文章摘要
朱平安,钟立达,马贤聪,卢绮琪,黎志良,曹哲嘉,鲍晓.动作观察疗法联合重复经颅磁刺激对脑卒中后下肢功能障碍的影响[J].中国康复,2023,38(4):208-212
动作观察疗法联合重复经颅磁刺激对脑卒中后下肢功能障碍的影响
Effect of motion observation therapy combined with repetitive transcranial magnetic stimulation on lower extremity function after stroke
  
DOI:
中文关键词: 动作观察  重复经颅磁刺激  脑卒中  运动功能障碍
英文关键词: action observation  repetitive transcranial magnetic stimulation  stroke  motor dysfunction
基金项目:韶关市科技计划项目(200813104530737)
作者单位
朱平安 1.赣南医学院康复学院江西 赣州 3410002.粤北人民医院康复医学科广东 韶关 512025 
钟立达 粤北人民医院康复医学科广东 韶关 512025 
马贤聪 粤北人民医院康复医学科广东 韶关 512025 
卢绮琪 粤北人民医院康复医学科广东 韶关 512025 
黎志良 粤北人民医院康复医学科广东 韶关 512025 
曹哲嘉 南方医科大学临床医学系广州 510515 
鲍晓 粤北人民医院康复医学科广东 韶关 512025 
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中文摘要:
  目的:探讨动作观察疗法(AOT)联合重复经颅磁刺激(rTMS)对缺血性脑卒中患者下肢运动功能的影响。方法:选择72名缺血性脑卒中后下肢功能障碍的患者作为研究对象,随机分为A~D 4组各18例,4组都进行常规康复治疗,在此基础上再给与不同治疗措施。A组:AOT+rTMS ,B组:AOT,C组:rTMS;D组:无其他治疗措施。每组均治疗8周。在治疗开始前、治疗4、8周后分别进行Fugl-Meyer下肢评分(FMA-LE)、10m步行测试(10MWT)、体感诱发电位(SEP)评估。结果:4组患者治疗4周、8周后的FMA-LE、10MWT、SEP潜伏期以及SEP波幅均存在交互效应(均P<0.05)。4组患者治疗4周、8周后的FMA-LE、10MWT以及SEP波幅均高于治疗前(均P<0.05);4组患者治疗8周后的FMA-LE,10MWT以及SEP波幅均较治疗4周后升高(均P<0.05);4组患者治疗4周及8周后SEP潜伏期均降低(均P<0.05);4组患者治疗8周后SEP潜伏期较治疗4周后均有降低(均P<0.05)。治疗4周、8周时,A组FMA-LE、10MWT和SEP波幅均高于其他3组(均P<0.05),SEP潜伏期均低于其他3组(均P<0.05);但是在治疗4周和干预8周时,B组、C组和D组FMA-LE、10MWT、SEP潜伏期以及波幅均无显著性差异。结论:AOT联合rTMS治疗对于缺血性脑卒中后下肢功能障碍的改善更加有效,值得在临床上推广应用。
英文摘要:
  Objective: To investigate the effect of action observation therapy (AOT) in combination with repetitive transcranial magnetic stimulation (rTMS) on lower limb motor function in patients with ischemic stroke. Method: From July 2019 to February 2021, 72 patients with lower limb dysfunction after ischemic stroke who met the inclusion and exclusion criteria were selected. All patients were randomly divided into 4 groups (group A: 18 cases given AOT+rTMS; group B: 18 cases given AOT; group C: 18 cases given rTMS; group D: 18 cases given routine treatment). AOT treatment lasted about 30~45 min each time, twice a day, 5 days a week, for 8 consecutive weeks. The rTMS treatment was performed on the lower extremity region of the affected side motor cortex with 1000 pulses of 5Hz rTMS, the intensity was 80% of MT of tibialis anterior muscle, and the duration was about 20 min, once a day, 5 days a week for 4 weeks. Fugl-meyer lower extremity score (FMA-LE), 10-meter walk test (10MWT) and somatosensory evoked potential (SEP) were assessed at baseline, 4 weeks and 8 weeks after tredment. Results: Repeated ANOVA showed that FMA-LE, 10MWT, SEP latency and SEP peak had the interaction effect of time and group(P<0.05). For intragroup comparison, compared with the baseline, peak FMA-LE, 10MWT, and SEP were increased in all 4 groups at 4 and 8 weeks post-intervention (P<0.05); compared with those at week 4, FMA-LE, 10MWT, and SEP peaks were increased in all 4 groups at week 8 (P<0.05). The SEP latency in the 4 groups decreased after 4 and 8 weeks of intervention (P<0.05). The SEP latency was decreased after 8 weeks of treatment in all 4 groups compared with those after 4 weeks of treatment (P<0.05). Whether the intervention was 4 weeks or the intervention was 8 weeks, FMA-LE, 10MWT, and SEP amplitude was higher and SEP latency was lower in the group A than those in the other 3 groups (P<0.05). However, there were no significant differences in FAM-LE, 10MWT, SEP latency, or amplitudes among groups B, C, and D at either 4-week intervention or 8-week intervention. Conclusion: AOT combined with rTMS, AOT alone and rTMS alone can improve lower limb motor function and nerve conduction function, but compared with AOT alone or rTMS treatment, AOT combined with rTMS treatment is more beneficial for the improvement of lower limb dysfunction after ischemic stroke.
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