反馈式功能性电刺激对脑梗死患者上肢运动功能影响的fMRI研究

fMRI Study on Effects of Feedback Type Functional Electrical Stimulation on Motor Function of Upper Limb in Patients with Cerebral Infarction

目的:利用功能核磁共振成像(f MRI)技术探究反馈式功能性电刺激对脑梗死患者上肢运动功能的影响,为脑梗死患者的康复提供最佳治疗方案。方法:选取2010年1月至2014年12月我院收治的脑梗死患者42例,随机分为I、II、III组,各14例,3组患者均接受常规康复治疗和药物治疗,在此基础上,I组行反馈式功能电刺激治疗,II组行单纯功能性电刺激治疗,疗程均为28天。治疗前后对所有患者进行上肢功能Fugl-Meyer运动量表评估和腕背屈关节活动度测量,并于治疗后3 d内对患者大脑M1区的激活强度进行f MRI检查。结果:3组患者的运动功能均较治疗前有所改善,其中Fugl-Meyer运动量表评分和腕背屈关节活动度的测量结果显示,I、II组测量结果明显好于III组,I组测量结果明显好于II组,差异具有统计学意义(P<0.05)。患者大脑M1区激活强度对比,I、II组明显强于III组(P<0.05),I组测量明显强于II组,差异均有统计学意义(P<0.05)。结论:脑梗死康复期患者采用功能性电刺激治疗有助于受损脑功能重组,其中反馈式功能性电刺激强调人的主观性运动,较单纯性电刺激效果更好。

Objective： To explore the effect of feedback functional electrical stimulation on motor function of upper limb in patients with cerebral infarction by functional magnetic resonance imaging（f MRI）, and to provide the best treatment plan for patients with cerebral infarction. Methods： Selected 42 cases of patients with cerebral infarction who were treated in our hospital from January 2010 to December 2014, and were randomly divided into I, II, III group, with 14 cases of patients in each group, 3 groups of patients were treated with conventional rehabilitation therapy and drug therapy, based on that, I group were treated with feedback functional electrical stimulation, and II group were treated with simple functional electrical stimulation, the course of treatment was 28 days. Evaluated the upper limb function by Fugl-Meyer motor scale and measured the degree of activity of the wrist, and checked the intensity of activation of M1 in the brain of patients by f MRI. Results： The motor function of the patients in 3 groups were improved than before treatment, Fugl-Meyer motor scale score and measurement results of wrist joint activity showed that the measurement results of I and II groups were significantly better than the III group, and the I group was significantly better than the II group, the differences were statistically significant（P〈0.05）. Compared the intensity of activation of M1 in the brain of patients, the I, II groups were significantly better than the III group, and the I group was significantly better than the II group, the differences were statistically significant（P〈0.05）. Conclusion： Functional electrical stimulation in the treatment of patients with cerebral infarction is helpful to the rehabilitation of impaired brain function, and the feedback of functional electrical stimulation of human subjectivity movement, which is better than simple electrical stimulation.