经皮穴位电刺激联合阶梯式运动想象疗法对脑卒中上肢和手功能的闭环康复疗效分析

Efficacy of closed-loop-based transcutaneous electrical acupoint stimulation combined with stepped motor imagery training for upper limb and hand function rehabilitation after stroke

关键词:  脑卒中  经皮穴位电刺激  阶梯式运动想象  上肢  手功能

Key words:  stroke  transcutaneous electrical acupoint stimulation  stepped motor imagery training  upper extremity  hand function

摘要:

目的探究经皮穴位电刺激联合阶梯式运动想象疗法对脑卒中患者上肢和手功能康复的疗效。 方法选取2021年1月—2023年4月上海市静安区北部地区医疗服务共同体成员单位脑卒中患者80例随机分为试验组(n=40)和对照组(n=40)。两组患者均接受常规康复，试验组在此基础上接受基于“闭环康复”的经皮穴位电刺激联合阶梯式运动想象疗法，而对照组则接受经皮穴位电刺激治疗和注意力无效对照干预，总共干预4周。分别于治疗前后对两组患者进行Fugl-Meyer上肢运动功能评定量表(Fugl-Meyer assessment-upper extremities, FMA-UE)、积木盒障碍测试(boxing and blocking test, BBT)、改良Ashworth评分(modified Ashworth scale, MAS)和改良Barthel指数(modified Barthel index, MBI)的评定，并采用手心理旋转测试评价患者干预前的运动想象能力。 结果试验组和对照组分别有35名和36名患者完成研究的所有干预和评定。治疗后两组FMA-UE、BBT、MBI评分均显著改善(t>3.545，P<0.001)，试验组FMA-UE总分和近、远端子项目评分均显著优于对照组(t>2.187，P<0.05)。相关性分析显示试验组患者FMA-UE的远端子项目评分变化值与治疗前心理旋转反应时间呈负相关（r=-0.676，P<0.001）。 结论经皮穴位电刺激治疗联合阶梯式运动想象疗法可有效改善脑卒中的上肢和手运动功能，其疗效与患者的基线运动想象能力有关。

Abstract:

ObjectiveTo assess the efficacy of transcutaneous electrical acupoint stimulation(TEAS) combined with motor imagery-based training for hand and upper limb motorfunction rehabilitation after stroke. MethodsEighty stroke patients from January 2021 to April 2023 were randomly divided into study group(n=40) and control group(n=40). Both groups received conventional rehabilitation. The study group received additional TEAS combined with stepped motor imagery training, while the control group received TEAS and attention-placebo control intervention for 4 weeks. The hand and upper limb motor functions ofpatients were assessed with the Fugl-Meyer upper limb assessment scale(FMA-UE), wooden box handicap test(BBT), modified Ashworth scale(MAS) and modified Barthel index(MBI) before and after the treatment. The hand mental rotation test was used to evaluate the patient’s motor imagery ability before intervention. ResultsThere were 35 and 36 cases in study and control groups who completed the intervention and were included in the final analysis, respectively. After 4 weeks of treatment, the FMA-UE, BBT, and MBI scores in both groups were significantly improved(t>3.545, P<0.001). The total FMA-UE score and proximal and distal subscores in the study group were significantly better than those in the control group(t>2.187, P<0.05). Correlation analysis showed a significant negative correlation(r=-0.676, P<0.001) between the change in the distal subscores of FMA-UE and the pre-treatment reaction time during HMRT in the study group. ConclusionTEAS combined with stepped motor imagery training can effectively improve the upper limb and hand motor function after stroke, and its efficacy is related to the patient’s baseline motor imagery ability.