基于运动想象的脑机接口在脑卒中后手功能康复中的应用  

Application of motor imagery-based brain computer interface in stroke patients with hand dysfunction

作　　者：刘玲玉 秦文婷 靳令经 屈雪莹 张秋珍 聂志余[2] Liu Lingyu;Qin Wenting;Jin Lingjing(Department of Neurological Rehabilitation,Shanghai Yangzhi Rehabilitation Hospital(Shanghai Sunshine Rehabilitation Center),Shanghai 201619,China)

机构地区：[1]上海市养志康复医院(上海市阳光康复中心)神经康复科,上海201619 [2]同济大学附属同济医院神经科,上海200065

出　　处：《中国康复》2024年第12期707-713,共7页Chinese Journal of Rehabilitation

基　　金：国家临床重点专科建设项目(Z155080000004);上海市重中之重康复医学研究中心(2023ZZ02027)。

摘　　要：目的:研究单纯机械手和基于运动想象的脑机接口(MI-BCI)手功能康复系统对脑卒中后手功能康复的疗效差异。方法:选取恢复期脑卒中患者53例。按随机数字表法分为研究组25例和对照组28例。2组患者均接受神经康复常规治疗,在此基础上,研究组给予MI-BCI手功能康复系统训练,对照组给予单纯机械手重复抓握功能训练。2组手功能康复的总训练时间相同。在治疗前,治疗10次、20次后及治疗结束随访1个月时,采用Wolf手运动功能评定量表(WMFT)、Fugl-Meyer评定量表上肢部分(FMA-UE)、改良Ashworth量表(MAS)、7级手功能评级、握力、美国国立卫生研究院卒中量表NIHSS评分、改良Barthel指数(MBI)进行评估。结果:治疗10及20次和治疗结束随访1个月时,2组WMFT总完成时间、NIHSS评分较治疗前均减少(P<0.05),2组WMFT总分、FMA-UE总分、FMA-手腕和MBI评分及研究组手握力评分较治疗前增加(P<0.05),且研究组FMA-UE总分、FMA-手腕、手握力、MBI评分较对照组增加(P<0.01),研究组NIHSS评分较对照组减少(P<0.05);治疗20次后及随访1个月时,研究组WMFT总完成时间较对照组显著减少(P<0.01),研究组WMFT总分较对照组显著增加(P<0.001)。治疗10次及随访1个月时7级手功能分级的组内和组间比较差异无统计学意义;研究组治疗20次后7级手功能分级较治疗前和对照组提高(P<0.05)。2组各指标组间均有显著的时间效应(P<0.001),研究组WMFT总完成时间和握力较对照组具有显著的组别效应(P<0.05)。结论:MI-BCI手康复训练系统可显著改善脑卒中恢复期中重度手功能障碍患者的手功能,且无明显不良反应,可以被视为脑卒中恢复期手功能康复的有效标准化干预方案之一。Objective:To investigate the efficacy of motor imagery-based brain computer interface(MI-BCI)system for hand function rehabilitation after stroke.Methods:According to the inclusion criteria,53 chronic stroke patients who were hospitalized,and randomly divided into two groups:the research group(n=25)and the control group(n=28).The research group underwent MI-BCI hand rehabilitation training based on traditional rehabilitation training,while the control group underwent mechanical hand and traditional rehabilitation training.both for 20 times intervention in 4 weeks.The Wolf motor function test(WMFT),Fugl-Meyer assessment for upper extremity(FMA-UE),modified Ashworth score(MAS),7-level hand function score,grip strength,NIHSS,modified Barthel index(MBI)were used for assessment at baseline,10 times of intervention,20 times of intervention,and 1 month of follow-up.Results:After 10 and 20 treatments,and 1-month follow-up,the total WMFT completion time and NIHSS score in both groups reduced compared with the pre-treatment(P<0.05).The total WMFT score,FMA-UE score,FMA-wrist score,research group hand grip strength,and MBI score in both groups increased com-pared with the pre-treatment(P<0.05).The FMA-UE score,FMA-wrist score,hand grip strength,and MBI score in the BG increased compared with the CG(P<0.01),while the NIHSS score in the BG reduced compared with the CG(P<0.05).The 7-level hand function grade in the BG improved compared with the pre-treatment and the CG(P<0.05).There was a sig-nificant time effect(P<0.001)in all indicators between the two groups.And a significant group effect(P<0.05)in the total WMFT completion time and the hand grip strength,which were significantly higher in the BG than in the CG(P<0.05).Conclusion:MI-BCI rehabilitation training system can significantly improve hand function in patients with moderate-to-severe dysfunction in the chronic phase of stroke without significant adverse reactions,and it can be regarded as one of the effective standardized intervention programs.

关 键 词：脑卒中 运动想象 脑机接口 手功能康复 

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