镜像神经元康复策略联合经颅磁刺激对卒中后神经与功能康复的作用研究

doi:10.3969/j.issn.1006-6233.2024.06.025

摘要
图/表
参考文献
相关文章 (6)

全文: PDF (1238 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要 目的: 研究镜像神经元康复策略(Mirror Neuron System,MNS)联合经颅磁刺激(Transcranial Magnetic Stimulation,TMS)对卒中后神经与功能康复的作用。方法: 选取2019年1月至2023年6月某部队康复中心收治的198例卒中后遗留有运动功能障碍患者,采用随机数字表法分为三组,各66例。三组均给予常规康复指导,磁刺激组给予TMS治疗,镜像组给予MNS治疗,联合组给予TMS+MNS治疗。比较三组干预前、干预2周后、干预4周后神经功能(NIHSS)、上下肢运动功能(FMA)、日常生活能力(ADL)、平衡能力(BBS)、上肢与下肢肌张力(MAS)、健患侧步长差、患侧负重时间百分比及语言功能。结果: 联合组干预2周、4周后NIHSS评分低于磁刺激组、镜像组,差异具有统计学意义(P<0.05),磁刺激组、镜像组组间比较,差异无统计学意义(P>0.05);联合组干预2周、4周后FMA-上肢、FMA-下肢评分高于磁刺激组、镜像组,且镜像组高于磁刺激组,差异具有统计学意义(P<0.05);联合组干预2周、4周后ADL评分、BBS评分高于磁刺激组、镜像组,且镜像组高于磁刺激组,差异具有统计学意义(P<0.05);联合组干预4周后上肢和下肢MAS分级0~1级患者占比高于磁刺激组、镜像组,且磁刺激组高于镜像组,差异具有统计学意义(P<0.05);联合组干预2周、4周后健患侧步长差低于磁刺激组、镜像组,患侧负重时间百分比高于磁刺激组、镜像组,且镜像组变化幅度大于磁刺激组,差异具有统计学意义(P<0.05);联合组干预2周、4周后语言功能中阅读理解、复述、流畅度、命名评分高于磁刺激组、镜像组,且磁刺激组高于镜像组,差异具有统计学意义(P<0.05)。结论: MNS联合TMS能促进卒中后神经与功能康复,有利于改善患者日常生活能力,且二者各有优势,互相补充,联合治疗效果显著,值得临床推广。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章

关键词 ：镜像神经元康复策略, 经颅磁刺激, 卒中, 神经康复, 平衡能力, 上下肢运动功能

Abstract：Objective: To study the effects of the Mirror Neuron System (MNS) rehabilitation strategy combined with Transcranial Magnetic Stimulation (TMS) on neurological and functional recovery post-stroke.Methods: A total of 198 patients with motor dysfunction following a stroke, treated at a military rehabilitation center from January 2019 to June 2023, were selected and randomly divided into three groups of 66 patients each. All three groups received conventional rehabilitation guidance; the TMS group received TMS treatment, the MNS group received MNS treatment, and the combined group received TMS+MNS treatment. Neurological function (NIHSS), upper and lower limb motor function (FMA), activities of daily living (ADL), balance ability (BBS), upper and lower limb muscle tone (MAS), step length difference between healthy and affected sides, percentage of weight-bearing time on the affected side, and language function were compared among the three groups before the intervention, after 2 weeks of intervention, and after 4 weeks of intervention.Results: After 2 and 4 weeks of intervention, the NIHSS scores of the combined group were lower than those of the TMS group and the MNS group, with statistically significant differences (P<0.05); there was no statistically significant difference between the TMS group and the MNS group (P>0.05). After 2 and 4 weeks of intervention, the FMA-upper limb and FMA-lower limb scores of the combined group were higher than those of the TMS group and the MNS group, and the MNS group scored higher than the TMS group, with statistically significant differences (P<0.05). After 2 and 4 weeks of intervention, the ADL scores and BBS scores of the combined group were higher than those of the TMS group and the MNS group, and the MNS group scored higher than the TMS group, with statistically significant differences (P<0.05). After 4 weeks of intervention, the proportion of patients with upper and lower limb MAS grades 0-1 in the combined group was higher than in the TMS group and the MNS group, and higher in the TMS group than in the MNS group, with statistically significant differences (P<0.05). After 2 and 4 weeks of intervention, the step length difference between the healthy and affected sides in the combined group was lower than that in the TMS group and the MNS group, and the percentage of weight-bearing time on the affected side was higher than that in the TMS group and the MNS group, with greater changes observed in the MNS group compared to the TMS group, with statistically significant differences (P<0.05). After 2 and 4 weeks of intervention, scores for reading comprehension, repetition, fluency, and naming in language function were higher in the combined group than in the TMS group and the MNS group, and higher in the TMS group than in the MNS group, with statistically significant differences (P<0.05).Conclusion: MNS combined with TMS can promote neurological and functional recovery post-stroke, and improve patients' activities of daily living, and each method has its advantages and complements the other. The combined treatment is significantly effective and worthy of clinical promotion.

