基于镜像视觉反馈的康复训练治疗老年脑卒中偏瘫患者疗效研究

Effect of Rehabilitation Training based on Mirror Vision Feedback on the Old Age Stroke Patients with Hemiplegia

目的:观察基于镜像视觉反馈的康复训练对老年脑卒中偏瘫患者上下肢肌力、运动功能及生活质量的影响。方法:选取2017年3月—2019年3月在哈尔滨医科大学附属第一医院康复科门诊及住院治疗的老年脑卒中偏瘫患者120例,采用随机数字表分为对照组和观察组,每组60例。对照组给予包括偏瘫侧肢体锻炼(每组5~10次,每天2~3个循环)、立位平衡(30 min/次,1次/d)、坐位平衡(30 min/次,1次/d)、步行(30 min/次,每天2~3次)、日常活动(30 min/次,每天2~3次)等在内的常规康复训练,每周训练5 d,持续训练4周;观察组给予基于镜像视觉反馈的康复训练,在专业医师的指导下,患者通过镜子集中观察自身镜像的运动成像,将看到的运动成像想象成自己的患侧并尽可能使患侧自主完成训练,训练内容同对照组,持续训练4周。采用改良Ashworth肌张力量表(MAS)评估上、下肢肌力;采用Fugl-Meyer运动功能评分(FMA)评估上、下肢运动功能;采用日常生活能力量表(ADL)评估生活质量。结果:治疗前,2组患侧上下肢肌力、运动功能评分和生活质量评分比较,差异无统计学意义(P>0.05)。与治疗前比较,2组治疗4周后上肢(患侧臂旋前、屈肘肌群)及下肢(患侧髋屈肌群和伸肌群)MAS评分均明显降低,差异有统计学意义(P<0.05);2组治疗2、4周后上肢、下肢FMA评分和ADL评分均明显升高,差异有统计学意义(P<0.05)。与对照组比较,观察组治疗4周后上肢、下肢MAS评分明显更低,差异有统计学意义(P<0.05);观察组治疗2、4周后上肢、下肢FMA评分和ADL评分均明显更高,差异有统计学意义(P<0.05)。结论:基于镜像视觉反馈的康复训练可改善老年脑卒中偏瘫患者上肢及下肢的肌力和运动功能,提高患者生活质量,值得临床推广。

Objective:To observe the effect of rehabilitation training based on mirror vision feedback on upper and lower limb muscle strength,motor function and quality of life in old age stroke patients with hemiplegia.Methods:A total of 120 old age stroke patients with hemiplegia were treated in the outpatient department and inpatient department of Rehabilitation Department of the First Affiliated Hospital of Harbin Medical University from March 2017 to March 2019.The patients were randomly divided into the control group and the observation group,with 60 cases in each group,according to the method of random number table.The control group was given routine rehabilitation training including hemiplegic side limb exercise(5-10 times for each item,and 2-3 cycles every day),standing balance(30 min a time,one time a day),sitting balance(30 min a time,one time a day),walking(30 min a time,2-3 times per day),daily activities(30 min a time,2-3 times every day),treatments for five days per week and continuous treatment for four weeks.The observation group was given rehabilitation training based on mirror vision feedback,under the guidance of professional doctors.The patients focused on observing their own mirror image of motion imaging,imagining the seen motion imaging as their own patient side and making the patient side complete the training independently as much as possible.The training contents were the same as that of the control group,treatments for five days per week,continuous treatment for four weeks.The muscle strength of upper and lower extremities was assessed by the modified Ashworth muscle tension scale(MAS),the motor function of upper and lower extremities was assessed by Fugl-Meyer motor function score(FMA),and the quality of life was assessed by activity of daily living scale(ADL).Results:Before treatment,there was no significant difference in the scores of muscle strength,motor function and quality of life between the two groups(P>0.05).Compared with before treatment,the MAS scores of upper limb(pronator and elbow flexors of the affected side)and lower limb(flexion and extensor groups of the affected hip)in the two groups were significantly lower at 4 weeks after treatment,and the difference was statistically significant(P<0.05),while the FMA scores and ADL scores of upper limbs and lower limbs in the two groups were significantly higher at 2 and 4 weeks after treatment,and the difference was statistically significant(P<0.05).Compared with the control group,the MAS scores of upper and lower limbs in the observation group were significantly lower at 4 weeks after treatment,and the difference was statistically significant(P<0.05);the FMA and ADL scores of upper limbs and lower limbs in the observation group were significantly higher at 2 and 4 weeks after treatment,and the difference was statistically significant(P<0.05).Conclusions:The rehabilitation training based on mirror vision feedback can improve the muscle strength of upper and lower limbs and the motor function of elderly stroke patients with hemiplegia,and it can improve the quality of life of patients,it's worthy of further clinical promotion.