动作观察疗法对脑卒中患者功能康复及实时脑功能成像的影响

发布时间：2018-03-31 10:21

  本文选题：动作观察疗法　切入点：脑卒中　出处：《郑州大学》2017年博士论文

【摘要】：第一部分基于镜像神经元理论的动作观察疗法对脑卒中患者神经功能缺损程度和运动功能康复的影响目的:探讨基于镜像神经元理论的动作观察疗法对脑卒中患者神经功能缺损程度和运动功能的影响。方法:选取脑卒中偏瘫患者136例,随机分为动作观察组和常规康复治疗组,两组患者均给予相同的常规康复治疗措施,另外给予动作观察组患者动作观察疗法,给予常规康复组与动作观察疗法相似的安慰治疗,每天2次,每次30min,每周10次,共治疗8周。采用美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)、简化Fugl-Meyer运动功能评分(Simplified Fugl-Meyer Assessment,FMA)、改良Ashwoth痉挛评定量表(Modified Ashworth scale,MAS)、Brunnstrom运动功能分期评定量表(Brunstrom motor function assessment),分别于入组时、治疗4周后、8周后、12周随访时,评定患者的神经功能缺损程度和运动功能,并进行统计学分析。结果:动作观察组和常规康复治疗组在入组时的一般情况、NIHSS评分、FMA评分、MAS评分、Brunnstrom分期评定均无统计学差异(P0.05),在治疗4周后、8周后、12周随访时,两组患者NIHSS、FMA评分、MAS评分、Brunnstrom运动功能分期评分,随时间的进展,均较治疗前显著改善,差异具有统计学差异(P0.05);组间比较,动作观察组患者评分以及治疗前后差值均显著高于常规康复治疗组,差异具有统计学意义(P0.05)。结论:动作观察疗法,可以改善脑卒中患者神经功能缺损程度,促进神经功能恢复;可以提高患者运动功能评分,降低脑卒中患者关键肌肉的肌张力,促进患者运动功能的恢复。第二部分基于镜像神经元理论的动作观察疗法对脑卒中患者日常生活活动能力的影响目的:探讨基于镜像神经元理论的动作观察疗法对脑卒中患者日常生活活动能力(activities of daily living,ADL)和独立性的影响。方法:选取脑卒中偏瘫患者136例,随机分为动作观察组和常规康复治疗组,两组患者均给予相同的常规康复治疗措施,另外给予动作观察组患者动作观察疗法,给予常规康复组与动作观察疗法相似的安慰治疗,每天2次,每次30min,每周10次,共治疗8周。采用改良巴士指数量表(Modified Barthel Index,MBI)、改良Rankin量表(modified Rankin Scale,m RS),分别于入组时、治疗4周后、8周后、12周随访时,评定患者的日常生活活动能力和独立生活能力,并进行统计学分析。结果:动作观察组患者治疗前MBI评分为(27.88±5.35),治疗后为MBI评分(75.48±4.51),MBI改善值为(48.12±5.56);常规康复治疗组治疗前MBI评分(27.36±5.28),治疗后MBI评分为(66.72±3.21),MBI改善值为(38.85±4.81)。组内比较,治疗后两组患者MBI评分均较治疗前有显著改善,具有显著性差异(P0.05);两组间比较,两组患者治疗前MBI评分无统计学差异(P0.05),而治疗动作观察组患者MBI评分及MBI改善值均高于常规康复治疗组,差异具有统计学意义(P0.05)。治疗前动作观察组患者m RS评分为(4.41±0.61),治疗后为(2.08±0.54),治疗前常规康复治疗组患者m RS评分为(4.25±0.56),治疗后为(2.31±0.46),两组患者治疗前m RS评分无统计学差异(P0.05),治疗后动作观察组患者m RS评分显著低于常规康复治疗组,差异具有统计学意义(P0.05)。结论:基于镜像神经元理论的动作观察疗法有助于提高脑卒中患者ADL能力,降低致残率,改善脑卒中患者预后。第三部分基于镜像神经元理论的动作观察疗法对脑卒中患者实时脑功能成像的影响目的:探讨基于镜像神经元理论的动作观察疗法对脑卒中偏瘫患者实时脑功能成像的影响。方法:选取脑卒中偏瘫患者31例,随机分为动作观察组和常规康复治疗组,两组患者均给予相同的常规康复治疗措施,另外给予动作观察组患者动作观察疗法,给予常规康复组与动作观察疗法相似的安慰治疗,每天2次,每次30min,每周10次,共治疗8周。分别在入组时、8周后时,行实时功能磁共振(real time functional Magnetic Resonance Imaging,rtf MRI)检查,选择初级运动区(primary motor cortex,M1)、运动前区(premotor cortex,PMC)、辅助运动区(supplementary motor area,SMA)为感兴趣区域(region of interest,ROI),然后做相应的数据处理,观察患者脑功能成像情况、激活体积,并进行统计学分析。结果:rtf MRI数据分析结果显示,治疗后两组患者在M1区、SMA区、PMC区的激活体素数均较治疗前有显著增加,动作观察组患者治疗前激活体素为M1(153.94±15.93)、PMV(97.75±17.28)、SMA(90.38±18.11),治疗后激活体素数为M1(416.81±64.42)、PMC(199.50±30.06)、SMA(189.94±23.35),治疗后激活体积显著高于治疗前(P0.05),常规康复治疗组治疗前激活体素数分别为M1(161.53±17.66)、PMC(95.13±19.10)、SMA(92.33±19.61),治疗后为M1(334.13±36.69)、PMC(162.27±28.89)、SMA(152.20±23.21),治疗后激活体积显著高于治疗前激活体积(P0.05)。两组比较,动作观察组患者ROI区激活区体积与增加值,均显著高于常规康复治疗组,差异具有统计学意义(P0.05)。结论:动作观察疗法可以影响患者实时脑功能成像,增加M1区、PMC区、SMA区等运动区激活体积,改变运动功能重组,促使患者偏瘫肢体运动功能恢复。
