中华物理医学与康复杂志
中華物理醫學與康複雜誌
중화물리의학여강복잡지
CHINESE JOURNAL OF PHYSICAL MEDICINE AND REHABILITATION
2013年
2期
107-111
,共5页
曾明%王晶%顾旭东%崔尧%姚云海%傅建明%李亮%吴华%尹汉逵
曾明%王晶%顧旭東%崔堯%姚雲海%傅建明%李亮%吳華%尹漢逵
증명%왕정%고욱동%최요%요운해%부건명%리량%오화%윤한규
动作观察疗法%镜像神经元%脑卒中%上肢功能%康复%体感诱发电位
動作觀察療法%鏡像神經元%腦卒中%上肢功能%康複%體感誘髮電位
동작관찰요법%경상신경원%뇌졸중%상지공능%강복%체감유발전위
Action observation%Mirror neurons%Stroke%Upper extremity function%Rehabilitation%Somatosensory evoked potentials
目的 探讨基于镜像神经元理论的动作观察疗法对早期脑卒中患者上肢运动功能和体感诱发电位(SEP)的影响.方法 将30例脑卒中患者按随机数字表法分为观察组(15例)和对照组(15例).对照组采用常规康复治疗,如肢体良肢位摆放、平衡训练、日常生活活动(ADL)能力训练等,观察组在对照组基础上辅以动作观察疗法,每周治疗10次,共治疗8周.分别于治疗前、治疗4周和治疗8周后采用Fugl-Meyer运动功能评分法(FMA)(上肢部分)及Barthel指数(BI)对2组患者的上肢运动功能和SEP进行评估检测,记录SEP检测中N9 、N20的潜伏期和波幅.结果 观察组治疗4周及治疗8周后的上肢FMA评分分别为(18.87±6.62)分和(26.27 ±9.22)分,与治疗前相比,差异均有统计学意义(P＜0.05)；对照组治疗4周和治疗8周后的上肢FMA评分分别为(16.53±4.79)分和(20.07 ±6.77)分,组内比较仅治疗8周后的上肢FMA评分与治疗前差异有统计学意义(P＜0.05)；与对照组比较,观察组治疗8周后上肢FMA评分的提高值大于对照组治疗8周后上肢FMA评分的提高值(P＜0.05).观察组治疗4周及治疗8周后的BI指数评分分别为(58.00 ±19.89)分和(62.33±20.34)分,而对照组治疗4周及治疗8周后的BI指数评分分别为(65.67±18.01)分和(71.33 ±14.82)分,2组BI评分与治疗前相比,差异均具有统计学意义(P＜0.05)；治疗8周后观察组BI提高值与对照组BI提高值相比,差异无统计学意义(P＞0.05).治疗4周及治疗8周后,观察组偏瘫侧SEP的N9和N20潜伏期分别为[(9.35±1.63) ms和(9.03±1.68)ms、(20.84 ±2.07)ms和(20.32±2.56)ms],波幅分别为[(3.71±1.28) μV和(3.91 ±1.18) μV、(1.83±0.44) μV和(2.08±0.51)μV],比较后发现,N9、N20的潜伏期均逐渐缩短、波幅逐渐增高(P＜0.05)；对照组偏瘫侧SEP的N9 、N20潜伏期分别为[(9.87±1.68)ms和(9.52±1.54) ms、(20.89 ±2.38)ms和(20.51±2.69) ms],波幅分别为[(2.75±1.54)μV和(2.84±1.47) μV、(1.38 ±0.43) μV和(1.51±0.44)μV],治疗4周后的N20潜伏期和治疗8周后的N9、N20潜伏期与治疗前相比,差异有统计学意义(P＜0.05),对照组偏瘫侧仅治疗8周后的N20波幅与治疗前相比,差异有统计学意义(P＜0.05).结论 基于镜像神经元理论的动作观察疗法可改善早期脑卒中患者的上肢运动功能,改善其SEP.
目的 探討基于鏡像神經元理論的動作觀察療法對早期腦卒中患者上肢運動功能和體感誘髮電位(SEP)的影響.方法 將30例腦卒中患者按隨機數字錶法分為觀察組(15例)和對照組(15例).對照組採用常規康複治療,如肢體良肢位襬放、平衡訓練、日常生活活動(ADL)能力訓練等,觀察組在對照組基礎上輔以動作觀察療法,每週治療10次,共治療8週.分彆于治療前、治療4週和治療8週後採用Fugl-Meyer運動功能評分法(FMA)(上肢部分)及Barthel指數(BI)對2組患者的上肢運動功能和SEP進行評估檢測,記錄SEP檢測中N9 、N20的潛伏期和波幅.結果 觀察組治療4週及治療8週後的上肢FMA評分分彆為(18.87±6.62)分和(26.27 ±9.22)分,與治療前相比,差異均有統計學意義(P＜0.05)；對照組治療4週和治療8週後的上肢FMA評分分彆為(16.53±4.79)分和(20.07 ±6.77)分,組內比較僅治療8週後的上肢FMA評分與治療前差異有統計學意義(P＜0.05)；與對照組比較,觀察組治療8週後上肢FMA評分的提高值大于對照組治療8週後上肢FMA評分的提高值(P＜0.05).觀察組治療4週及治療8週後的BI指數評分分彆為(58.00 ±19.89)分和(62.33±20.34)分,而對照組治療4週及治療8週後的BI指數評分分彆為(65.67±18.01)分和(71.33 ±14.82)分,2組BI評分與治療前相比,差異均具有統計學意義(P＜0.05)；治療8週後觀察組BI提高值與對照組BI提高值相比,差異無統計學意義(P＞0.05).治療4週及治療8週後,觀察組偏癱側SEP的N9和N20潛伏期分彆為[(9.35±1.63) ms和(9.03±1.68)ms、(20.84 ±2.07)ms和(20.32±2.56)ms],波幅分彆為[(3.71±1.28) μV和(3.91 ±1.18) μV、(1.83±0.44) μV和(2.08±0.51)μV],比較後髮現,N9、N20的潛伏期均逐漸縮短、波幅逐漸增高(P＜0.05)；對照組偏癱側SEP的N9 、N20潛伏期分彆為[(9.87±1.68)ms和(9.52±1.54) ms、(20.89 ±2.38)ms和(20.51±2.69) ms],波幅分彆為[(2.75±1.54)μV和(2.84±1.47) μV、(1.38 ±0.43) μV和(1.51±0.44)μV],治療4週後的N20潛伏期和治療8週後的N9、N20潛伏期與治療前相比,差異有統計學意義(P＜0.05),對照組偏癱側僅治療8週後的N20波幅與治療前相比,差異有統計學意義(P＜0.05).結論 基于鏡像神經元理論的動作觀察療法可改善早期腦卒中患者的上肢運動功能,改善其SEP.
