基于镜像神经元理论的动作观察对脑卒中后上肢运动功能的临床疗效
摘要
目的观察镜像神经元训练系统对脑卒中后患者上肢运动功能的影响。方法将50名脑卒中偏瘫患者随机分为镜像组(n=25)和对照组(n=25)。两组患者均接受常规康复治疗,同时对照组患者使用舒尔特方格训练,镜像组患者使用镜像神经元训练系统训练,每次训练时间为20 min,3次/w,共6 w。治疗前后,通过Fugl-Myer上肢量表和Barthel指数分别对上肢运动功能和日常生活能力进行评估。结果经过6 w治疗后,两组Fugl-Myer量表上肢评分及Barthel指数较治疗前有显著提高(P<0.05);镜像组治疗前后上述评定结果的评分差值均显著优于对照组(P<0.05)。结论基于镜像神经元理论的动作观察对脑卒中患者具有较好的临床疗效,可改善上肢运动功能,提高生活质量。
引文
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29 Ramachandran VS.Mirror neurons and imitation learning as the driving force behind "the great leapforward" in human evolution[EB/OL].http://www.edge.org/3rd_culture/ramachandran/ramachandran_index.html.
30 Rizzolatti G,Fogassi L.The mirror mechanism:recent findings and perspectives[J].Philos Trans R Soc Lond B Biol Sci,2014;369(1644):20130420.
31 Hunnius S,Bekkering H.What are you doing?How active and observational experience shape infants' action understanding[J].Philos Trans R Soc Lond B Biol Sci,2014;369(1644):20130490.
32 Lacoste-Badie S,Droulers O.Advertising memory:the power of mirror neurons[J].J Neurosc Psychol Econom,2014;7(4):195-202.
33 Brucker B,Ehlis AC,H?uβinger FB,et al.Watching corresponding gestures facilitates learning with animations by activating human mirror-neurons:an fNIRS study[J].Learn Instru,2015;36:27-37.
34 Hari R, Forss N, Avikainen S, et al.Activation of human primary motor cortex during action observation:a neuromagnetic study[J].Proc Natl Acad Sci U S A,1998;95(25):15061-5
35 Cooper NR,Puzzo I,Pawley AD,et al.Bridging a yawning chasm:EEG investigations into the debate concerning the role of the human mirror neuron system in contagious yawning[J].Cogn Affect Behav Neurosci,2012;12(2):393-405.
36 Giromini L, Porcelli P, Viglione DJ, et al.The feeling of movement:EEG evidence for mirroring activity during the observations of static,ambiguous stimuli in the Rorschach cards[J].Biol Psychol,2010;85(2):233-41.
2 Gill HL,Siracuse JJ,Parrack IK,et al.Complications of the endovascular management of acute ischemic stroke[J].Vasc Health Risk Manag,2014;28(10):675-81.
3 Feigin VL,Krishnamurthi RV,Parmar P,et al.Update on the global burden ofischemic and hemorrhagic stroke in 1990-2013:the GBD 2013 study[J].Neuroepidemiology,2015;45(3):161-76.
4 Saeed E,Ali R,Jalal-ud-din M,et al.Hypercholesterolemia in patients of ischemic stroke[J].J Ayub Med Coll Abbottabad,2015;27(3):637-9.
5 Lawrence ES,Coshall C,Dundas R,et al.Estimates of the prevalence of acute stroke impairments and disability in a multiethnic population[J].Stroke,2001;32(6):1279-84.
6 Gurbuz N,Afsar SI,Ayas S,et al.Effect of mirror therapy on upper extremity motor function in stroke patients:a randomized controlled trial[J].J Phys Ther Sci,2016;28(9):2501-6.
7 Corbetta D,Sirtori V,Castellini G,et al.Constraint-induced movement therapy for upper extremities in people with stroke[J].Cochrane Database Syst Rev,2015;(10):CD004433.
8 Shah MV,Kumar S,Muragod AR.Effect of constraint induced movement therapy v/s motor relearning program for upper extremity function in subacute hemiparetic patients-a randomized clinical trial[J].Indian J Physiother Occup,2016;10:71-5.
9 Tsaih PL,Chiu MJ,Luh JJ,et al.Effects of electromyographic biofeedback muscle training on motor function and cortical excitability in stroke patients[J].Physiotherrapy,2015;101(1):e1538-e1539.
10 Lo AC,Guarino PD,Richards LG,et al.Robot-assisted therapy for longterm upper-limb impairment after stroke[J].N Engl J Med,2010;362(19):1772-83.
11 Ringman JM,Saver JL,Woolson RF,et al.Frequency,risk factors,anatomy,and course of unilateral neglect in an acute stroke cohort[J].Neurology,2004;63(3):468-74.
