运动想象训练结合头皮针治疗对脑卒中后偏瘫患者下肢运动功能恢复的影响

Motor imagery therapy supplemented with scalp acupuncture for improving lower limb motor function after stroke

目的 观察运动想象训练结合头皮针治疗对脑卒中后偏瘫患者下肢运动功能恢复的影响.方法 使用随机数字表法将120例脑卒中后偏瘫患者分为对照组（60例）及治疗组（60例）.2组患者均给予常规药物治疗及头皮针治疗（头皮针治疗区域为偏瘫侧对侧的顶颞前、后斜线部位）,每天治疗1次,连续治疗3周为1个疗程,共治疗2个疗程;治疗组患者在上述干预基础上辅以运动想象训练,每次治疗持续25 min,每天治疗1次,连续治疗3周为1个疗程,共治疗2个疗程.于治疗前、治疗6周后分别采用步态时间-空间参数（包括10 m MWS、跨步长和步频）、Fugl-Meyer运动功能量表下肢部分（FMA-L）及Holden步行功能分级量表（FAC）对2组患者下肢功能改善情况进行评定.结果 2组患者分别经6周治疗后,治疗组10 m MWS、跨步长及步频分别为（0.52±0.19）m/s,（78.85 ±20.64）cm和（78.08±13.56）步/min,FMA-L评分及FAC评分分别为（24.15±5.75）分和（3.61±0.31）分,对照组10 m MWS、跨步长及步频分别为（0.43±0.14）m/s,（69.95±17.22）cm和（71.45±8.93）步/min,FMA-L评分及FAC评分分别为（20.58±4.75）分和（2.92±0.87）分,2组患者上述指标均较治疗前明显改善（均P＜0.05）,并且上述指标改善幅度均以治疗组较显著,与对照组间差异均具有统计学意义（均P ＜0.05）.结论 运动想象训练结合头皮针治疗可进一步改善脑卒中后偏瘫患者下肢运动功能,其疗效优于单纯头皮针治疗.

Objective To investigate the effect of motor imagery therapy supplemented with scalp acupuncture for improving the lower limb motor function of stroke patients with hemiplegia.Methods A total of 120 hemiplegic stroke patients were randomly divided into an experimental group and a control group with 60 patients in each.All were given routine medical care and scalp acupuncture （stimulating the posterior and anterior oblique line of the parietal-temporal lobe contralateral to the hemiplegic limb）.The treatment was given daily for 3 weeks as one session,and 2 sessions were administered to both groups.The experimental group was given motor imagery therapy in addition.Each treatment took about 25 min every day for 3 weeks as one session,and again 2 consecutive sessions were administered.The temporal and spatial gait parameters （10m maximum walking speed,stride length and cadence） of all of the patients were assessed,the Fugl-Meyer lower extremity assessment （FMA-L） was conducted and functional ambulation classifications （FACs） were assigned before therapy and at the end of the 6 weeks.Results After 6 weeks of treatment,all of the measures had improved significantly for both groups.The experimental group,however,had improved significantly more than the control group.Conclusion Motor imagery therapy can supplement scalp acupuncture to improve lower limb motor function in hemiplegic stroke patients.Hemiplegia