镜像疗法对脑卒中患者下肢运动功能、日常生活活动能力及平衡能力的影响
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摘要
目的:观察镜像疗法在改善脑卒中偏瘫患者下肢运动功能、日常生活活动能力及平衡能力方面的疗效。方法:将62例脑卒中患者按分层随机分组法分为镜像组和对照组,每组31例。对照组接受常规康复训练,镜像组在常规康复训练的基础上接受健侧下肢的镜像疗法训练。于治疗前和治疗4周后采用简化Fugl-Meyer评分法(FMA)下肢部分、Brunnstrom运动功能评价法、Barthel指数(BI)及Berg平衡量表(BBS)分别评定患者下肢运动功能、下肢运动功能分期、日常生活活动能力及平衡能力。结果:治疗前两组患者上述各指标差异无显著性意义(P>0.05)。治疗后两组患者上述各指标与同组治疗前相比均显著提高(P<0.05)。镜像组患者治疗前后FMA、BI评分差值均大于对照组,且差异均具有显著性意义(P<0.05)。治疗后镜像组与对照组Brunnstrom分期差异无显著性意义(P>0.05),但治疗后镜像组处于分离运动期的患者多于对照组。镜像组与对照组BBS评分差值虽无显著性意义(P>0.05),但镜像组BBS评分差值更大。结论:镜像疗法能有效提高脑卒中偏瘫患者下肢运动功能和日常生活活动能力,并可能对下肢分离运动及平衡能力恢复具有一定促进作用。
Objective: To observe the influence of mirror therapy on lower-limb motor function, ADL and balance in hemiplegia after stroke.Method: Totally 62 patients with hemiplegia after stroke were randomly assigned to the mirror group and the control group according to stratified random grouping method, 31 cases in each group. Both groups accepted routine rehabilitation training. Additionally, the mirror group accepted mirror therapy to train the non-paretic limb for 30 minutes per day, 5 days a week, for 4 weeks. The LE part of Fugl-Meyer Assessment(FMA),Brunnstrom Stage, Barthel Index and Berg Balance Scale were used to evaluate the lower-limb motor function,the lower-limb motor pattern and the ADL respectively at baseline and after 4-weeks training.Result: Before training, there were no significant difference between groups in all indexes said above(P>0.05). After training, there were significant improvements in both groups in all indexes said above compared with baseline(P<0.05). Compared with the control group, the change scores of FMA and BI in the mirror group were more prominent(P<0.05). After training, there was no significant difference between groups in the Brunnstrom Stage(P>0.05), but there were more patients having separation movement in mirror group. There was no significant difference in BBS between groups(P>0.05), but the change scores of BBS in mirror group was bigger.Conclusion: mirror therapy can prominently enhance lower-limb motor function and ADL, and also showed some advantage on promoting recovery of lower-limb voluntary movement and balance.
Objective: To observe the influence of mirror therapy on lower-limb motor function, ADL and balance in hemiplegia after stroke.Method: Totally 62 patients with hemiplegia after stroke were randomly assigned to the mirror group and the control group according to stratified random grouping method, 31 cases in each group. Both groups accepted routine rehabilitation training. Additionally, the mirror group accepted mirror therapy to train the non-paretic limb for 30 minutes per day, 5 days a week, for 4 weeks. The LE part of Fugl-Meyer Assessment(FMA),Brunnstrom Stage, Barthel Index and Berg Balance Scale were used to evaluate the lower-limb motor function,the lower-limb motor pattern and the ADL respectively at baseline and after 4-weeks training.Result: Before training, there were no significant difference between groups in all indexes said above(P>0.05). After training, there were significant improvements in both groups in all indexes said above compared with baseline(P<0.05). Compared with the control group, the change scores of FMA and BI in the mirror group were more prominent(P<0.05). After training, there was no significant difference between groups in the Brunnstrom Stage(P>0.05), but there were more patients having separation movement in mirror group. There was no significant difference in BBS between groups(P>0.05), but the change scores of BBS in mirror group was bigger.Conclusion: mirror therapy can prominently enhance lower-limb motor function and ADL, and also showed some advantage on promoting recovery of lower-limb voluntary movement and balance.
