CAJ | 학술논문

目的探讨反馈式功能性电刺激治疗对脑梗死患者上肢运动功能恢复的影响以及应用功能核磁共振成像(MRI)分析其作用机制. 方法将自2011年8月至2012年12月在中国康复研究中心神经康复中心住院的脑梗死患者21例(一侧肢体瘫痪且偏瘫侧肢体腕背屈关节活动度大于15°及肌张力为改良Ashworth Ⅰ+级及以下的可完成部分主动运动的患者、按随机数字表法分为反馈式功能性电刺激组8例、单纯功能性电刺激组7例及常规康复治疗组6例.3组患者均进行常规神经内科药物治疗和康复治疗,其中反馈式功能性电刺激组进行反馈式功能性电刺激治疗,单纯功能性电刺激组行功能性电刺激治疗,疗程4周.分别在治疗前及治疗4周后次日进行Fugl-Meyer运动功能量表上肢部分项目及腕背伸角度评估,以及3d内应用fMRI进行脑M1区激活强度检查. 结果 (1)治疗后4周时,3组患者的Fugl-Meyer运动功能量表上肢部分项目评分及腕背伸角度较治疗前均有改善,其中反馈式功能性电刺激组、单纯功能性电刺激组差异均有统计学意义(P＜0.05)；反馈式功能性电刺激组亦明显优于单纯功能性电刺激组,差异有统计学意义(P＜0.05).(2)治疗后4周时,3组患者的患侧脑M1区激活强度较治疗前均有改善,其中反馈式功能性电刺激组差异有统计学意义(P＜0.05)；反馈式功能性电刺激组亦明显优于单纯功能性电刺激组,差异有统计学意义(P＜0.05). 结论单纯功能性电刺激和反馈式功能性电刺激均有利于脑梗死后上肢运动功能的提高,并有助于脑功能的重组,且后者较前者疗效更佳.
목적 탐토반궤식공능성전자격치료대뇌경사환자상지운동공능회복적영향이급응용공능핵자공진성상(MRI)분석기작용궤제. 방법 장자2011년8월지2012년12월재중국강복연구중심신경강복중심주원적뇌경사환자21례(일측지체탄탄차편탄측지체완배굴관절활동도대우15°급기장력위개량Ashworth Ⅰ+급급이하적가완성부분주동운동적환자、안수궤수자표법분위반궤식공능성전자격조8례、단순공능성전자격조7례급상규강복치료조6례.3조환자균진행상규신경내과약물치료화강복치료,기중반궤식공능성전자격조진행반궤식공능성전자격치료,단순공능성전자격조행공능성전자격치료,료정4주.분별재치료전급치료4주후차일진행Fugl-Meyer운동공능량표상지부분항목급완배신각도평고,이급3d내응용fMRI진행뇌M1구격활강도검사. 결과 (1)치료후4주시,3조환자적Fugl-Meyer운동공능량표상지부분항목평분급완배신각도교치료전균유개선,기중반궤식공능성전자격조、단순공능성전자격조차이균유통계학의의(P＜0.05)；반궤식공능성전자격조역명현우우단순공능성전자격조,차이유통계학의의(P＜0.05).(2)치료후4주시,3조환자적환측뇌M1구격활강도교치료전균유개선,기중반궤식공능성전자격조차이유통계학의의(P＜0.05)；반궤식공능성전자격조역명현우우단순공능성전자격조,차이유통계학의의(P＜0.05). 결론 단순공능성전자격화반궤식공능성전자격균유리우뇌경사후상지운동공능적제고,병유조우뇌공능적중조,차후자교전자료효경가.
Objective To explore the effect of feedback functional electrical stimulation (BFES) treatment on upper limb movement functions in patients with stroke and analyze its mechanism with functional magnetic resonance imaging (fMRI).Methods Twenty-one inpatients with stroke were chose in our study from 2011 August to 2012 December.They were hemiplegy,and their wrist dorsiflexion ranges of motion of hemiplegic limbs were greater than 15 degrees; their muscular tension was equal or less than modified Ashworth I+,and they could complete some active movements.The patients were randomly divided into BFES treatment group (n=8),functional electrical stimulation treatment (FES) group(n=7) and conventional rehabilitation group (n=6).Three groups of patients were given routine drug treatment and rehabilitation treatment.They were assessed with Fugl-Meyer scale (upper limbs),wrist flexion and M1 of fMRI before treatment and 4 weeks after treatment.Results The scores of Fugl-Meyer (upper limbs) and wrist extension improved after treatment in 3 groups,and the BFES group enjoyed more obvious effect than the other groups (P＜0.05); 4 weeks after treatment,the three groups of patients affected brain areas activated M1 area strength improved more significantly as compared with those before treatment,where BFES treatment group showed statistically difference (P＜0.05).Conclusion Both FES and BFES treatment can improve the motor recovery of upper limbs after stroke and they can contribute to brain functional reorganization,BFES,as compared with FES,is more effective.