목적 탐토기우경상신경원이론적동작관찰요법대조기뇌졸중환자상지운동공능화체감유발전위(SEP)적영향.방법 장30례뇌졸중환자안수궤수자표법분위관찰조(15례)화대조조(15례).대조조채용상규강복치료,여지체량지위파방、평형훈련、일상생활활동(ADL)능력훈련등,관찰조재대조조기출상보이동작관찰요법,매주치료10차,공치료8주.분별우치료전、치료4주화치료8주후채용Fugl-Meyer운동공능평분법(FMA)(상지부분)급Barthel지수(BI)대2조환자적상지운동공능화SEP진행평고검측,기록SEP검측중N9 、N20적잠복기화파폭.결과 관찰조치료4주급치료8주후적상지FMA평분분별위(18.87±6.62)분화(26.27 ±9.22)분,여치료전상비,차이균유통계학의의(P＜0.05)；대조조치료4주화치료8주후적상지FMA평분분별위(16.53±4.79)분화(20.07 ±6.77)분,조내비교부치료8주후적상지FMA평분여치료전차이유통계학의의(P＜0.05)；여대조조비교,관찰조치료8주후상지FMA평분적제고치대우대조조치료8주후상지FMA평분적제고치(P＜0.05).관찰조치료4주급치료8주후적BI지수평분분별위(58.00 ±19.89)분화(62.33±20.34)분,이대조조치료4주급치료8주후적BI지수평분분별위(65.67±18.01)분화(71.33 ±14.82)분,2조BI평분여치료전상비,차이균구유통계학의의(P＜0.05)；치료8주후관찰조BI제고치여대조조BI제고치상비,차이무통계학의의(P＞0.05).치료4주급치료8주후,관찰조편탄측SEP적N9화N20잠복기분별위[(9.35±1.63) ms화(9.03±1.68)ms、(20.84 ±2.07)ms화(20.32±2.56)ms],파폭분별위[(3.71±1.28) μV화(3.91 ±1.18) μV、(1.83±0.44) μV화(2.08±0.51)μV],비교후발현,N9、N20적잠복기균축점축단、파폭축점증고(P＜0.05)；대조조편탄측SEP적N9 、N20잠복기분별위[(9.87±1.68)ms화(9.52±1.54) ms、(20.89 ±2.38)ms화(20.51±2.69) ms],파폭분별위[(2.75±1.54)μV화(2.84±1.47) μV、(1.38 ±0.43) μV화(1.51±0.44)μV],치료4주후적N20잠복기화치료8주후적N9、N20잠복기여치료전상비,차이유통계학의의(P＜0.05),대조조편탄측부치료8주후적N20파폭여치료전상비,차이유통계학의의(P＜0.05).결론 기우경상신경원이론적동작관찰요법가개선조기뇌졸중환자적상지운동공능,개선기SEP.
Objective To explore the effects of action observation therapy based on mirror neuron theory on upper-extremity motor function and somatosensory evoked potentials after stroke.Methods Thirty stroke patients were randomly assigned to an observational group (15 cases) or a control group (15 cases).Both groups received conventional rehabilitation including,for example,good limb positioning,balance training and training in the activities of daily living (ADL).The observational group also received action observation therapy for 8 weeks,10 times per week.Both groups were assessed before treatment with the Fugl-Meyer assessment (FMA),the Barthel index (BI)and somatosensory evoked potentials (SEPs) and then again after 4 and 8 weeks of treatment.Their SEP N9 and N20 latencies were also analyzed.Results The average FMA scores at the 4th week (18.87 ± 6.62) and the 8th week (26.27± 9.22) in the observational group had increased significantly compared with the pre-treatment assessment.The control group's FMA score at the 8th week (20.07 ± 6.77) had also increased significantly compared with pretreatment.But at the 8th week the increase in the average FMA score of the observational group was significantly better than that of the control group.The average BI scores of both groups had increased significantly at both the 4th and the 8th week compared with each group's pre-treatment assessment.There was no significant difference in the increases in BI score between the two groups after 8 weeks of treatment.At both the 4th and the 8th week the N9 and N20 latencies on the affected side in the observational group had shortened significantly compared with the pre-treatment assessment.And the N9 and N20 amplitudes on the affected side in the observational group had also increased significantly compared with before treatment.In the control group,the N20 latency on the affected side had shortened significantly at the 4th week,and both the N9 and N20 latencies were significantly shortened at the 8th week compared with before treatment.Only the N20 amplitudes at the 8th week were observed to increase significantly compared with before treatment in the control group.Conclusions Action observation therapy promoted the recovery of upper-extremity motor function and SEPs in hemiparetic patients after stroke.
