重复经颅磁刺激结合镜像神经元疗法治疗卒中后非流利性失语的疗效观察

Effect of repetitive transcranial magnetic stimulation combined with mirror neuron therapy on non-fluent aphasia after stroke

目的探讨重复经颅磁刺激(rTMS)结合镜像神经元疗法对脑卒中后非流利性失语症患者语言功能的影响。方法选取2018年1月至2018年12月于本院接受治疗的30例非流利性失语患者作为研究对象。30例非流利性失语的患者随机分成对照组与观察组,各15例。对照组采用发音训练、Schull刺激疗法、交流促进法(PACE)、旋律语调法(MIT)等常规方法治疗;观察组进行高频的rTMS治疗后,佩戴VR眼镜进行镜像神经元系统训练版块中"语言组"的视频观察和跟读训练。训练时间每天40 min,每周5天。治疗6周后,采用西方成套失语症检查(WAB)和波士顿命名测验(BNT)对两组患者的临床效果进行评估,对失语商(AQ)以及BNT评分结果进行统计分析。结果治疗6周后,观察组和对照组WAB中的AQ值以及BNT评分较治疗前比较差异具有统计学意义(P<0.05);两组比较,WAB中自发言语、听理解、命名以及复述各项分值比较差异无统计学意义;但观察组AQ值的提升更为显著(P<0.05)。结论镜像神经元疗法结合重复经颅磁刺激治疗脑卒中后非流利性失语症有效,效果与常规的语言康复训练相当。神经调控技术结合基于镜像神经元系统的动作视频观察在失语症的早期康复中值得进一步推广应用。

Objective To investigate the effect of repetitive transcranial magnetic stimulation(rTMS) combined with mirror neuron therapy on language function in patients with non-fluent aphasia after stroke. Methods 30 patients with non-fluent aphasia who were treated in our hospital from January 2018 to December 2018 were selected as the research subjects. 30 patients with non-fluent aphasia were randomly divided into control group and observation group, with 15 cases in each group. The control group was treated with pronunciation training, Schull stimulation therapy,PACE, MIT and other conventional methods. After high frequency rTMS treatment, the observation group wore VR glasses to observe the video of language group in the training block of mirror neuron system and follow up reading training. The training time is 40 minutes a day, 5 days a week. After 6 weeks of treatment, the clinical effects of the two groups were evaluated by Western Aphasia Battery(WAB) and Boston Naming Test(BNT),and the Aphasia Quotient(AQ) and BNT scores were analyzed statistically. Results After 6 weeks of treatment, the AQ value and BNT score of WAB in the observation group and control group were significantly improved compared with those before treatment(P<0.05). There was no significant difference in the scores of spontaneous speech, listening comprehension, naming and retelling between the two groups. But the AQ value of the observation group increased more significantly(P<0.05). Conclusion Mirror neuron therapy combined with repetitive transcranial magnetic stimulation is effective in the treatment of non-fluent aphasia after stroke, and its effect is no less than that of routine language rehabilitation training. The combination of neuromodulation and video observation based on mirror neuron system is worthy of further application in the early rehabilitation of aphasia.