Fugl-Meyer量表在脑卒中镜像治疗中应用及与FIM量表相关性分析
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摘要
目的研究Fugl-Meyer运动功能评分量表上肢部分(upper Fugl-Meyer motor function assessment,U-FMA)在脑卒中患者镜像康复治疗中的评估作用及与功能独立性评测量表(functional independence measure, FIM)的关系。方法将80例脑卒中后偏瘫的患者随机分为常规康复组(40例)和镜像治疗组(40例)。常规康复组给予常规康复训练,镜像治疗组在常规康复训练的基础上加用镜像疗法;疗程均为24周。治疗前及治疗8、16、24周后采用U-FMA量表评估运动功能、FIM量表评估日常独立活动能力。分析患者运动功能及日常生活活动能力改善程度,并分析两者间的相关性。结果两组治疗8周、16周、24周后,与治疗前U-FMA评分、FIM评分相比,差异有统计学意义(P<0.05)。两组U-FMA评分、FIM评分相比,差异有统计学意义(P<0.05)。相关性分析显示,U-FMA评分与FIM评分呈正相关。结论镜像治疗能够提高脑卒中偏瘫患者上肢运动功能,改善日常生活活动能力。U-FMA量表、FIM量表均能较好反映卒中患者康复后上肢运动功能、日常生活能力改善程度,两者具有良好的相关性。
Objective To evaluate the role of the upper Fugl Meyer motor function assessment(U-FMA) in the mirror therapy of stroke patients and its correlation with the functional independence measure(FIM). Methods A total of 80 patients with hemiplegia were randomly divided into the mirror therapy group(40 cases) and the routine rehabilitation group(40 cases). Patients in the routine rehabilitation group were given routine rehabilitation training, mirror treatment group were given the mirror therapy based on routine rehabilitation therapy. The treatment lasted 24 weeks. Before the treatment and after 8, 16, and 24 weeks' treatment, the U-FMA was used to evaluate the motor function with the FIM to assess the daily independent activity ability in order to analyze the patient's motor function and daily life. The improvement degree of the patient's motor function and the daily living activities and the correlation between the two scales were analyzed. Results After 8, 16 and 24 weeks' treatment, the scores of U-FMA and FIM in two groups were significantly different compared with before treatment(P<0.05). The scores in mirror treatment group were statistically significant than those in routine rehabilitation group(P<0.05). Correlation analysis showed that U-FMA score was positively correlated with FIM score.Conclusion The mirror treatment can improve the upper limb motor function and the activities of daily living in stroke patients with hemiplegia. U-FMA and FIM can better reflect the improvement of upper limb motor function and daily living ability of stroke patients after rehabilitation, and the two scores show positive correlation.
Objective To evaluate the role of the upper Fugl Meyer motor function assessment(U-FMA) in the mirror therapy of stroke patients and its correlation with the functional independence measure(FIM). Methods A total of 80 patients with hemiplegia were randomly divided into the mirror therapy group(40 cases) and the routine rehabilitation group(40 cases). Patients in the routine rehabilitation group were given routine rehabilitation training, mirror treatment group were given the mirror therapy based on routine rehabilitation therapy. The treatment lasted 24 weeks. Before the treatment and after 8, 16, and 24 weeks' treatment, the U-FMA was used to evaluate the motor function with the FIM to assess the daily independent activity ability in order to analyze the patient's motor function and daily life. The improvement degree of the patient's motor function and the daily living activities and the correlation between the two scales were analyzed. Results After 8, 16 and 24 weeks' treatment, the scores of U-FMA and FIM in two groups were significantly different compared with before treatment(P<0.05). The scores in mirror treatment group were statistically significant than those in routine rehabilitation group(P<0.05). Correlation analysis showed that U-FMA score was positively correlated with FIM score.Conclusion The mirror treatment can improve the upper limb motor function and the activities of daily living in stroke patients with hemiplegia. U-FMA and FIM can better reflect the improvement of upper limb motor function and daily living ability of stroke patients after rehabilitation, and the two scores show positive correlation.
引文
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[12] Guo J, Qian S, Wang Y, et al.Clinical study of combined mirror and extracorporeal shock wave therapy on upper limb spasticity in poststroke patients[J]. Int J Rehabil Res, 2019, 42(1):31-35.
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[14] Wang W, Zhang X, Ji X, et al. Mirror neuron therapy for hemispatial neglect patients[J].Sci Rep, 2015, 5: 8664.
[15] Oi HS, Van Heng Y, Danielsson L, et al. Mirror therapy for phantom limb and stump pain: a randomized controlled clinical trial in landmine amputees in Cambodia[J]. Scand J Pain, 2018, 18(4): 603-610.
[16] Mano Y, Chuma T, WatanabeI.Cortical reorganization in training[J].J Electromyogr Kinesiol, 2003, 13(1):57-62.
[17] Pascolo PB, Cattarinussi A.On the relationship between mouthopening and “broken mirror neurons” in autistic individuals[J].J Electromyogr Kinesiol, 2012, 22(1):98-102.
[18] Sale P, Franceshini M.Action observation and mirror neuron network:a tool for motor stroke rehabilitation[J].Eur J Phys Rehabil Med, 2012, 48(2):313-318.
