早期主动活动瘫肢及运动意想训练对脑卒中偏瘫上肢运动功能的作用

Effects of early voluntary exercise and motor imagery conditioning on the upper limb motor function of hemiplegic stroke patients

目的探讨脑卒中患者早期主动活动瘫肢结合运动意想训练对其偏瘫上肢运动功能的影响。方法选择符合入选标准的90例急性脑梗死患者,随机分成对照组30例,主动活动瘫肢组(治疗1组)30例,主动活动瘫肢结合运动意想训练组(治疗2组)30例。3组药物治疗基本相同,记录疗程开始与结束时,伸腕时肌肉最大收缩时肌电幅值(EMG)、简式运动功能评定方法(FMA)中上肢运动功能积分、功能独立性评定(FIM)自我照顾中的进食、梳洗、穿上衣项目等各项指标进行评分。结果3组患者治疗前后EMG、FMA、FIM均有明显改变,差异有非常显著性(P<0.01),但治疗后治疗1组和治疗2组各项观察指标积分均高于对照组,并且治疗2组高于治疗1组,组间比较差异有统计学意义(P<0.01)。结论各种正规的康复训练均能改善瘫肢运动功能,但主动活动瘫肢结合运动意想训练更有助于偏瘫上肢运动功能康复。

Objective To investigate the effects of early voluntarily exercising the upper limb of hemiplegic patients com- bined with motor imagery conditioning on the functional rehabilitafion. Methods Ninety eligible patients with acute cerebral infarction were included and randomized into groups of control subjects （ n = 30 ） ,voluntary exercise [ therapy group I （ G - I ） , n = 30] and voluntary exercise plus motor imagery conditioning[ therapy group Ⅱ （G - Ⅱ） , n = 30]. The three groups were giv- en similar medications and the data were registered at the commencement and the closure of the intervention concerning elec- tromyography { EMG） in the state of maximal muscle contraction by extending the arm, the motor function scores for upper limb by Fugl-Meyer Assessment （FMA ） and the scores by Functional Independence Measure （FIM）in terms of self-aided eating, dressing and with coat on. Results The scores in the three groups shifted a lot after the intervention with regard to maximal EMG, FMA and FIM, with difference by t-test { P 〈 0. 01 ）. The scores in G- I and G- Ⅱ were higher than those of the controls after the therapy. In addition, G- Ⅱ ranked higher than G- I , which was different in statistics （ P 〈 O. O1 ）. Conclusion The programmed exercise can improve the disabled upper limb, but the voluntary exercise plus motor imagery conditioning may be more effective in the function rehabilitation for hemiplegic patients.