Theta爆发式磁刺激联合镜像治疗对脑卒中恢复期患者上肢运动功能的康复效果

Effects of Theta Burst Stimulation Combined with Mirror Therapy on Motor Recovery of Upper Limbs of Patients in Stroke Recovery Period

目的:探讨间断性Theta爆发式磁刺激(iTBS)联合镜像治疗(MT)对脑卒中恢复期患者上肢运动功能及日常生活活动能力的影响。方法:脑卒中恢复期患者46例随机分为4组:对照组11例、iTBS组12例、MT组11例、联合组12例。对照组进行常规康复治疗,治疗组在对照组治疗的基础上分别加用iTBS、MT和iTBS联合MT治疗。所有治疗均为1次/d,5 d/周,共10次。分别于治疗前(T_(0))、治疗结束后当天(T_(1))、治疗结束后1个月(T_(2))、3个月(T_(3)),采用美国国立卫生研究院卒中量表(NIHSS)、Fugl-Meyer评定量表上肢部分(UL-FMA)、Brunnstrom分期(BS)和改良Barthel指数(MBI)对患者进行评估和比较。结果:组内比较,4组的UL-FMA(近端)、上肢BS、NIHSS和MBI评分在治疗后各时间点较治疗前改善(P<0.05);联合组从T_(1)开始UL-FMA(远端)评分和手部BS评分高于治疗前(P<0.05),而其他3组从T_(2)开始高于治疗前(P<0.05)。组间比较发现,联合组的UL-FMA(近端)(T_(3))、上肢和手部BS分期(T_(3))、MBI(T_(2))高于对照组(P<0.05),上肢BS分期(T_(3))高于MT组(P<0.05);iTBS组的上肢BS分期(T_(3))高于对照组(P<0.05)。结论:iTBS联合MT治疗较能更好地促进脑卒中恢复期患者的上肢运动功能和日常生活活动能力。

Objective:To investigate the effects of intermittent theta burst stimulation(iTBS)combined with mirror image therapy(MT)on upper limb motor function and daily living ability of patients in stroke recovery period.Methods:Forty-six stroke patients were randomly divided into four groups:control group(n=11),iTBS group(n=12),MT group(n=11)and combination group(n=12).Patients in control group received routine rehabilitation treatment,and patients in treatment groups were additionally treated with iTBS,MT and MT combined with iTBS respectively.All the patients received the therapy 5 days per week for 10 working days.Patients were evaluated before treatment(T_(0)),then immediately(T_(1)),1 month(T_(2))and 3 months(T_(3))after treatment.The evaluation included:National Institutes of Health Stroke Scale(NIHSS),upper limb Fugl-Meyer assessment(UL-FMA),Brunnstrom Scale(BS)and Modified Barthel Index(MBI).Results:On comparison with baseline data,the UL-FMA(proximal),upper extremity BS,NIHSS and MBI scores of the four groups were improved after treatment at each time point(P<0.05).For the UL-FMA(distal)score and hand BS,the combination group increased at T_(1)(P<0.05),while the other three groups began to increase significantly at T_(2)(P<0.05).The UL-FMA(proximal)(T_(3)),upper limb and hand BS(T_(3))and MBI(T_(2))in combination group were significantly higher than those in control group(P<0.05)and the upper limb BS(T_(3))was also significantly higher than that in MT group(P<0.05).The upper limb BS(T_(3))in iTBS group was higher than that in control group(P<0.05).Conclusion:The combination of iTBS and MT therapy can better promote upper limb motor function and activities of daily living of patients in stroke recovery period.