强制性运动疗法联合重复经颅磁刺激对脑卒中患者上肢运动功能的影响  

Constraint-induced movement therapy combined with repetitive transcranial magnetic stimulation can improve upper extremity motor function after a strok

作　　者：韩茜茜 徐宁[1] 王秀秀 吴伟[3] 杨英兰 鹿钦雪 韩晴 Han Qianqian;Xu Ning;Wang Xiuxiu;Wu Wei;Yang Yinglan;Lu Qinxue;Han Qing(Rehabilitation Medical College,Shandong University of Traditional Chinese Medicine,Jinan 250355,China;Department of Rehabilitation Medicine,Municipal TCM Hospital of the Shandong Provincial Hospital Group,Jinan 250002,China;Department of Neurology,Qilu Hospital of Shandong University,Jinan 250012,China)

机构地区：[1]山东中医药大学康复医学院,济南250355 [2]山东省立医院(集团)市中医院康复医学科,济南250002 [3]山东大学齐鲁医院神经内科,济南250012

出　　处：《中华物理医学与康复杂志》2020年第12期1067-1071,共5页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：山东省社会科学规划研究项目(20CZXJ06)。

摘　　要：目的探讨强制性运动疗法(CIMT)联合重复经颅磁刺激(rTMS)对脑卒中患者上肢运动功能的影响。方法选取脑卒中后上肢运动功能障碍患者60例,采用随机数字表法将其分为CIMT组、rTMS组和联合组,每组20例。所有患者均接受常规药物治疗和康复训练,CIMT组增加CIMT进行上肢功能训练,rTMS组增加rTMS治疗,联合组患者先接受rTMS治疗,结束后立即进行CIMT训练。每日治疗1次,每周5 d,持续4周。治疗前及治疗4周后(治疗后),分别采用简化Fugl-Meyer运动功能评定量表上肢部分(FMA-UE)、Carroll上肢功能测试(UEFT)及改良Barthel指数(MBI)对患者进行康复评定。结果治疗前,3组患者FMA-UE、UEFT、MBI评分比较,差异无统计学意义(P>0.05)。与组内治疗前比较,3组患者FMA-UE、UEFT、MBI评分均改善(P<0.05)。与rTMS组治疗后比较,CIMT组及联合组上述指标均显著改善(P<0.05)。与CIMT组治疗后比较,联合组治疗后FMA-UE[(51.60±1.85)分]、UEFT[(35.60±2.93)分]、MBI评分[(68.75±3.01)分]较为优异(P<0.05)。结论CIMT联合rTMS可有效改善脑卒中患者的上肢运动功能及手功能,提高日常生活活动能力。Objective To investigate the effect of combining constraint-induced movement therapy(CIMT)with repeated transcranial magnetic stimulation(rTMS)in treating post-stroke upper extremity motor dysfunction.Methods Sixty stroke survivors with upper extremity motor dysfunction were randomly allocated to a CIMT group(n=20),an rTMS group(n=20)or a combination group(n=20).All three groups received conventional rehabilitation.The CIMT and rTMS groups additionally performed constraint-induced movement training and received rTMS respectively,while the combination group received rTMS followed by CIMT.The treatment was performed once a day,5 days a week for 4 weeks.All three groups were assessed using the simplified Fugl-Meyer upper extremity assessment(FMA-UE),Carroll′s upper extremity function test(UEFT)and the modified Barthel index(MBI)before and after the treatment.Results There were no significant differences in the average FMA-UE,UEFT or MBI scores among the three groups before the intervention.Afterward significant improvement was observed in all of the measurements in all three groups,but the improvement of the combination group was significantly greater than in the other two,and the improvement of CIMT group was greater than in the rTMS group.Conclusion Constraint-induced movement therapy combined with repetitive transcranial magnetic stimulation can effectively improve upper extremity motor function,hand function and ability in the activities of daily living of stroke survivors.

关 键 词：脑卒中 强制性运动疗法 重复经颅磁刺激 上肢 运动功能 

分 类 号：R743.3[医药卫生—神经病学与精神病学]