基于闭环理论的动作观察疗法联合躯干控制训练对脑卒中后下肢运动的影响  

Effect of closed-loop theory-based action observation therapy combined with trunk control training on lower limb movement after stroke

作　　者：许方军 曹晓光[1] 王修敏[1] 王婷[1] 陈冬冬 余程冬 张鹤言 Fangjun Xu;Xiaoguang Cao;Xiumin Wang;Ting Wang;Dongdong Chen;Chengdong Yu;Heyan Zhang(Department of Rehabilitation Medicine,the Second People's Hospital of Hefei,Hefei 230011,China)

机构地区：[1]合肥市第二人民医院康复医学科,230011

出　　处：《中华脑科疾病与康复杂志(电子版)》2024年第5期292-299,共8页Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition)

基　　金：合肥市应用医学研究项目(Hwk2021zd006);蚌埠医科大学自然科学重点项目(2023byzd250)

摘　　要：目的分析动作观察疗法(AOT)联合躯干控制训练(TCT)对脑卒中后偏瘫患者下肢运动功能、平衡和步行功能及日常生活活动(ADL)能力的影响。方法选取合肥市第二人民医院康复医学科自2022年1月至2024年4月收治的80例脑卒中偏瘫患者,采用分层随机分组法分为4组,每组20例。对照组进行传统康复训练及同样时长健侧下肢训练,AOT组在传统康复训练基础上增加下肢动作AOT,TCT组在传统康复训练基础上增加TCT,联合组在传统康复训练基础上给与AOT和TCT联合治疗。治疗前及治疗2、4周后,运用Fugl-Meyer下肢部分(FMA-LE)评估患者下肢运动功能,Berg平衡量表(BBS)及Fugl-Meyer平衡部分(FMA-LB)评估患者的平衡能力,改良Barthel指数(MBI)评估患者的ADL能力。治疗后运用功能性步行分级(FAC)评估患者的步行能力。结果治疗2、4周后,4组患者的BBS、FMA-LE、FMA-LB及MBI评分均较同组治疗前改善,差异有统计学意义(P<0.05)。治疗2周后,联合组的FMA-LE、FMA-LB及MBI评分均优于对照组,差异有统计学意义(P<0.05)。治疗4周后,联合组的BBS、FMA-LE、FMA-LB及MBI评分均优于其余3组,差异有统计学意义(P<0.05)。AOT组、TCT组及联合组的BBS、FMA-LE、FMA-LB及MBI评分治疗4周后与治疗前的差值优于对照组,差异均有统计学意义(P<0.05),AOT组与TCT组比较,差异无统计学意义(P>0.05)。治疗4周后,联合组的FAC分级优于对照组,且联合组FACⅢ~Ⅴ级的占比优于对照组,差异均有统计学意义(P<0.05)。结论基于“中枢-外周-中枢”的闭环康复理论,AOT结合TCT,有助于偏瘫患者恢复下肢运动能力、平衡能力和行走功能,进一步提高ADL能力。Objective To analyze the effects of action observation therapy(AOT)combined with trunk control training(TCT)on lower limb motor function,balance and walking function,and activities of daily living(ADL)ability in post-stroke hemiplegic patients.Methods Eighty cases of hemiplegic stroke patients admitted to Rehabilitation Medicine Department of the Second People&apos;s Hospital of Hefei from January 2022 to April 2024 were selected and divided into four groups of 20 cases each by using the stratified randomized grouping method.In the control group,traditional rehabilitation training and the same duration of training of the healthy lower limb were carried out;in the AOT group,the training of lower limb AOT was added on the basis of traditional rehabilitation training;in the TCT group,the TCT was added on the basis of traditional rehabilitation training;and in the combined group,received AOT and TCT combined therapy on the basis of traditional rehabilitation training was given.Before the treatment,after 2 weeks and after 4 weeks of the treatment,the lower extremity motor ability of patients was evaluated using the Fugl-Meyer assessment scale lower extremity portion(FMA-LE),the patients&apos;balance ability was evaluated using the Berg balance scale(BBS)and Fugl-Meyer assessment scale balance portion(FMA-LB),the patients&apos;ADL was evaluated using the modified Barthel index(MBI).The patients&apos;walking ability was assessed using the functional walking classification(FAC)after treatment.Results After 2 and 4 weeks of treatment,the BBS,FMA-LE,FMA-LB and MBI scores of the four groups improved compared with those of the same group before treatment,and the difference was statistically significant(P<0.05).After 2 weeks of treatment,the FMA-LE,FMA-LB and MBI scores of the combined group were better than those of the control group,and the difference was statistically significant(P<0.05).After 4 weeks of treatment,the BBS,FMA-LE,FMA-LB and MBI scores of the combined group were better than those of the remaining three group

关 键 词：脑卒中 动作观察疗法 躯干控制训练 日常生活活动 

分 类 号：R743.3[医药卫生—神经病学与精神病学]