间歇性Theta节律刺激后行镜像疗法对脑卒中患者上肢运动功能及生活自理能力的影响

EFFECT OF MIRROR THERAPY AFTER INTERMITTENT THETA BURST STIMULATION ON MOTOR FUNCTION OF THE UPPER LIMBS AND SELF-CARE ABILITY OF DAILY LIVING IN PATIENTS WITH STROKE

目的探讨Theta节律刺激(iTBS)后行镜像疗法(MT)对脑卒中患者上肢运动功能及生活自理能力的影响。方法选取2020年4月-2021年5月于威海市立医院康复医学科住院的脑卒中患者45例,随机分为对照组、iTBS组和联合组(每组15例)。3组患者均接受常规康复治疗及作业治疗,iTBS组作业治疗前行iTBS刺激,联合组作业治疗前行iTBS刺激及MT。使用FUGL-MEYER简易上肢运动功能量表(UL-FMA)和手臂动作调查量表(ARAT)对患者上肢运动功能进行评价,使用改良Barthel指数(MBI)对患者日常生活活动能力进行评价,比较3组患者治疗前及治疗4周后上述各指标结果。结果3组患者治疗前UL-FMA、ARAT、MBI评分无显著差异(P>0.05),治疗4周后UL-FMA、ARAT、MBI评分均较治疗前显著提高(t=4.320~28.441,P<0.05)。iTBS组、联合组UL-FMA、ARAT、MBI评分治疗前后差值与对照组相比差异有显著性(t=3.307~6.592,P<0.05),iTBS组与联合组比较差异有显著性(t=2.248~2.824,P<0.05)。结论iTBS联合MT可明显改善脑卒中患者上肢运动功能和自理生活能力,建议在临床推广使用。

Objective To investigate the effect of mirror therapy(MT)after intermittent Theta burst stimulation(iTBS)on the motor function of the upper limbs and self-care ability of daily living in patients with stroke.Methods A total of 45 patients with stroke who were hospitalized in Department of Rehabilitation Medicine,Weihai Municipal Hospital,from April 2020 to May 2021 were randomly divided into control group,iTBS group,and combined group,with 15 patients in each group.All three groups received routine rehabilitation therapy and occupational therapy;the patients in the iTBS group received iTBS before occupational therapy,and those in the combined group received iTBS and MT before occupational therapy.Fugl-Meyer Upper Limb Motor Assessment(UL-FMA)scale and Action Research Arm Test(ARAT)were used to evaluate the motor function of the upper limbs,and modified Barthel index(MBI)was used to evaluate the activities of daily living.The three groups were compared in terms of the above indicators before treatment and after 4 weeks of treatment.Results There were no significant differences in UL-FMA,ARAT,and MBI scores between the three groups before treatment(P>0.05),and there were significant increases in UL-FMA,ARAT,and MBI scores after 4 weeks of treatment(t=4.320-28.441,P<0.05).There were significant differences in the changes in UL-FMA,ARAT,and MBI scores after treatment between the iTBS/combined groups and the control group(t=3.307-6.592,P<0.05),and there were also significant differences between the iTBS group and the combined group(t=2.248-2.824,P<0.05).Conclusion The combination of iTBS and MT can significantly improve the motor function of the upper limbs and the self-care ability of daily living in patients with stroke,and thus it is recommended for clinical application.