基于运动想象的手部机器人辅助训练对脑卒中患者上肢运动功能的疗效
|
摘要
目的观察基于运动想象的手部机器人辅助训练对脑卒中患者手功能及上肢运动功能的影响。方法 2016年11月至2018年5月,脑卒中后手功能障碍患者55例,随机分为对照组(n=25)和观察组(n=30),对照组采用常规手功能活动,观察组采用手部机器人辅助训练,共4周。于治疗前(t0)、治疗1周(t1)、治疗后即刻(t2)、治疗后2个月(t3)采用简式Fugl-Meyer评定量表上肢部分(FMA-UE)、Wolf上肢运动功能评价量表(WMFT)和改良Barthel指数(MBI)进行评定。结果 t1时,观察组WMFT评分较t0改善(P <0.05),两组间无显著性差异(Z=-0.901, P> 0.05)。t2、t3时,两组FMA-UE评分、MBI评分和WMFT评分均较t0时改善(P <0.05),观察组FMA-UE评分和MBI评分优于对照组(Z>-2.073, t> 2.034, P <0.05)。结论基于运动想象的手部机器人辅助训练比常规手训练更有效。
Objective To investigate the effect of hand robot-assisted training based on motor imagery on upper limb function of stroke patients.Methods From November, 2016 to May, 2018, 55 hemiplegic patients with upper limb dysfunction were randomly assigned to control group(n = 25) and experimental group(n = 30). The control group received routine hand motor training, while the experimental group received hand robot-assisted training, for four weeks. They were assessed with simplified Fugl-Meyer Assessment-Upper Extremity(FMA-UE), Wolf Motor Function Test(WMFT) and Modified Barthel Index(MBI) before treatment(t0), one week of treatment(t1), immediately after treatment(t2)and 2 months after treatment(t3).Results The score of WMFT improved in the experimental group at t1(P < 0.05), with no significant difference between groups(Z =-0.901, P > 0.05). The scores of FMA, WMFT and MBI improved in both groups at t2 and t3(P < 0.05), and the scores of FMA and MBI improved more in the experimental group than in the control group(Z >-2.073, t > 2.034, P < 0.05).Conclusion Hand robot-assisted training based on motor imagery can promote recovery of upper limb function in stroke patients more effective than routine hand function training.
Objective To investigate the effect of hand robot-assisted training based on motor imagery on upper limb function of stroke patients.Methods From November, 2016 to May, 2018, 55 hemiplegic patients with upper limb dysfunction were randomly assigned to control group(n = 25) and experimental group(n = 30). The control group received routine hand motor training, while the experimental group received hand robot-assisted training, for four weeks. They were assessed with simplified Fugl-Meyer Assessment-Upper Extremity(FMA-UE), Wolf Motor Function Test(WMFT) and Modified Barthel Index(MBI) before treatment(t0), one week of treatment(t1), immediately after treatment(t2)and 2 months after treatment(t3).Results The score of WMFT improved in the experimental group at t1(P < 0.05), with no significant difference between groups(Z =-0.901, P > 0.05). The scores of FMA, WMFT and MBI improved in both groups at t2 and t3(P < 0.05), and the scores of FMA and MBI improved more in the experimental group than in the control group(Z >-2.073, t > 2.034, P < 0.05).Conclusion Hand robot-assisted training based on motor imagery can promote recovery of upper limb function in stroke patients more effective than routine hand function training.
引文
[1]姜荣荣,陈艳,潘翠环.脑卒中后上肢和手运动功能康复评定的研究进展[J].中国康复理论与实践,2015,21(10):1173-1177.
[2]Franceschini M,La Porta F,Agosti M,et al.Is health-relatedquality of life of stroke patients influenced by neurological im‐pairments at one year after stroke?[J].Eur J Phys Rehabi Med,2010,46(3):389-399.
[3]Morris J,van Wijck F,Joice S,et al.Predicting health related quality of life 6 months after stroke:the role of anxiety and upper limb dysfunction[J].Disabil Rehabil,2013,35(4):291-299.
[4]Balamurugan J,Raja P A,Mahil A,et al.Bilateral object exploration training to improve the hand function in stroke subjects[J].Int J Med Res Health Sci,2013,2(3):479.
