动作观察疗法联合重复经颅磁刺激对脑卒中后下肢功能障碍的影响  

Effect of motion observation therapy combined with repetitive transcranial magnetic stimulation on lower extremity function after stroke

作　　者：朱平安 钟立达 马贤聪 卢绮琪 黎志良 曹哲嘉 鲍晓[2] Zhu Pingan;Zhong Lida;Ma Xiancong(School of Rehabilitation,Gannan Medical University,Ganzhou 341000,China)

机构地区：[1]赣南医学院康复学院,江西赣州341000 [2]粤北人民医院康复医学科,广东韶关512025 [3]南方医科大学临床医学系,广州510515

出　　处：《中国康复》2023年第4期208-212,共5页Chinese Journal of Rehabilitation

基　　金：韶关市科技计划项目(200813104530737)。

摘　　要：目的:探讨动作观察疗法(AOT)联合重复经颅磁刺激(rTMS)对缺血性脑卒中患者下肢运动功能的影响。方法:选择72名缺血性脑卒中后下肢功能障碍的患者作为研究对象,随机分为A~D 4组各18例,4组都进行常规康复治疗,在此基础上再给与不同治疗措施。A组:AOT+rTMS,B组:AOT,C组:rTMS;D组:无其他治疗措施。每组均治疗8周。在治疗开始前、治疗4、8周后分别进行Fugl-Meyer下肢评分(FMA-LE)、10m步行测试(10MWT)、体感诱发电位(SEP)评估。结果:4组患者治疗4周、8周后的FMA-LE、10MWT、SEP潜伏期以及SEP波幅均存在交互效应(均P<0.05)。4组患者治疗4周、8周后的FMA-LE、10MWT以及SEP波幅均高于治疗前(均P<0.05);4组患者治疗8周后的FMA-LE,10MWT以及SEP波幅均较治疗4周后升高(均P<0.05);4组患者治疗4周及8周后SEP潜伏期均降低(均P<0.05);4组患者治疗8周后SEP潜伏期较治疗4周后均有降低(均P<0.05)。治疗4周、8周时,A组FMA-LE、10MWT和SEP波幅均高于其他3组(均P<0.05),SEP潜伏期均低于其他3组(均P<0.05);但是在治疗4周和干预8周时,B组、C组和D组FMA-LE、10MWT、SEP潜伏期以及波幅均无显著性差异。结论:AOT联合rTMS治疗对于缺血性脑卒中后下肢功能障碍的改善更加有效,值得在临床上推广应用。Objective:To investigate the effect of action observation therapy(AOT)in combination with repetitive transcranial magnetic stimulation(rTMS)on lower limb motor function in patients with ischemic stroke.Method:From July 2019 to February 2021,72 patients with lower limb dysfunction after ischemic stroke who met the inclusion and exclusion criteria were selected.All patients were randomly divided into 4 groups(group A:18 cases given AOT+rTMS;group B:18 cases given AOT;group C:18 cases given rTMS;group D:18 cases given routine treatment).AOT treatment lasted about 30~45 min each time,twice a day,5 days a week,for 8 consecutive weeks.The rTMS treatment was performed on the lower extremity region of the affected side motor cortex with 1000 pulses of 5Hz rTMS,the intensity was 80%of MT of tibialis anterior muscle,and the duration was about 20 min,once a day,5 days a week for 4 weeks.Fugl-meyer lower extremity score(FMA-LE),10-meter walk test(10MWT)and somatosensory evoked potential(SEP)were assessed at baseline,4 weeks and 8 weeks after tredment.Results:Repeated ANOVA showed that FMA-LE,10MWT,SEP latency and SEP peak had the interaction effect of time and group(P<0.05).For intragroup comparison,compared with the baseline,peak FMA-LE,10MWT,and SEP were increased in all 4 groups at 4 and 8 weeks post-intervention(P<0.05);compared with those at week 4,FMA-LE,10MWT,and SEP peaks were increased in all 4 groups at week 8(P<0.05).The SEP latency in the 4 groups decreased after 4 and 8 weeks of intervention(P<0.05).The SEP latency was decreased after 8 weeks of treatment in all 4 groups compared with those after 4 weeks of treatment(P<0.05).Whether the intervention was 4 weeks or the intervention was 8 weeks,FMA-LE,10MWT,and SEP amplitude was higher and SEP latency was lower in the group A than those in the other 3 groups(P<0.05).However,there were no significant differences in FAM-LE,10MWT,SEP latency,or amplitudes among groups B,C,and D at either 4-week intervention or 8-week intervention.Conclusion:AOT combined with rTMS,AOT

关 键 词：动作观察 重复经颅磁刺激 脑卒中 运动功能障碍 

分 类 号：R49[医药卫生—康复医学] R743.3[医药卫生—临床医学]