基于脑机接口的电刺激训练对脑卒中患者上肢功能障碍康复的临床研究

Clinical study of brain-computer interface based electrical stimulation training in improving upper limb dysfunction of patients with stroke

目的探究基于脑机接口的电刺激训练联合常规康复对缺血性脑卒中患者上肢功能障碍的临床疗效,观察治疗前后脑电信号的变化。方法选择40例缺血性脑卒中后上肢功能障碍患者,其中男性21例,女性19例;年龄61~78岁,平均年龄68.15岁;体质量指数20.06~28.94 kg/m^(2),平均体质量指数23.73 kg/m^(2);病程0.2~3.0个月,平均病程1.49个月;糖尿病13例;偏瘫左侧24例,右侧16例。随机分为对照组(20例)和研究组(20例)。对照组给予常规康复治疗,研究组在常规康复治疗的基础上给予基于脑机接口的电刺激训练。治疗前和治疗4周后采用Fugl-Meyer评定量表上肢部分(FMA-UE)、Wolf运动功能评定量表(WMFT)、上肢动作研究量表(ARAT)及改良Barthel指数(MBI)评价患侧上肢运动功能和日常生活活动能力。并对患者进行脑电图的检测,提取脑电信号α波绝对功率值,观察其治疗前后的变化。结果治疗4周后,两组患者FMA-UE评分、WMFT评分、ARAT评分和MBI均较治疗前显著提高[FMA-UE:研究组(16.45±3.43)分vs(39.90±4.44)分,对照组(17.15±3.83)分vs(36.20±6.21)分;WMFT:研究组(14.05±3.05)分vs(31.85±7.06)分,对照组(13.25±3.92)分vs(26.40±7.01)分;ARAT:研究组(4.50±2.69)分vs(17.40±5.73)分,对照组(4.95±2.42)分vs(12.45±4.54)分;MBI:研究组(47.25±8.33)分vs(71.30±2.92)分,对照组(46.05±10.58)分vs(69.35±4.13)分。P<0.01];且研究组FMA-UE评分、WMFT评分和ARAT评分明显高于对照组(P<0.05),MBI两组差异无统计学意义(P>0.05)。治疗后,组间比较,研究组FP1、FP2、AF4、C1、C3、CZ、C4、P3、CP1、CP2、CP3导联α波绝对功率值较对照组均显著提高(P<0.05)。组内比较,研究组患者脑电图FP1、FP2、AF4、C1、C3、CZ、C4、P3、CP1、CP2、CP3导联的α波绝对功率值较治疗前显著提高(P<0.05),对照组各导联α波绝对功率值未见明显变化(P>0.05)。结论基于脑机接口的电刺激训练联合常规康复能有效改善缺血性脑卒中后上肢功能障碍,提高患者日常生活活动能力,大脑电信号有相应改变。

Objective To explore the clinical effect of brain-computer interface(BCI)based electrical stimulation training combined with conventional rehabilitation on upper limb dysfunction in patients with ischemic stroke,and probe the changes of electroencephalogram(EEG)signals before and after treatment.Methods A total of 40 patients with upper limb dysfunction after ischemic stroke were enrolled,which included 21 males and 19 females,aged 61-78 years old with mean age of68.15 years old;body mass index(BMI)was 20.06-28.94 kg/m^(2) with mean BMI of 23.73 kg/m^(2);disease course was 0.2-3.0 months with mean of 1.49 months;13 cases with diabetes;24 cases with hemiplegia on the left side and 16 on the right side.All of them were randomly divided into control group(n=20)and study group(n=20).The control group was given conventional rehabilitation treatment and study group was given BCI electrical stimulation training on the basis of conventional rehabilitation treatment.Before and 4-week after treatment,Fugl-Meyer assessment-upper extremity(FMA-UE),Wolf motor function test(WMFT),action research arm test(ARAT)and modified Barthel index(MBI)were used to evaluate motor function of injured upper limb and activities of daily living.The EEG detection was performed to extract absolute power value of EEG alpha wave,and changes before and after the treatment was observed.Results After 4-week treatment,the FMA-UE,WMFT,ARAT and MBI scores of 2 groups were significantly improved than before treatment[FMA-UE:study group(16.45±3.43)scores vs(39.90±4.44)scores,control group(17.15±3.83)scores vs(36.20±6.21)scores;WMFT:study group(14.05±3.05)scores vs(31.85±7.06)scores,control group(13.25±3.92)scores vs(26.40±7.01)scores;ARAT:study group(4.50±2.69)scores vs(17.40±5.73)scores,control group(4.95±2.42)scores vs(12.45±4.54)scores;MBI:study group(47.25±8.33)scores vs(71.30±2.92)scores,control group(46.05±10.58)scores vs(69.35±4.13)scores.P<0.01];The FMA-UE,WMFT and ARAT scores in study group were significantly higher than those in control group(P<0.05).There was no statistically significant difference in MBI score between 2 groups(P>0.05).After treatment,the absolute power values of alpha wave in leads FP1,FP2,AF4,C1,C3,CZ,C4,P3,CP1,CP2 and CP3 of study group were significantly higher than those of control group(P<0.05).Meantime,the absolute power value of alpha waves in leads FP1,FP2,AF4,C1,C3,CZ,C4,P3,CP1,CP2 and CP3 were significantly higher after treatment than before treatment in study group(P<0.05),and there was no significant change in absolute power value of alpha waves in each lead of control group(P>0.05).Conclusion It is demonstrated that BCI electrical stimulation training combined with conventional rehabilitation could effectively improve upper limb dysfunction after ischemic stroke and improve daily living activities,and cause corresponding changes of EEG.