摘要: |
目的: 探讨改良强制性运动疗法联合健侧1 Hz重复经颅磁刺激对脑卒中患者偏瘫上肢运动功能恢复的影响。方法: 选择2020年5月至10月复旦大学附属金山医院收治的脑卒中患者90例,随机分为对照组(n=30)、改良组(n=30)和联合组(n=30)。对照组给予常规康复训练,改良组在常规康复训练基础上增加改良强制性运动疗法,联合组在常规康复训练基础上给予改良强制性运动疗法联合1 Hz重复经颅磁刺激治疗。于治疗前、治疗4周后采用Fugl-Meyer上肢运动功能评定量表(Fugl-Meyer assessment scale of upper extremity, FMA-UE)评估患者偏瘫上肢运动功能,并同时检测患侧中枢运动传导时间(central motor conduction time, CMCT)。结果: 治疗后,对照组、改良组和联合组的FMA-UE评分由(25.97±5.83)分、(25.47±6.96)分和(26.10±5.29)分提高至(32.77±7.68)分、(38.07±8.16)分和(42.17±7.89)分(P<0.001);CMCT由(11.78±0.44)ms、(11.62±0.45)ms和(11.78±0.40)ms缩短至(10.91±0.44)ms、(10.58±0.60)ms和(10.19±0.67)ms(P<0.001)。联合组各项指标改善最显著(P<0.001)。结论: 改良强制性运动疗法联合低频重复经颅磁刺激可协同提高脑卒中患者患侧大脑皮质兴奋性,促进半球间平衡重建,有助于患侧皮质脊髓束功能修复,进而改善偏瘫上肢运动功能。 |
关键词: 脑卒中 强制性运动疗法 经颅磁刺激 低频 上肢 运动功能 |
DOI:10.12025/j.issn.1008-6358.2021.20210334 |
分类号:R743.3 |
基金项目:上海市金山区科技创新资金(2020-3-21). |
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Effect of modified constraint-induced movement therapy combined with low-frequency repetitive transcranial magnetic stimulation on upper limb motor function in stroke patients with hemiplegia |
TAO Feng, ZHU Jie, WANG Chuan-jie, YANG Lei, CHEN Ben-mei
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Department of Rehabilitation, Jinshan Hospital, Fudan University, Shanghai 201508, China
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Abstract: |
Objective: To explore the effect of modified constraint-induced movement therapy (mCIMT) combined with 1-Hz repetitive transcranial stimulation (rTMS) on upper limb motor function in stroke patients with hemiplegia.Methods: From May to October 2020, 90 patients with stroke were selected from Jinshan Hospital, Fudan University, and were randomly divided into the control group (n=30), modified group (n=30), and combination group (n=30). The control group received conventional rehabilitation training (CRT) only, the modified group received CRT+mCIMT, and the combination group received CRT+mCIMT+rTMS. Before and 4 weeks after treatment, the Fugl-Meyer assessment scale of the upper extremity (FMA-UE) was used to evaluate the motor function; meanwhile, the central motor conduction time (CMCT) was measured.Results: After treatment, the FMA-UE score in the control group, the improved group, and the combined group increased from 25.97±5.83, 25.47±6.96, and 26.10±5.29 to 32.77±7.68, 38.07±8.16, and 42.17±7.89 (P<0.001); CMCT was shortened from (11.78±0.44) ms, (11.62±0.45) ms, and (11.78±0.40) ms to (10.91±0.44) ms, (10.58±0.60) ms, and (10.19±0.67) ms (P<0.001); the indicators of the combination group had the most significant improvements (P<0.05).Conclusions: Modified constraint-induced movement therapy combined with low-frequency repetitive transcranial magnetic stimulation can improve the excitability of the cerebral cortex, may promote the reconstruction of interhemispheric balance, promote the functional repair of the corticospinal tract, then improve the motor function of hemiplegic upper limb. |
Key words: stroke constraint-induced movement therapy transcranial magnetic stimulation low frequency upper limb motor function |