| 徐立伟,胡志,高光仪,李月红,郭廷超,李美玲,赵小会,杨新波.强化运动想象疗法对脑卒中偏瘫患者步行的影响与机制研究[J].中国康复,2016,31(5):345-348 |
| 强化运动想象疗法对脑卒中偏瘫患者步行的影响与机制研究 |
| Effect and possible mechanism of intensive motor imagery therapy on the recovery of gait in hemiplegic stroke patients |
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| DOI： |
| 中文关键词: 单光子发射计算机断层显像 步态 运动想象 强化训练 脑卒中 |
| 英文关键词: single photon emission computed tomography gait intensive motor imagery training stroke |
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| 中文摘要: |
| 目的：通过单光子发射计算机断层显像（SPECT）局部脑血流半定量分析方法，探讨强化运动想象疗法对脑卒中偏瘫患者步行恢复的影响及其可能机制。方法：脑卒中后偏瘫患者30例，随机分为基础运动想象组（A组）和强化运动想象组（B组），每组各15例，另选入健康人5例为对照组，A、B组分别进行偏瘫侧下肢的步态运动想象训练与强化的步态运动想象训练，应用SPECT观察皮质局部脑血流（rCBF）灌注的动态改变情况，并通过简化Fugly-Meyer量表下肢部分（FMA-L）、10m最大步行速度（MWS）和Berg平衡量表（BBS）进行治疗前后评定。结果：A、B组与对照组均激活初级运动区、辅助运动区及顶叶。A、B组患者运动想象训练后激活中心主要为对侧初级感觉区 、同侧初级运动区、同侧辅助运动区及相关后顶叶。A、B组患者治疗后大脑皮层脑血流灌注均有改善（P＜0.05），但2组间比较差异无统计学意义。治疗后，A、B组患者的下肢功能均有提高，且B组MWS及BBS评分均高于A组（P＜0.05），2组治疗后FMA评分比较差异无显著性。结论：强化步态运动想象疗法可更好提高脑卒中后偏瘫患者下肢功能，改善步行功能，疗效优于基础运动想象疗法，其机制可能与相关脑区的脑血流改变而引起脑功能重组有关，是脑卒中偏瘫患者下肢功能恢复的有效治疗手段。 |
| 英文摘要: |
| Objective: To observe the effect and possible mechanism of intensive motor imagery therapy on the recovery of gait in hemiplegic stroke patients by using semi-quantitative analysis of regional cerebral blood flow (rCBF) through single photon emission computed tomography (SPECT). Methods: Five healthy cases served as control group. Thirty patients with hemiplegia after stroke were randomly divided into basic motor imagery group, which was treated with gait motor imagery (group A); and intensive motor imagery group, which was treated with gait intensive motor imagery (group B) (n=15 each). SPECT was used to observe the changes of cerebral blood flow (rCBF). Before and after treatment, Fugl-Meyer motor assessment (FMA) for the lower extremity, maximum walking speed (MWS) and Berg Balance Scale (BBS) were assessed. Results: Both control group and stroke group activated primary motor area, supplementary motor area and parietal lobe. As compared with the control group, activated center of stroke patients after motor imagery training was mainly to contralateral primary sensory area (S1), ipsilateral primary motor area (M1), ipsilateral supplementary motor area (SMA) and associated posterior parietal lobe. The regional rCBF in the cortex was significantly improved in both two groups (P<0.05), but there was no significant difference between the two groups after treatment (P>0.05). Before treatment, there was no significant difference in FMA, MWS or BBS scores between the two groups (P>0.05). After treatment, all the scores of lower limb function were improved (P<0.05), and MWS and BBS improvement was significantly greater in group B than in group A (P<0.05), but there was no significant difference in FMA scores between the two groups (P>0.05). Conclusion: The gait intensive motor imagery therapy could more effectively improve lower extremity motor function and gait than the basic motor imagery therapy, possibly by promoting the reorganization of brain function. Gait intensive motor imagery therapy is an effective method for the recovery of lower extremity motor function in hemiplegic stroke patients. |
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