[19] NojimaI, Mima T, Koganemaru S, et al.Human motor plasticity induced by mirror visual feedback[J].J Neurosci, 2012, 32(4):1293-1300.
[20] Cheng CH, Sun HH, Weng JQ, et al.Differential motor cortex excitability during observation of normal and abnormal goal-directed movement patterns[J]. Neurosci Res, 2017, 123: 36-42.
[21] Deconinck FJ, Smorenburg AR, Benham A, et al.Reflections on mirror therapy: a systematic review of the effect of mirror visual feedback on the brain[J]. Neurorehabil Neural Repair, 2015, 29(4): 349-361.
[22] Thieme H, Morkisch N, Mehrholz J, et al. Mirror therapy for improving motor function after stroke[J]. Cochrane Database Syst Rev, 2018, 7: CD008449.
[2] 中华医学会第四届全国脑血管病学术会议.各项脑血管病诊断要点[J].中华神经内科杂志,1996, 29(6):379-380.
[3] Rizzolatti G, Fadiga L, Gallese V, et al.Premotor codex and the recognition of motor actions[J].Brain Res Cogn Brain Res,1996, 3(2):131-141.
[4] Pomeroy VM, Clark CK, Miller JS, et al.The potential for utilizing the "mirrorneuronesystem" to enhance recovery of the severely affected upper limb early after stroke:a review and hypothesis[J].Neurorehabil Neural Repair,2005, 19(1):4-13.
[5] Mulder T. Motor imagery and action observation: cognitive tools for rehabilitation[J]. J Neural Transm (Vienna), 2007,114(10): 1265-1278.
[6] Son YL, Kim JW.The effects of mirror neuron system-based self-observation training on lower limb muscle activity and dynamic balance in patients with chronic stroke[J]. J Phys Ther Sci, 2018, 30(10): 1241-1244.
[7] Ding L, Wang X, Guo X, et al. Camera-based mirror visual feedback: potential to improve motor preparation in stroke patients[J]. Ieee Trans Neural Syst Rehabil Eng, 2018, 26(9): 1897-1905.
[8] Kim J, Yim J. Effects of high-frequency repetitive transcranial magnetic stimulation combined with task-oriented mirror therapy training on hand rehabilitation of acute stroke patients[J]. Med Sci Monit, 2018, 24: 743-750.
[9] Ju Y, Yoon IJ.The effects of modified constraint-induced movement therapy and mirror therapy on upper extremity function and its influence on activities of daily living[J]. J Phys Ther Sci, 2018, 30(1): 77-81.
[10] Invernizzi M, Negrini S, Carda S, et al. The value of adding mirror therapy for upper limb motor recovery of subacute stroke patients: a randomized controlled trial[J]. Eur J Phys Rehabil Med, 2013, 49(3): 311-317.
[11] Zeng W, Guo Y, Wu G, et al. Mirror therapy for motor function of the upper extremity in patients with stroke: a meta-analysis[J]. J Rehabil Med, 2018, 50(1): 8-15.
[12] Guo J, Qian S, Wang Y, et al.Clinical study of combined mirror and extracorporeal shock wave therapy on upper limb spasticity in poststroke patients[J]. Int J Rehabil Res, 2019, 42(1):31-35.
[13] Arya KN, Pandian S, Vikas, et al. Mirror illusion for sensori-motor training in stroke: a randomized controlled trial[J].J Stroke Cerebrovasc Dis, 2018, 27(11): 3236-3246.
[14] Wang W, Zhang X, Ji X, et al. Mirror neuron therapy for hemispatial neglect patients[J].Sci Rep, 2015, 5: 8664.
[15] Oi HS, Van Heng Y, Danielsson L, et al. Mirror therapy for phantom limb and stump pain: a randomized controlled clinical trial in landmine amputees in Cambodia[J]. Scand J Pain, 2018, 18(4): 603-610.
[16] Mano Y, Chuma T, WatanabeI.Cortical reorganization in training[J].J Electromyogr Kinesiol, 2003, 13(1):57-62.
[17] Pascolo PB, Cattarinussi A.On the relationship between mouthopening and “broken mirror neurons” in autistic individuals[J].J Electromyogr Kinesiol, 2012, 22(1):98-102.
[18] Sale P, Franceshini M.Action observation and mirror neuron network:a tool for motor stroke rehabilitation[J].Eur J Phys Rehabil Med, 2012, 48(2):313-318.
[19] NojimaI, Mima T, Koganemaru S, et al.Human motor plasticity induced by mirror visual feedback[J].J Neurosci, 2012, 32(4):1293-1300.
[20] Cheng CH, Sun HH, Weng JQ, et al.Differential motor cortex excitability during observation of normal and abnormal goal-directed movement patterns[J]. Neurosci Res, 2017, 123: 36-42.
[21] Deconinck FJ, Smorenburg AR, Benham A, et al.Reflections on mirror therapy: a systematic review of the effect of mirror visual feedback on the brain[J]. Neurorehabil Neural Repair, 2015, 29(4): 349-361.
[22] Thieme H, Morkisch N, Mehrholz J, et al. Mirror therapy for improving motor function after stroke[J]. Cochrane Database Syst Rev, 2018, 7: CD008449.