Key words： Mirror neuron rehabilitation strategy Transcranial magnetic stimulation Stroke Neurological rehabilitation Balance ability Upper and lower limb motor function

基金资助:2020年福建省卫生健康科技计划项目资助计划项目,(编号:2020GGA506)

通讯作者: 林莉

引用本文:

范白燕, 朱建文, 左惠荣, 王蕾, 黄赛云, 林莉. 镜像神经元康复策略联合经颅磁刺激对卒中后神经与功能康复的作用研究[J]. 河北医学, 2024, 30(6): 1007-1014.
FAN Baiyan, ZHU Jianwen, ZUO Huirong, et al. Study on the Effects of Mirror Neuron Rehabilitation Strategy Combined with Transcranial Magnetic Stimulation on Neurological and Functional Recovery Post-Stroke. HeBei Med, 2024, 30(6): 1007-1014.

链接本文:

http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2024.06.025 或 http://www.hbyxzzs.cn/CN/Y2024/V30/I6/1007

[1] Ozgozen S,Guzel R,Basaran S,et al.Residual deficits of knee flexors and plantar flexors predict normalized walking performance in patients with poststroke hemiplegia[J].Stroke Cerebrovasc Dis,2020,29(4):104658.
[2] Binder E,Leimbach M,Pool EM,et al.Cortical reorganization after motor stroke:a pilot study on differences between the upper and lower limbs[J].Hum Brain Mapp,2021,42(4):1013-1033.
[3] Chang AJ,Wilmskoetter J,Fridriksson J,et al.Cortical microstructural changes associated with treated aphasia recovery[J].Ann Clin Transl Neurol,2021,8(9):1884-1894.
[4] 凌晴,胡世红,王田尧,等.镜像疗法促进脑卒中上肢功能恢复和皮质脊髓束重塑的弥散张量成像研究[J].中国康复理论与实践,2021,27(1):31-36.
[5] Jannati A,Oberman LM,Rotenberg A,et al.Assessing the mechanisms of brain plasticity by transcranial magnetic stimulation[J].Neuropsychopharmacology,2023,48(1):191-208.
[6] 吴毅.重复经颅磁刺激在脑卒中康复中的临床应用与作用机制的研究进展[J].中国康复医学杂志,2023,38(2):147-150.
[7] Hao J,Xie HY,Harp K,et al.Effects of virtual reality intervention on neural plasticity in stroke rehabilitation:a systematic review[J].Arch Phys Med Rehabil,2022,103(3):523-541.
[8] 中华医学会神经病学分会脑血管病学组急性缺血性脑卒中.中国急性缺血性脑卒中诊治指南2010[J].中国全科医学,2011,14(35):4013-4017.
[9] 甘勇,杨婷婷,刘建新,等.国内外脑卒中流行趋势及影响因素研究进展[J].中国预防医学杂志,2019,20(2):139-144.
[10] Lin S,Wang D,Sang H,et al.Predicting poststroke dyskinesia with resting-state functional connectivity in the motor network[J].Neurophotonics,2023,10(2):25001.
[11] 王帅,王东岩,郑应康,等.基于脑-肢协同调控治疗卒中后肢体运动功能障碍的研究进展[J].华西医学,2023,38(1):140-146.
[12] 林邢波,黄夏莲.镜像视觉反馈疗法联合电刺激对脑卒中后下肢功能障碍的影响[J].中国医刊,2020,55(10):1138-1141.
[13] Mao HW,Li Y,Tang L,et al.Effects of mirror neuron system-based training on rehabilitation of stroke patients[J].Brain Behav,2020,10(8):1729.
[14] Bai Z,Zhang J,Fong KNK.Effects of transcranial magnetic stimulation in modulating cortical excitability in patients with stroke:a systematic review and meta-analysis[J].Neuroeng Rehabil,2022,19(1):24.