摘要
目的:探讨低频重复经颅磁刺激(rTMS)联合MOTOmed智能运动训练系统对脑卒中偏瘫患者上肢痉挛和运动功能的影响。方法:将90例脑卒中恢复期偏瘫患者随机分为联合治疗组、rTMS治疗组和伪rTMS治疗组,每组各30例。伪rTMS治疗组患者在常规康复治疗基础上辅以rTMS假刺激治疗,rTMS治疗组患者在常规康复治疗基础上辅以1Hz rTMS治疗,联合治疗组在常规康复治疗基础上给予1Hz rTMS治疗以及MOTOmed智能运动训练系统治疗。3组患者在治疗前及治疗后4周,采用改良Ashworth量表(MAS)、Fugl-Meyer运动功能评定量表上肢部分(FMA-UE)、改良Barthel指数(MBI)以及上肢F波进行评定。结果:治疗4周后,三组患者的MAS评分以及F波潜伏期、波幅、Hmax/Mmax均较治疗前明显下降(均P<0.05),且联合治疗组明显低于其他两组(均P<0.05),rTMS治疗组明显低于伪rTMS治疗组(P<0.05);三组患者的FMA-UE、MBI评分与治疗前比较,均有明显提高(均P<0.05),且联合治疗组明显高于其他两组(均P<0.05),但rTMS治疗组的FMA-UE、MBI评分与伪rTMS治疗组比较无明显差异(P>0.05)。结论:低频重复经颅磁刺激(rTMS)联合MOTOmed智能运动训练系统可明显改善脑卒中偏瘫患者上肢肌肉痉挛和运动功能,提高患者日常生活能力。
Objective:To investigate the effects of low-frequency repetitive transcranial magnetic stimulation combined with MOTOmed gracile on the upper limb motor function and activities of daily living(ADL)in stroke patients with hemiplegia.Method:90 stroke patients with hemiplegia were divided into combined treatment group,rTMS treatment group and sham rTMS treatment group with 30 patients in each group.The sham rTMS group received routine rehabilitation and sham rTMS treatment.The rTMS treatment group and combined treatment group both received routine rehabilitation and 1Hz rTMS treatment at primary motor area(M1)for four weeks.In addition,the combined treatment group was trained with MOTOmed gracile.Their upper limb motor function and ADL were assessed with modified Ashworth scale(MAS),Fugl-Meyer assessment upper extremity(FMA-UE),modified Barthel index(MBI),upper limb F-wave and H-reflex parameters before and after treatment.Result:After treatment for 4weeks,the scores of MAS,MBI and FMA-UE,the parameters of F-wave amplitude,latency and Hmax/Mmax were significantly improved in the three groups than before treatment(P<0.05).After 4 weeks of treatment,the scores of MAS,MBI and FMA-UE,the parameters of F-wave amplitude,latency and Hmax/Mmax were significantly improved in the combined treatment group than other groups(P<0.05).The MAS scores of wrist flexion and elbow flexion,the parameters of F-wave amplitude,latency and Hmax/Mmaxratio in rTMStreatment group were significantly lower than that of the sham rTMS treatment group(P<0.05),but the FMA-UE and BI scores after treatment between rTMS treatment group and sham rTMS treatment group did not showed significant difference(P>0.05).Conclusion:rTMS combined with MOTOmed gracile can be applied for rehabilitation of upper limb spasticity after stroke.
作者
陈清法
黄华垚
陈振强
倪国新
CHEN Qingfa;HUANG Huayao;CHEN Zhenqiang(Fujian Medical University Union Hospital,Fujian,Fuzhou,350001)
出处
《中国康复医学杂志》
CAS
CSCD
北大核心
2021年第4期437-442,共6页
Chinese Journal of Rehabilitation Medicine
