影响脑卒中患者脑机接口上肢训练效果的相关因素

Factors Related to Curative Effect of Brain-computer Interface Training on Upper Limb Paralysis after Stroke

目的探讨影响接受基于运动想象的脑机接口(MI-BCI)综合康复训练的亚急性期脑卒中患者上肢运动功能疗效的相关因素。方法2018年1月至2019年7月,北京清华长庚医院完成MI-BCI综合康复训练的脑卒中患者23例,收集性别、年龄、病程、是否伴有失语症、病变部位、病变性质、是否使用肉毒毒素、损伤半球、患侧手指屈肌改良Ashworth量表(MAS)评分。训练前后采用Fugl-Meyer评定量表上肢部分(FMA-UE)进行评定,以训练后FMA-UE腕手部分评分提高≥2分为标准,将患者分为显效组(n=11)和非显效组(n=12)。结果训练前,非显效组患侧手指屈肌MAS评分(t=2.677,P<0.05)和曾使用肉毒毒素人数(Z=0.000,P<0.05)高于显效组;训练后FMA-UE总分及各项评分与训练前FMA-UE相应评分呈正相关(r>0.831,P<0.01);是否伴失语症与训练后FMA-UE总分(Eta=0.453,P<0.05)和上臂评分(Eta=0.506,P<0.05)相关;患侧手指屈肌MAS评分与训练后FMA-UE腕手评分呈负相关(r=-0.521,P<0.05)。结论基础运动功能较差、伴有言语障碍和痉挛可能是影响脑卒中上肢功能障碍患者MI-BCI训练效果的不利因素。

Objective To explore the factors affecting curative effect of motor imagery brain-computer interface(MI-BCI) training on upper limb paralysis for subacute stroke patients.Methods From January, 2018 to July, 2019, 23 inpatients with post-stroke upper limb paralysis accepting MI-BCI training were reviewed. The gender, age, course of disease, aphasia, location and nature of lesion, history of Botulinum toxin, hemisphere injured and modified Ashworth Scale(MAS) score of affected fingers were recorded, and they were assessed with Fugl-Meyer Assessment-Upper Extremities(FMA-UE) before and four weeks after MIBCI training. According to improvement of FMA-UE wrist and hand scores(≥ 2), the patients were divided into effective group(n = 11) and inefficacy group(n = 12).Results The MAS scores before MI-BCI training(t = 2.677, P < 0.05) and history of botulinum toxin(Z = 0.000, P <0.05) were more in the inefficacy group than in the efficacy group. FMA-UE scores(total and dimensions) after training were correlated to their baseline levels(r > 0.831, P < 0.01), FMA-UE total scores(Eta = 0.453, P <0.05) and upper arms scores(Eta = 0.506, P < 0.05) were correlated to aphasia, FMA-UE scores of hands were correlated with MAS(r =-0.521, P < 0.05).Conclusion Poor baseline motor function, spasticity and complication with aphasia were the factors unfavorable to MIBCI training for subacute stroke patients with upper limb paralysis.