Zhongguo cuzhong zazhi (Dec 2022)
运动想象-动觉治疗对缺血性卒中患者手功能康复效果的研究 The Efficacy of Kinesthetic Motor Imagery Therapy for Hand Function Rehabilitation of Stroke Patients
Abstract
目的 研究运动想象-动觉治疗对缺血性卒中患者偏瘫侧手功能的康复效果，探索对缺血性卒中患者有效的手功能训练方法。 方法 前瞻性入组2021年1月-2022年1月在首都医科大学附属北京天坛医院康复科住院及门诊诊疗的发病1个月内的缺血性卒中患者，将患者随机分为研究组（运动想象-动觉治疗组）和对照组（常规康复组）。研究组每日分别进行1次运动想象-动觉治疗和1次常规康复，治疗时间均为30 min，每周5 d，持续4周。对照组每日进行2次常规康复，每次治疗时间为30 min，每周5 d，持续4周。在治疗前对患者采用MoCA评定认知功能，采用混乱运动想象评估（chaotic motor imagery assessment battery，CMIA）和运动觉及视觉想象问卷（kinesthetic and visual imagery questionnaire，KVIQ）评定患者的运动想象能力，采用汉密尔顿抑郁量表（Hamilton depression scale，HAMD）评定患者是否存在抑郁。在治疗前、治疗4周后对患者进行Fugl-Meyer运动量表上肢部分（Fugl-Meyer assessment-upper extremity，FMA-UE）、Wolf上肢运动量表（Wolf motor function test，WMFT）、手臂动作调查测试（action research arm test，ARAT）进行手运动功能评定，采用日常生活能力（activity of daily living，ADL）量表评定日常生活能力，比较患者治疗前后上述指标的差异。 结果 研究共入组67例患者，对照组33例，脱落1例，研究组34例，脱落3例。两组基线数据差异无统计学意义。在治疗4周后，研究组的FMA-UE量表[50（40～58）分 vs. 37（24～56）分，P=0.017]、WMFT量表评分等级[53（41～64）分 vs. 42（32～57）分，P=0.013]、ARAT量表[45（35～50）分 vs. 35（16～48）分，P=0.005]、ADL量表[80（70～85）分 vs. 65（60～85）分，P=0.008]均高于对照组，但WMFT上肢运动量表中的作业时间差异无统计学意义。 结论 运动想象-动觉疗法与常规康复相比，可明显改善缺血性卒中患者偏瘫侧的手功能及日常生活能力。 Abstract: Objective To investigate the efficacy of kinesthetic motor imagery therapy in the recovery of hand function in stroke patients with upper-limb hemiparesis. Methods This study prospectively enrolled the patients with ischemic stroke within one month of onset who were treated in Department of Rehabilitation Medicine and Outpatient Department of Rehabilitation of Beijing Tiantan Hospital, Capital Medical University from January 2021 to January 2022. The patients were randomly divided into observation group (Kinesthetic motor imagery group) and control group (routine rehabilitation group). The observation group received kinesthetic motor imagery therapy based on routine rehabilitation once a day, 30 minutes each time, 5 days a week and for 4 weeks. The control group received routine rehabilitation twice a day, 30 minutes each time, 5 days a week and for 4 weeks. Before treatment, MoCA scale was used to assess cognitive function, chaotic motor imagery assessment battery (CMIA) and kinesthetic and visual imagery questionnaire (KVIQ) were used to assess motor imagery ability, and Hamilton depression scale (HAMD) was used to assess depression state. Before treatment and at one month of treatment, Fugl-Meyer assessment-upper extremity (WMFT), Wolf motor function test (FAM-UE) and action research arm test (ARAT) were used to assess hand function, activity of daily living (ADL) scale was used to assess daily living ability. The differences of the above indexes between the two groups were compared before and after treatment. Results A total of 67 patients were enrolled in the final analysis, with 33 patients in control group and 34 patients in observation group. There were no statistical differences in the baseline data between the two groups. At one month of treatment, the scores of FMA-UE [50 (40-58) vs. 37 (24-56), P=0.017], WMFT [53 (41-64) vs. 42 (32-57), P=0.013], ARAT [45 (35-50) vs. 35(16-48), P=0.005], ADL [80 (70-85) vs. 65 (60-85), P=0.008] were higher in observation group than those in control group. However, there was no statistical difference in WMFT operation time between the two groups. Conclusions Compared with conventional rehabilitation, kinesthetic motor imagery therapy can significantly improve the recovery of hemiplegic hand function and daily living activities ability of stroke patients.
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