引文
[1]贾建平主编.神经病学[M].第7版.北京:人民卫生出版社,2013.170.
[2]Hendricks HT,van Limbeek J,Geurts AC,et al.Motor recovery after stroke:a systematic review of the literature[J].Arch Phys Med Rehabil,2002,83(11):1629-1637.
[3]崔韶阳,许明珠,王曙辉,等.针刺配合镜像疗法对脑梗死偏瘫患者下肢功能障碍的影响[J].上海针灸杂志,2017,36(1):9-13.
[4]Ramachandran VS,Rogers-Ramachandran D,Cobb S.Touching the phantom limb[J].Nature,1995,377(6549):489-490.
[5]Altschuler EL,Wisdom SB,Stone L,et al.Rehabilitation of hemiparesis after stroke with a mirror[J].Lancet,1999,353(9169):2035-2036.
[6]Mirela Cristina,L,Matei D,Ignat B,et al.Mirror therapy enhances upper extremity motor recovery in stroke patients[J].Acta Neurol Belg,2015,115:597-603.
[7]Dohle C,Püllen J,Nakaten A,et al.Mirror therapy promotes recovery from severe hemiparesis:a randomized controlled trial[J].Neurorehabilitation and Neural Repair,2009,23:209-217.
[8]Park JY,Chang M,Kim KM,et al.The effect of mirror therapy on upper-extremity function and activities of daily living in stroke patients[J].J Phys Ther Sci,2015,27:1681-1683.
[9]彭娟,胥方元.镜像疗法对脑卒中后肢体功能康复的研究进展[J].中国康复医学杂志,2017,32(03):359-363.
[10]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.
[11]袁栋才,张凤春,魏巍,等.神经可塑性与脑卒中后运动功能恢复的研究进展[J].中国康复医学杂志,2014,29(4):391-394.
[12]任彩丽,付娟娟,王红星,等.早期康复临床路径对缺血性脑卒中患者功能恢复影响的多中心、单盲、随机对照研究[J].中国康复医学杂志,2017,32(3):275-282.
[13]杨颐,王雪飞,王麟鹏.神经可塑性与脑卒中后运动功能恢复[J].中国医刊,2016,51(6):15-19.
[14]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,2014,29(4):349-361.
[15]Kumru H,Albu S,Pelayo R,et al.Motor cortex plasticity during unilateral finger movement with mirror visual feedback[J].Neural Plast,2016,2016:6087896.
[16]王玉龙.康复功能评定学[M].第2版.北京:人民卫生出版社,2013:296.
[17]陈钢妹,洪显钗,吴雪洁,等.脑卒中后偏瘫患者肢体运动能力与日常生活能力的相关性分析[J].中国现代医生,2013,51(31)35-37.
[18]Sütbeyaz S,Yavuzer G,Sezer N,et al.Mirror therapy enhances lower extremity motor recovery and motor functioning after stroke:a randomized controlled trial[J].Arch Phys Med Rehabil,2007,88(5):555-559.
[19]Hassan M,Abo Salem,Xiaolin Huang.The effects of mirror therapy on clinical improvement in hemiplegic lower extremity rehabilitation in subjects with chronic stroke[J].International Journal of Medical,Health,Biomedical and Pharmaceutical Engineering,2015,9(2):163-166.
[20]Bowden MG,Clark DJ,Kautz SA.Evaluation of abnormal synergy patterns poststroke:relationship of the Fugl-Meyer Assessment to hemiparetic locomotion[J].Neurorehabilitation&Neural Repair,2010,24(4):328-337.
