) vs. 10.00 (7.75-23.25), P=0.028] and the control group [13.00 (10.50-27.50) vs. 9.00 (8.50-21.00), P=0.042] after intervention compared with that before intervention. The ARAT [4.00 (3.50-10.50) vs. 2.00 (1.00-14.00), P=0.042] and MBI scores [75.00 (58.75-87.5) vs. 57.50 (50.00-67.50), P=0.041] in experimental group after intervention also improved compared with those before intervention. The MBI score after intervention in experimental group was higher than that in the control group [75.00 (58.75-87.5) vs. 45.00 (45.00-55.00), P=0.023], and there were no satistical differences in other indexes. The improvements of FMA-UE [9.50 (6.75-15.25) vs. 4.50 (3.00-8.25), P=0.030] and flexion MAS scores [-0.50 (-1.00-0.00) vs. 0.00 (0.00-0.50), P=0.020] in the experimental group were better than those in the control group. Conclusions For patients with impaired sensory function, brain-computer interface intervention can promote the recovery of motor function and activity of daily living.
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