低频重复经颅磁刺激结合作业疗法对卒中患者上肢功能恢复的疗效  

Effect of Low Frequency Repetitive Transcranial Magnetic Stimulation Combined with Occupational Therapy on Recovery of Upper Limb Function in Stroke Patients

作　　者：姜艳平 张瑞莲 朱强 JIANG Yan-ping;ZHANG Rui-lian;ZHU Qiang(Department of Rehibilitation,Jiaozhou Central Hospital of Qingdao,Shandong 266300,China;Department of Neurology,Jiaozhou Central Hospital of Qingdao,Shandong 266300,China;Department of Emergency,Jiaozhou Central Hospital of Qingdao,Shandong 266300,China)

机构地区：[1]青岛市胶州中心医院康复医学科,山东青岛266300 [2]青岛市胶州中心医院神经内科,山东青岛266300 [3]青岛市胶州中心医院急诊科,山东青岛266300

出　　处：《神经损伤与功能重建》2018年第3期130-133,共4页Neural Injury and Functional Reconstruction

摘　　要：目的:探究低频重复经颅磁刺激(r TMS)结合作业疗法(OT)治疗后卒中患者的上肢痉挛和运动功能的变化。方法:选择卒中后伴上肢偏瘫患者47例,按Brunnstrom分期量表分为3期组(12例)、4期组(15例)、5期组(20例),进行低频r TMS结合OT治疗15 d。在治疗前、治疗后及30 d随访时对受影响的上肢痉挛和运动功能进行评估。结果:所有患者治疗后及30 d后随访发现MAS评分和WMFT评分明显下降(P<0.01),FMA评分明显提高(P<0.01),4期组最明显。同时发现偏瘫上肢痉挛改善的患者较未改善的患者上肢运动功能提高更明显。结论:卒中后伴有上肢偏瘫的患者经低频r TMS结合OT治疗15 d后可明显改善受损上肢的偏瘫和运动功能,其中Brunnstrom偏瘫分期为4期的患者受益最明显。且改善受损上肢的痉挛症状有助于提高其运动功能。Objective:To investigate the changes in upper limb spasm and motor function of patients with stroke after low-frequency repetitive transcranial magnetic stimulation(rTMS)combined with occupational therapy(OT.)Methods:Forty-seven patients with upper limb hemiplegia after stroke were recruited to the study.Patients were divided according to the Brunnstrom stages into the stage 3 group(12 patients),stage 4 group(15 patients),and stage 5 group(20 patients)then treated with rTMS combined with OT for 15 days.The affected upper limb spasm and motor function were evaluated prior to and after treatment as well as during the 30-day follow-up.Results:The MAS score and WMFT score for all patients post-treatment and during the 30 day follow-up were significantly decreased(P<0.01),and the FMA score was significantly improved(P<0.01);this was especially apparent in the stage 4 group.At the same time,it was found that patients with improvement to hemiplegia upper limb spasticity improved upper limb motor function significantly more than those without improvement to spasticity.Conclusion:Patients with upper limb hemiplegia after stroke who have been treated with low-frequency rTMS combined with OT for 15 days can significantly improve hemiplegia and motor function in the upper limbs,with patients in Brunnstrom hemiplegia stage 4 experiencing the most benefit.Moreover,improving the spastic symptoms of the damaged upper limb helps to improve its motor function.

关 键 词：低频重复经颅磁刺激 作业疗法 卒中 偏瘫 痉挛 

分 类 号：R741[医药卫生—神经病学与精神病学]