[5]Jiang C,Yang S,Tao J,et al.Clinical efficacy of acupuncture treatment in combination with Reha Com cognitive training for improving cognitive function in stroke:a 2×2 factorial design randomized controlled trial[J].J Am Med Dir Assoc,2016,17(12):1114-1122.
[6]张桃,杨帮华,段凯文,等.基于运动想象脑机接口的手功能康复系统设计[J].中国康复理论与实践,2017,23(1):4-9.
[7]Lotze M,Cohen L.Volition and imagery in neurorehabilitation[J].Cogn Behav Neurol,2006,19(3):135-140.
[8]Jeannerod M.Motor Cognition:What Actions Tell the Self[M].New York:Oxford University Press,2006:16-20.
[9]倪俊杰,杨万章,向云.脑卒中病人上肢功能康复的研究进展[J].中西医结合心脑血管病杂志,2016,14(8):859-862.
[10]何斌,张超,刘璇.上肢机器人辅助疗法对急性期脑卒中患者上肢运动功能的效果[J].中国康复理论与实践,2016,22(6):688-692.
[11]中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[12]Bohannon R,Smith M.Interrater reliability of a modified Ashworth scale of muscle spasticity[J].Phys Ther,1987,67(2):206-207.
[13]Folstein M,Folstein S,Mc Hugh P."Mini-Mental State".Apractical method for grading the cognitive state of patients for the clinician[J].J Psychiatr Res,1975,12(3):189-198.
[14]Gladstone D,Danells C,Black S.The Fugl-Meyer Assess‐ment of motor recovery after stroke:a critical review of its mea‐surement properties[J].Neurorehabil Neural Repair,2002,16(3):232-240.
[15]Wolf S,Catlin P,Ellis M,et al.Assessing Wolf Motor Func‐tion Test as outcome measure for research in patients after stroke[J].Stroke,2001,32(7):1635-1639.
[16]Shah S,Vanclay F,Cooper B.Predicting discharge status at commencement of stroke rehabilitation[J].Stroke,1989,20:766-769.
[17]Sharma N,Pomeroy V,Baron J.Motor imagery:a backdoor to the motor system after stroke?[J].Stroke,2006,37(7):1941-1952.
[18]Rizzolatti G,Craighero L.The mirror-neuron system[J].Annu Rev Neurosci,2004,27(1):169-192.
[19]崔尧,丛芳,刘霖.镜像神经元系统的基本理论及其在运动功能康复中的意义[J].中国康复理论与实践,2012,18(3):239-243.
[20]梁明,窦祖林,王清辉,等.虚拟现实技术在脑卒中患者偏瘫上肢功能康复中的应用[J].中国康复医学杂志,2013,28(2):114-118.
[21]贾杰."中枢-外周-中枢"闭环康复--脑卒中后手功能康复新理念[J].中国康复医学杂志,2016,31(11):1180-1182.
[22]Veerbeek J,Langbroek-Amersfoort A,van Wegen E,et al.Effects of robot-assisted therapy for the upper limb after stroke[J].Neurorehabil Neural Repair,2017,31(2):107-121.
[23]梁天佳,吴小平,莫明玉.上肢康复机器人在脑卒中单侧空间忽略康复中的作用[J].中国康复理论与实践,2012,18(4):369-371.
[24]刘霖,朱琳,单桂香,等.神经康复机器手对慢性期卒中偏瘫患者上肢功能康复的疗效分析[J].中国脑血管病杂志,2016,13(11):579-582.
[25]侯红,范亚蓓,吴玉霞,等.康复机器人辅助训练对偏瘫患者上肢功能及日常生活活动能力的影响[J].中国康复医学杂志,2015,30(10):1013-1016.
[26]Colombo R,Pisano F,Delconte C,et al.Comparison of exercise training effect with different robotic devices for upper limb rehabilitation:a retrospective study[J].Eur J Phys Rehabil Med,2017,53(2):240-248.
[2]Franceschini M,La Porta F,Agosti M,et al.Is health-relatedquality of life of stroke patients influenced by neurological im‐pairments at one year after stroke?[J].Eur J Phys Rehabi Med,2010,46(3):389-399.
