可穿戴式振动训练系统对脑卒中后遗症期患者上肢功能障碍的疗效及神经影像机制研究

Study on the Efficacy and Neuroimaging Mechanism of Wearable Vibration Training System in Treating Upper Limb Dysfunction in the Post-Stroke Sequelae

目的:探讨可穿戴式振动训练系统对脑卒中后遗症期患者上肢功能障碍康复的疗效及神经影像机制。方法:选取2022年1月至8月在四川省八一康复医院住院的脑卒中后遗症患者76例,随机分成对照组和试验组,各38例。2组患者均接受常规康复治疗,试验组在常规康复的基础上采用可穿戴式振动训练系统进行康复治疗。在康复前、康复治疗1个月和2个月时,采用改良Ashwroth量表(MAS)评估肌张力,改良Barthel指数(MBI)评估日常生活活动能力,Fugl-Meyer上肢运动功能量表(FMA-UE)估上肢运动功能。选取2023年7月至2024年4月在威海市立医院招募的10例脑卒中后遗症患者,予以可穿戴式振动训练系统康复治疗2个月,分别在康复前和康复开始后3个月时,行磁共振弥散张量成像(DTI)检查。结果:康复治疗1个月后,2组患者MAS评分低于同组治疗前(P<0.05),MBI和FMA-UE评分高于同组治疗前(P<0.05),但2组间差异无统计学意义(P>0.05)。康复治疗2个月后,2组的MAS评分继续降低,且试验组低于对照组(P<0.05);2组的MBI和FMA-UE评分继续升高,且试验组高于对照组(P<0.05)。DTI影像显示,卒中后遗症患者脑损伤侧的各向异性分数(FA)值较正常侧显著降低(P<0.05),可穿戴式振动训练系统治疗2个月后,损伤侧的FA值较治疗前显著增加(P<0.05)。结论:穿戴式振动训练系统治疗可有效改善脑卒中后遗症期患者的上肢功能障碍,其机制可能与修复脑卒中后损伤的神经纤维束有关。

Objective:To investigate the efficacy of a wearable vibratory training system on the rehabilitation of upper limb dysfunction in patients during the post-stroke sequelae stage and its neural imaging mechanisms.Methods:Seventy-six patients with post-stroke sequelae who were hospitalized at Sichuan Bayi Rehabilitation Hospital from January to August 2022 were randomly divided into an experimental group and a control group,with 38 patients in each.Both groups received conventional rehabilitation treatments,while the experimental group additionally used the wearable vibratory training system for rehabilitation.The Modified Ashworth Scale(MAS) was used to assess muscle tone,the Modified Barthel Index(MBI) to evaluate activities of daily living,and the Fugl-Meyer Upper Extremity Scale(FMA-UE) to assess upper limb motor function before rehabilitation and after 1 and 2 months of treatment.Ten patients with post-stroke sequelae recruited from Weihai Municipal Hospital between July 2023 and April 2024 were given rehabilitation treatment using the wearable vibratory training system for 2 months.Diffusion Tensor Imaging(DTI) scans were performed before rehabilitation and 3months after the start of treatment.Results:After one month of rehabilitation,both groups showed lower MAS scores(P<0.05) and higher MBI and FMA-UE scores(P<0.05) compared to their pre-treatment levels,but there were no significant differences between the groups(P>0.05).After two months of rehabilitation,the MAS scores continued to decrease,with the experimental group showing lower scores than the control group(P<0.05);the MBI and FMA-UE scores also increased,with the experimental group scoring higher than the control group(P<0.05).DTI images indicated that the fractional anisotropy(FA) values in the affected hemisphere were significantly lower than those in the normal hemisphere(P<0.05),and after two months of treatment with the wearable vibratory training system,FA values in the affected side increased significantly(P<0.05).Conclusion:Treatment with the wearable vibratory training system can effectively improve upper limb dysfunction in patients during the post-stroke sequelae stage.The mechanism may be related to the repair of damaged neural fiber tracts following stroke.