| 施伯瀚,马书杰,任宁娜,唐燕甫,徐倩,王萍,朱薇嘉,朱燕.镜像疗法结合节律性听觉刺激对脑卒中患者上肢运动功能恢复的影响[J].中国康复,2025,40(2):83-88 |
| 镜像疗法结合节律性听觉刺激对脑卒中患者上肢运动功能恢复的影响 |
| Effect of mirror therapy combined with rhythmic auditory stimulation on upper limb motor functions in hemiplegic patients after stroke |
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| DOI：10.3870/zgkf.2025.02.004 |
| 中文关键词: 镜像疗法 节律性听觉刺激 脑卒中 表面肌电图 上肢功能 |
| 英文关键词: mirror therapy rhythmic auditory stimulation stroke surface electromyography upper limb function |
| 基金项目:上海市宝山区科学技术委员会科技创新专项资金项目（21-E-65）；上海市宝山区医学重点专科及（A类）特色品牌建设项目（BSZK-2023-A17） |
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| 中文摘要: |
| 目的：探讨镜像疗法结合节律性听觉刺激对脑卒中偏瘫患者上肢功能恢复的影响。方法：选取81例脑卒中患者按随机数字表法分为3组（各27例）：常规康复组、镜像疗法组及联合组。每位患者均接受常规干预及康复治疗，镜像疗法组增加镜像疗法的干预，联合组基于常规康复组增加镜像疗法和节律性听觉刺激治疗，各组均接受4周的治疗。采用Fugl-Meyer运动评估量表-上肢部分（FMA-UE）、表面肌电图评测偏瘫侧肱二头肌、肱三头肌的肌电信号值-均方根值（RMS）、改良Barthel指数（MBI）、改良Ashworth肌张力量表（MAS）对患者治疗前后进行评估。结果：治疗4周后，3组患者FMA-UE评分、MBI评分均较治疗前明显提高，MAS分级较治疗前明显降低（P＜0.01，0.05），镜像疗法组的FMA-UE评分、MBI评分均高于常规组（P＜0.05），而联合组FMA-UE、MBI评分高于常规组与镜像疗法组（P＜0.05）；联合组MAS分级改善例数显著多于常规组与镜像疗法组（P＜0.05）；治疗后，3组患者患侧肱二头肌（BB）的RMS均较治疗前降低，肱三头肌（TB）的RMS均较治疗前升高（P＜0.01），联合组BB、TB的RMS分别较常规组与镜像疗法组降低和升高更显著（P＜0.05）。结论：镜像疗法结合节律性听觉刺激能有效促进脑卒中偏瘫患者上肢功能的改善，提高日常生活活动能力，具有临床应用前景。 |
| 英文摘要: |
| Objective: To explore the effect of mirror therapy combined with rhythmic auditory stimulation on the recovery of upper limb function in patients with hemiplegia after stroke. Methods: A total of 81 patients with upper limb dysfunction following stroke were selected as research subjects, and divided into three groups (each with 27 cases) according to the random number table method: conventional rehabilitation group, mirror therapy group, and combined treatment group. Each patient received conventional intervention and rehabilitation treatment. The mirror therapy group was given mirror therapy intervention + the conventional rehabilitation group, and the combined treatment group was subjected to mirror therapy + rhythmic auditory stimulation + the conventional rehabilitation. Patients in each group received 4 weeks of treatment. The Fugl-Meyer motor assessment scale-upper extremity (FMA-UE) and surface electromyography (sEMG) were used to evaluate the electromyographic signal values - root mean square (RMS) of the biceps and triceps muscles on the paralyzed side, modified Barthel index (MBI), and modified Ashworth scale (MAS) were used to assess the patients before and after treatment, and the data were statistically analyzed. Results: Before treatment, there were no significant differences in FMA-UE scores, MAS grading, RMS, and MBI scores among the three groups. After a 4-week treatment period, intra-group comparisons among the three groups showed that the FMA-UE scores, MAS grades, and MBI scores were all improved compared to pre-treatment, with significant differences (P<0.05). The mirror therapy group had superior FMA-UE and MBI scores to the conventional group (P<0.05). The combined therapy group showed significantly higher FMA-UE and MBI scores than the conventional group and the mirror therapy group (P<0.05). The number of cases showing improvement in MAS grade in the combined therapy group was significantly greater than in the conventional and mirror therapy groups (P<0.05). Additionally, there was no significant difference in MAS grade between the mirror therapy group and the conventional group. Concurrently, post-treatment RMS of the biceps brachii on the affected side decreased, and RMS of the triceps brachii increased compared to pre-treatment in all three groups (P<0.05). The combined therapy group showed a more significant increase in RMS of both the biceps brachii and triceps brachii compared to the conventional and mirror therapy groups, with significant differences (P<0.05). Conclusion: The combination of mirror therapy and rhythmic auditory stimulation can effectively promote the improvement of upper limb function in patients with hemiplegia after stroke and enhance the ability to perform activities of daily living. |
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