[Abstract]:The first part of the theory of mirror neurons action observation therapy based on degree of functional impairment and motor nerve function rehabilitation of stroke patients Objective: To investigate the influence of mirror neuron theory of action observation therapy and motor nerve function defect in patients with cerebral stroke based on function. Methods: 136 cases of stroke patients were randomly divided into the observation of action group and routine rehabilitation therapy group, two patients were given routine rehabilitation treatment measures are the same, in addition to the action of patients in the observation group received action observation therapy, rehabilitation group and action observation therapy similar to placebo treatment, 2 times a day, 30min each time, 10 times a week, a total of 8 weeks of treatment. The National Institutes of health stroke research hospital scale (National Institute of Health Stroke Scale, NIHSS), simplified Fugl-Meyer motor function score (Simplified Fugl-Meyer Assessment, FMA), modified As Hwoth spasm scale (Modified Ashworth, scale, MAS, Brunnstrom) staging assessment of motor function scale (Brunstrom motor function assessment), respectively, in the group, after 4 weeks of treatment, after 8 weeks, 12 weeks of follow-up, the degree of neural function defect were evaluated and the movement function, and statistical analysis. Results: the observation group and routine rehabilitation therapy group in general, in the group of NIHSS score, FMA score, MAS score, Brunnstrom staging evaluation showed no statistical difference (P0.05), in the 4 weeks after treatment, after 8 weeks, 12 weeks, two patients in group NIHSS, FMA score, MAS score. Brunnstrom staging of motor function score, as time progressed, were significantly improved compared with before treatment, a statistically significant difference (P0.05); comparison between groups, patients in the observation group action score and the difference between before and after treatment were significantly higher than the conventional rehabilitation treatment group, the difference was statistically significant (P 0.05). Conclusion: the action observation therapy, can improve the degree of neurological impairment, promote the recovery of nerve function; can improve motor function in patients with muscle tension score, the key to reduce muscle of stroke patients, promote patients recovery of motor function. The second part is based on the theory of mirror neurons action observation therapy effects on brain activity life ability of stroke patients Objective: To investigate the ability of mirror neuron theory of action observation therapy on the activity of daily life of stroke patients based on (activities of daily living, ADL) and independent effects. Methods: 136 cases of stroke patients were randomly divided into observation group action and routine rehabilitation therapy group, two groups of patients to measure the same conventional rehabilitation therapy, the patients in the observation group were also given action action observation therapy, given conventional rehabilitation group and action observation therapy similar. 鎱版不鐤，

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