[3]Morris J,van Wijck F,Joice S,et al.Predicting health related quality of life 6 months after stroke:the role of anxiety and upper limb dysfunction[J].Disabil Rehabil,2013,35(4):291-299.
[4]Balamurugan J,Raja P A,Mahil A,et al.Bilateral object exploration training to improve the hand function in stroke subjects[J].Int J Med Res Health Sci,2013,2(3):479.
[5]Jiang C,Yang S,Tao J,et al.Clinical efficacy of acupuncture treatment in combination with Reha Com cognitive training for improving cognitive function in stroke:a 2×2 factorial design randomized controlled trial[J].J Am Med Dir Assoc,2016,17(12):1114-1122.
[6]张桃,杨帮华,段凯文,等.基于运动想象脑机接口的手功能康复系统设计[J].中国康复理论与实践,2017,23(1):4-9.
[7]Lotze M,Cohen L.Volition and imagery in neurorehabilitation[J].Cogn Behav Neurol,2006,19(3):135-140.
[8]Jeannerod M.Motor Cognition:What Actions Tell the Self[M].New York:Oxford University Press,2006:16-20.
[9]倪俊杰,杨万章,向云.脑卒中病人上肢功能康复的研究进展[J].中西医结合心脑血管病杂志,2016,14(8):859-862.
[10]何斌,张超,刘璇.上肢机器人辅助疗法对急性期脑卒中患者上肢运动功能的效果[J].中国康复理论与实践,2016,22(6):688-692.
[11]中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[12]Bohannon R,Smith M.Interrater reliability of a modified Ashworth scale of muscle spasticity[J].Phys Ther,1987,67(2):206-207.
[13]Folstein M,Folstein S,Mc Hugh P."Mini-Mental State".Apractical method for grading the cognitive state of patients for the clinician[J].J Psychiatr Res,1975,12(3):189-198.
[14]Gladstone D,Danells C,Black S.The Fugl-Meyer Assess‐ment of motor recovery after stroke:a critical review of its mea‐surement properties[J].Neurorehabil Neural Repair,2002,16(3):232-240.
[15]Wolf S,Catlin P,Ellis M,et al.Assessing Wolf Motor Func‐tion Test as outcome measure for research in patients after stroke[J].Stroke,2001,32(7):1635-1639.
[16]Shah S,Vanclay F,Cooper B.Predicting discharge status at commencement of stroke rehabilitation[J].Stroke,1989,20:766-769.
[17]Sharma N,Pomeroy V,Baron J.Motor imagery:a backdoor to the motor system after stroke?[J].Stroke,2006,37(7):1941-1952.
[18]Rizzolatti G,Craighero L.The mirror-neuron system[J].Annu Rev Neurosci,2004,27(1):169-192.
[19]崔尧,丛芳,刘霖.镜像神经元系统的基本理论及其在运动功能康复中的意义[J].中国康复理论与实践,2012,18(3):239-243.
[20]梁明,窦祖林,王清辉,等.虚拟现实技术在脑卒中患者偏瘫上肢功能康复中的应用[J].中国康复医学杂志,2013,28(2):114-118.
[21]贾杰."中枢-外周-中枢"闭环康复--脑卒中后手功能康复新理念[J].中国康复医学杂志,2016,31(11):1180-1182.
[22]Veerbeek J,Langbroek-Amersfoort A,van Wegen E,et al.Effects of robot-assisted therapy for the upper limb after stroke[J].Neurorehabil Neural Repair,2017,31(2):107-121.
[23]梁天佳,吴小平,莫明玉.上肢康复机器人在脑卒中单侧空间忽略康复中的作用[J].中国康复理论与实践,2012,18(4):369-371.
[24]刘霖,朱琳,单桂香,等.神经康复机器手对慢性期卒中偏瘫患者上肢功能康复的疗效分析[J].中国脑血管病杂志,2016,13(11):579-582.
[25]侯红,范亚蓓,吴玉霞,等.康复机器人辅助训练对偏瘫患者上肢功能及日常生活活动能力的影响[J].中国康复医学杂志,2015,30(10):1013-1016.
[26]Colombo R,Pisano F,Delconte C,et al.Comparison of exercise training effect with different robotic devices for upper limb rehabilitation:a retrospective study[J].Eur J Phys Rehabil Med,2017,53(2):240-248.