运动想象疗法联合平衡功能评定与训练对初发脑卒中患者平衡功能及日常生活活动能力的影响

Motor imagery therapy combined with balance training can improve performance in the activities of daily living after an initial stroke

目的观察运动想象疗法联合平衡功能评定与训练对初发脑卒中偏瘫患者早期平衡功能及日常生活活动（ADL）能力的影响。方法采用随机数字表法将48例脑卒中偏瘫患者分为观察组（23例）及对照组（25例）。2组患者均给予对症的药物治疗及常规康复干预，同时辅以平衡功能评定与训练，观察组患者在此基础上辅以运动想象疗法。于治疗前、治疗2周后、4周后对2组患者进行平衡功能及ADL能力评定。平衡功能评定项目包括重心摇动偏移测试指标和平衡障碍程度测试指标（如动摇角度、动摇总轨迹长、包络面积），同时采用Fugl—Meyer评定量表平衡功能部分（FM—B）对患者平衡功能进行评定；采用改良Barthel指数量表（MBI）对患者ADL能力进行评定。结果治疗前2组患者各项疗效指标组间差异均无统计学意义（P〉0．05），分别经2周、4周治疗后发现2组患者各项疗效指标均较组内治疗前明显改善（P〈0．05），并且观察组上述指标（除MBI评分外）改善幅度亦显著优于对照组水平，组间差异均具有统计学意义（P〈0．05）。结论常规康复干预结合平衡评定与训练并辅以运动想象疗法可显著提高初发脑卒中患者早期平衡功能，进一步改善患者运动功能及ADL能力，该联合疗法值得临床推广、应用。

Objective To explore the effect of motor imagery therapy combined with balance evaluation and training on balance and performance in the activities of daily living （ADL） after an initial stroke. Methods A total of 48 stroke patients were randomly divided into a control group （n = 25） and an observation group （n = 23）. All of the patients in both groups were given routine rehabilitation and balance training. In addition, the patients of the observation group were given motor imagery therapy. Balance and ADL performance were assessed before the training and 2 weeks and 4 weeks after the training began. The subjects＇ balance was analyzed using the center of the gravity shift index, shift angle, total length of shift trace and envelope area using a balance evaluation system and the balance subscale of the Fugl-Meyer assessment （FM-B）. Performance in the activities of daily living was assessed using the modified Barthel index （MBI）. Results Before the training there were no significant differences between the two groups in terms of any of the measurements. After 2 weeks and 4 weeks of training, all the measurements in both groups were significantly better than those before training, but the improvement of the observation group was significantly greater than that of the control group （ except in terms of the MBI）. Conclusion Motor imagery therapy combined with balance training can distinctly improve the balance and activities of daily living of stroke survivors. The combination is worthy of application in the clinic.