[21]Mohan U,Babu SK,Kumar KV,et al.Effectiveness of mirror therapy on lower extremity motor recovery,balance and mobility in patients with acute stroke:A randomized sham-controlled pilot trial[J].Ann Indian Acad Neurol,2013,16(4):634-639.
[2]Hendricks HT,van Limbeek J,Geurts AC,et al.Motor recovery after stroke:a systematic review of the literature[J].Arch Phys Med Rehabil,2002,83(11):1629-1637.
[3]崔韶阳,许明珠,王曙辉,等.针刺配合镜像疗法对脑梗死偏瘫患者下肢功能障碍的影响[J].上海针灸杂志,2017,36(1):9-13.
[4]Ramachandran VS,Rogers-Ramachandran D,Cobb S.Touching the phantom limb[J].Nature,1995,377(6549):489-490.
[5]Altschuler EL,Wisdom SB,Stone L,et al.Rehabilitation of hemiparesis after stroke with a mirror[J].Lancet,1999,353(9169):2035-2036.
[6]Mirela Cristina,L,Matei D,Ignat B,et al.Mirror therapy enhances upper extremity motor recovery in stroke patients[J].Acta Neurol Belg,2015,115:597-603.
[7]Dohle C,Püllen J,Nakaten A,et al.Mirror therapy promotes recovery from severe hemiparesis:a randomized controlled trial[J].Neurorehabilitation and Neural Repair,2009,23:209-217.
[8]Park JY,Chang M,Kim KM,et al.The effect of mirror therapy on upper-extremity function and activities of daily living in stroke patients[J].J Phys Ther Sci,2015,27:1681-1683.
[9]彭娟,胥方元.镜像疗法对脑卒中后肢体功能康复的研究进展[J].中国康复医学杂志,2017,32(03):359-363.
[10]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.
[11]袁栋才,张凤春,魏巍,等.神经可塑性与脑卒中后运动功能恢复的研究进展[J].中国康复医学杂志,2014,29(4):391-394.
[12]任彩丽,付娟娟,王红星,等.早期康复临床路径对缺血性脑卒中患者功能恢复影响的多中心、单盲、随机对照研究[J].中国康复医学杂志,2017,32(3):275-282.
[13]杨颐,王雪飞,王麟鹏.神经可塑性与脑卒中后运动功能恢复[J].中国医刊,2016,51(6):15-19.
[14]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,2014,29(4):349-361.
[15]Kumru H,Albu S,Pelayo R,et al.Motor cortex plasticity during unilateral finger movement with mirror visual feedback[J].Neural Plast,2016,2016:6087896.
[16]王玉龙.康复功能评定学[M].第2版.北京:人民卫生出版社,2013:296.
[17]陈钢妹,洪显钗,吴雪洁,等.脑卒中后偏瘫患者肢体运动能力与日常生活能力的相关性分析[J].中国现代医生,2013,51(31)35-37.
[18]Sütbeyaz S,Yavuzer G,Sezer N,et al.Mirror therapy enhances lower extremity motor recovery and motor functioning after stroke:a randomized controlled trial[J].Arch Phys Med Rehabil,2007,88(5):555-559.
[19]Hassan M,Abo Salem,Xiaolin Huang.The effects of mirror therapy on clinical improvement in hemiplegic lower extremity rehabilitation in subjects with chronic stroke[J].International Journal of Medical,Health,Biomedical and Pharmaceutical Engineering,2015,9(2):163-166.
[20]Bowden MG,Clark DJ,Kautz SA.Evaluation of abnormal synergy patterns poststroke:relationship of the Fugl-Meyer Assessment to hemiparetic locomotion[J].Neurorehabilitation&Neural Repair,2010,24(4):328-337.
[21]Mohan U,Babu SK,Kumar KV,et al.Effectiveness of mirror therapy on lower extremity motor recovery,balance and mobility in patients with acute stroke:A randomized sham-controlled pilot trial[J].Ann Indian Acad Neurol,2013,16(4):634-639.