镜像疗法联合功能性电刺激治疗脑卒中患者上肢运动功能障碍临床研究

Clinical Study of Mirror Therapy Combined with Functional Electrical Stimulation for Upper Limb Motor Dysfunction in Patients with Stroke

目的:观察镜像疗法(MT)联合功能性电刺激(FES)对脑卒中患者上肢运动功能障碍和鱼际肌萎缩的影响。方法:选择2017年8月—2020年8月邢台市第三医院康复医学科收治的120例脑卒中后上肢运动功能障碍患者,采用随机数字表法分为对照组和观察组,每组60例。2组均接受常规药物治疗和常规康复训练。对照组在常规治疗基础上接受FES疗法,观察组在对照组基础上接受MT疗法。分别于治疗前后采用Fugle-Meyer运动功能评定量表上肢部分(FMA-UE)、Wolf上肢运动功能评价量表(WMFT)、Brunnstrom偏瘫分级评定量表评定患者上肢运动功能;采用功能独立性评定量表(FIM)评定患者功能独立性;采用改良Barthel指数(MBI)评定患者日常生活活动能力;采用彩色超声诊断仪测量鱼际肌群横截面积(CSA)和周长。结果:①上肢运动功能:与治疗前比较,2组治疗后FMA-UE、WMFT和Brunnstrom偏瘫分级评分均明显提高,差异均具有统计学意义(P<0.05);与对照组比较,观察组治疗后FMA-UE、WMFT和Brunnstrom偏瘫分级评分均明显更高,差异均具有统计学意义(P<0.05)。②FIM、MBI评分:与治疗前比较,2组治疗后FIM、MBI评分均明显提高,差异均具有统计学意义(P<0.05);与对照组比较,观察组治疗后FIM、MBI评分均明显更高,差异均具有统计学意义(P<0.05)。③鱼际肌群CSA、周长:与治疗前比较,2组治疗后鱼际肌肌群CSA、周长均明显升高(P<0.05)。与对照组比较,观察组治疗后鱼际肌肌群CSA、周长均明显更高,差异均具有统计学意义(P<0.05)。结论:MT联合FES可以有效改善脑卒中患者上肢运动功能,减少鱼际肌萎缩程度,提高患者日常生活活动能力。

Objective:To observe the effect of mirror therapy(MT)combined with functional electrical stimulation(FES)on upper limb motor dysfunction and thenar muscle atrophy in stroke patients.Methods:A total of 120 patients with upper limb motor dysfunction after stroke in the Xingtai Third Hospital from August 2017 to August 2020 were randomly divided into control group and observation group,with 60 cases in each group.Both groups received routine drug treatment and conventional rehabilitation training.The control group received FES therapy in addition to the conventional therapy,while the observation group received MT therapy in addition to the conventional therapy.Before and after treatment,Fugl-Meyer assessment of upper extremity(FMA-UE),Wolf motor function test(WMFT)and Brunnstrom hemiplegia stage were used to evaluate the motor function of upper limbs of patients with stroke;functional independence measure(FIM)was used to evaluate the functional independence;modified Barthel index(MBI)was used to assess the activities of daily living of patients;and color ultrasound diagnostic instrument was used to measure the cross sectional area(CSA)and circumference of thenar muscles.Results:(1)Motor function of upper limbs:compared with those before treatment,FMA-UE,WMFT and Brunnstrom hemiplegia stage scores of both groups after treatment significantly improved,and the differences were statistically significant(P<0.05);compared with the control group,FMA-UE,WMFT and Brunnstrom hemiplegia stage scores in the observation group after treatment were significantly higher,and the differences were statistically significant(P<0.05).(2)FIM and MBI scores:compared with those before treatment,the FIM and MBI scores of both groups after treatment significantly increased,and the differences were statistically significant(P<0.05);compared with the control group,the FIM and MBI scores of the observation group after treatment were significantly higher,and the differences were statistically significant(P<0.05).(3)CSA and circumference of thenar muscles:compared with those before treatment,CSA and circumference of thenar muscles of both groups after treatment significantly increased(P<0.05).Compared with the control group,the CSA and circumference of thenar muscles in the observation group after treatment were significantly higher,and the differences were statistically significant(P<0.05).Conclusion:MT combined with FES can effectively improve the upper limb motor function of stroke patients,reduce the degree of thenar muscle atrophy,and improve the activities of daily living of patients.