运动想象结合任务导向训练对慢性期脑卒中患者上肢功能影响的随机对照研究

Effects of motor imagery combined with task-oriented training on the recovery of upper extremity function after stroke： A randomized controlled trial

目的 观察运动想象结合任务导向训练对慢性期脑卒中患者上肢功能恢复的影响.方法 采用随机数字表将慢性期脑卒中偏瘫患者34例分为治疗组（18例）和对照组（16例）.2组患者均给予相同的常规康复治疗,在此基础上,治疗组患者给予40 min运动想象治疗和60 min任务导向训练,对照组患者则接受40 min康复宣教和60 min任务导向训练,上述治疗均为每日1次,每周5次,共4周.2组患者均于治疗前和治疗4周后（治疗后）采用Fugl-Meyer量表上肢部分（FMA-UE）、改良Barthel指数（MBI）以及运动活动日志-14项（MAL）中的患手使用频率（MAL-AOU）和患手动作完成质量（MAL-QOM）进行功能评估,并进行统计学分析.结果 治疗后,2组患者的FMA-UE、MBI、MAL-AOU和MAL-QOM评分与组内治疗前比较,差异均有统计学意义（P＜0.05）,且治疗组患者的FMA-UE、MBI、MAL-AOU和MAL-QOM评分分别为（38.61±5.86）分、（80.55±7.25）分、（2.55±0.45）分和（3.12±0.59）分,分别与对照组治疗后的（31.87±6.31）分、（73.12±9.63）分、（1.78±0.71）分和（2.38±0.76）分比较,差异亦均有统计学意义（P＜0.01）.结论 运动想象结合任务导向训练可进一步促进慢性期脑卒中患者上肢功能的改善,治疗作用优于单纯的任务导向训练.

Objective To investigate the effect of motor imagery combined with task-oriented training on the recovery of upper extremity function after stroke.Methods Thirty-four chronic stroke patients were randomly divided into a treatment group （n =18 cases） and a control group （n =16 cases） using a random number table.All the patients in both groups were given similar conventional rehabilitation treatment.The patients in the treatment group were given motor imagery therapy for 40 min and task-oriented training for 60 min,while those in the control group were given rehabilitation education and task-oriented training for the same periods.All the treatments above were once a day,5 days a week,lasting 4 weeks.The Fugl-Meyer assessment of upper extremity （FMA-UE）,the modified Barthel index （MBI）,and motor activity logs,which included two sub-scales for assessing the amount of use （MAL-AOU） and quality of movement （MAL-QOM） of the affected hand were used to evaluate upper extremity motor ability before and after 4 weeks of treatment.Results At the end of 4 weeks＇ treatment,all measurements in both groups had significantly improved than those before training （P ＜ 0.05）.The average FMA-UE,MBI,MAL-AOU and MAL-QOM scores [（38.61±5.86）,（80.55±7.25）,（2.55 ±0.45） and （3.12±0.59） respectively] of the treatment group significantly exceeded those [（31.87 ±6.31）,（73.12 ±9.63）,（1.78 ±0.71） and （2.38 ± 0.76） respectively] of the control group （P ＜ 0.01）.Conclusions Motor imagery combined with task-oriented training is more effective than task-oriented training alone for promoting the recovery of upper limb function in chronic stroke patients.