12 Di Monaco M,Sehintu S,Dotta M,et al.Severity of unilateral spatial neglect is an independent predictor of functional outcome after acute in patients rehabilitation in individuals with right hemispheric stroke[J].Arch Phys Med Rehabil,2011;92(8):1250-6.
13 Thieme H,Bayn M,Wurg M,et al.Mirror therapy for patients with severe arm paresis after stroke:a randomized controlled trial[J].Clin Rehabil,2013;27(4):314-24.
14 Buccino G.Action observation treatment:a novel tool in neurorehabilitation[J].Philos Trans R Soc B Biol Sci,2014;369(1644):1-8.
15 谢青,宋小慧.脑卒中康复治疗技术发展史[J].中国现代神经疾病杂志,2015;15(3):177-81.
16 Dobkin BH.Clinical practice.Rehabilitation after stroke[J].N Engl J Med,2005;352(16):1677-84.
17 Aprile I,Rabuffetti M,Padua L,et al.Kinematic analysis of the upper limb motor strategies instroke patients as a tool towards advanced neurorehabilitation strategies:a preliminary study[J].Biomed Res Int,2014;2014:636123.
18 Duncan PW,Goldstein LB,Horner RD,et al.Similar motor recovery of upper and lower extremities after stroke[J].Stroke,1994;25(6):1181-8.
19 张晓妍.基于脑电的注意力个性化训练研究[D].绵阳:西南科技大学,2015.
20 Fogassi L,Ferrari PF,Gesierich B,et al.Parietal lobe:from action organization to intention understanding[J].Science,2005;308(5722):662-7.
21 Iacoboni M,Molnar-Szakacs I,Gallese V,et al.Grasping the intentions of others with one's own mirror neuron system[J].Public Library Sci Biol,2005;3(3):529-35.
22 Kang YJ,Park HK,Kim HJ,et al.Upper extremity rehabilitation of stroke:facilitation of corticospinal excitability using virtual mirror paradigm[J].J Neuroeng Rehabil,2012;9:71.
23 Saleh S,Adamovich SV,Tunik E.Mirrored feedback in chronic stroke:recruitment and effective connectivity of ipsilesional sensorimotor networks[J].Neurorehabil Neural Rep,2014;28(4):344-54.
24 叶浩生.镜像神经元的意义[J].心理学报,2016;48(4):444-56.
25 Kilner JM,Lemon RN.What we know currently about mirror neurons[J].Curr Biol,2013;23(23):R1057-62.
26 Cook R,Bird G,Catmur C,et al.Mirror neurons:from origin to function[J].Behav Brain Sci,2014;37(2):177-92.
27 Jacob P.The tuning-fork model of human social cognition:a critique[J].Consci Cogn,2009;18(1):229-43.
28 Lamm C,Majdandzic J.The role of shared neural activations,mirror neurons,and morality in empathy-a critical comment[J].Neuro Res,2015;90:15-24.
29 Ramachandran VS.Mirror neurons and imitation learning as the driving force behind "the great leapforward" in human evolution[EB/OL].http://www.edge.org/3rd_culture/ramachandran/ramachandran_index.html.
30 Rizzolatti G,Fogassi L.The mirror mechanism:recent findings and perspectives[J].Philos Trans R Soc Lond B Biol Sci,2014;369(1644):20130420.
31 Hunnius S,Bekkering H.What are you doing?How active and observational experience shape infants' action understanding[J].Philos Trans R Soc Lond B Biol Sci,2014;369(1644):20130490.
32 Lacoste-Badie S,Droulers O.Advertising memory:the power of mirror neurons[J].J Neurosc Psychol Econom,2014;7(4):195-202.
33 Brucker B,Ehlis AC,H?uβinger FB,et al.Watching corresponding gestures facilitates learning with animations by activating human mirror-neurons:an fNIRS study[J].Learn Instru,2015;36:27-37.
34 Hari R, Forss N, Avikainen S, et al.Activation of human primary motor cortex during action observation:a neuromagnetic study[J].Proc Natl Acad Sci U S A,1998;95(25):15061-5
35 Cooper NR,Puzzo I,Pawley AD,et al.Bridging a yawning chasm:EEG investigations into the debate concerning the role of the human mirror neuron system in contagious yawning[J].Cogn Affect Behav Neurosci,2012;12(2):393-405.
36 Giromini L, Porcelli P, Viglione DJ, et al.The feeling of movement:EEG evidence for mirroring activity during the observations of static,ambiguous stimuli in the Rorschach cards[J].Biol Psychol,2010;85(2):233-41.