| 305 | 15 | 155 |
| 下载次数 | 被引频次 | 阅读次数 |
目的:观察针刺联合镜像视觉反馈训练(MVF)对脑卒中偏瘫患者上肢功能及日常生活能力的影响。方法:2018年1月至2019年6月,选择住院治疗的脑卒中患者64例,采用随机数字表法分为观察组、对照组各32例。对照组采用靳三针疗法,选取病灶侧头部行颞三针,患侧上肢行肩三针、手三针,观察组在对照组基础上增加MVF。治疗6周后,采用临床神经功能缺损程度评分标准进行疗效等级判定,采用简化Fugl-Meyer运动功能评分量表(FMA)评定上肢运动功能,Carroll手功能评定(UEFT)评估手部精细运动能力,改良Barthel指数(MBI)评定日常生活活动能力。结果:治疗后,观察组总有效率(81.25%)明显高于对照组(59.38%),两组疗效差异具有统计学意义(P<0.01)。治疗后,两组患者FMA(上肢部分)、UEFT、MBI评分均较治疗前显著增加,差异具有统计学意义(P<0.01);治疗后观察组FMA(上肢部分)、UEFT、MBI评分较对照组显著增加,差异具有统计学意义(P<0.01)。结论:针刺联合MVF相较单一疗法,能够有效改善脑卒中患者上肢功能障碍及日常生活活动能力。
Abstract：Objective:To observe the effect of acupuncture combined with mirror vision feedback training(MVF) on upper limb function and daily life ability of patients with hemiplegic stroke. Methods:From January 2018 to June 2019,64 patients hospitalized with hemiplegic stroke were numbered according to the admission order,and were divided into observation group and control group with a random number table,32 patients in each group. The control group was treated with Jin's three-needle therapy,in which three temporal needles were applied on the head side of the lesion,three shoulder needles and three hand needles on the upper limb of the affected side. In the observation group,mirror therapy was applied besides the treatment of the control group. After 6 weeks of treatment,the clinical neurological defect scale was used to evaluate the efficacy,modified Fugl-Meyer assessment(FMA) to assess the upper limb motor function,carroll hand function upper extremity function test(UEFT) to assess the fine motor ability of the hand,and the modified Barthel index(MBI) to assess the daily life activity. Results:After the treatment,the total effectiveness rate of the observation group(81.25%) was significantly higher than that of the control group(59.38%),and the difference between the two groups was significant(P<0.01). After the treatment,FMA(upper limb),UEFT and MBI scores in the two groups were significantly increased compared with those before treatment,with statistical difference(P<0.01). FMA(upper limb),UEFT and MBI scores in the MVF group after treatment were significantly higher than those in the control group after treatment,with significant differences(P<0.01). Conclusion:Compared with monotherapy,acupuncture combined with MVF training can effectively improve upper limb dysfunction and daily life activity in stroke patients.
[1] MERIANS A S,DAVID J,RARES B,et al. Virtual realityaugmented rehabilitation for patients following stroke[J].Physical Therapy,2002,82(9):898-915.
[2] STEVENS J A,MARY E P S. Simulation of bilateral movement training through mirror reflection:A case report demonstrating an occupational therapy technique for hemiparesis[J]. Top Stroke Rehabil,2004,11(1):59-66.
[3]沈芳，王晶，曾明.镜像疗法在脑卒中偏瘫患者上肢运动功能康复中应用的研究进展[J].中国康复医学杂志，2016,31(5):590-593.
[4] FRANCESCHINI M,AGOSTI M,CANTAGALLO A,et al.Mirror neurons:Action observation treatment as a tool in stroke rehabilitation[J]. Eur J Phys Rehabil Med,2010,46(4):517-523.
[5] ALTSCHULER E L. Motor rehabilitation in a stroke patient using a mirror[J]. Society for Neuroscience Abstracts,1998,24(1/2):1408.
[6]林强，陈安亮，程凯，等.针刺疗法对脑卒中患者的运动功能、平衡功能及日常生活活动能力的影响[J].中国康复医学杂志，2015,30(9):898-901,906.
[7]余瑾，庄礼兴，吴至凤，等.靳三针疗法文献特征分析[J].广州中医药大学学报，2007,24(3):244-246.
[8]中华神经科学会.各类脑血管疾病诊断要点[J].中华神经科杂志，1996,29(6):379.
[9]纪树荣.运动疗法技术学[M].北京：华夏出版社，2011:335.
[10]崔韶阳，许明珠，郑盛惠，等.靳三针配合镜像疗法对偏瘫患者上肢、手功能障碍的影响[J].中华物理医学与康复杂志，2015,37(7):550-551.
[11]脑卒中患者临床神经功能缺损程度评分标准（1995)[J].中华神经科杂志，1996,29(6):62-64.
[12] FUGL-MEYER A R,L JAASKO,LEYMAN I L,et al.The post stroke hemiplegic patient. 1. A method for evaluation of physical performance[J]. Scand J Rehabil Med,1975,7(1):13-31.
[13] MAHONEY F I,BARTHEL D W. Functional evaluation:The barthel index[J]. Md State Med J,1965,14(14):61-65.
[14] RAMACHANDRAN V S, ROGERSRAMACHANDRAN D,COBB S. Touching the phantom limb[J]. Nature,1995,377(6549):489-490.
[15]许明，张健，尹秀婷，等.迟缓型偏瘫患者健侧治疗的理论基础[J].山东中医杂志，2016,35(7):579-580,583.
[16]崔尧，丛芳，刘霖.镜像神经元系统的基本理论及其在运动功能康复中的意义[J].中国康复理论与实践，2012,18(3):239-243.
[17] LISALDE-RODRIGUEZ M E,GARCIA-FERNANDEZ J A. Mirror therapy in hemiplegic patient[J]. Rev Neurol,2016,62(1):28.
[18] RAMACHANDRAN VS,ROGERS-RAMACHANDRAN D,COBB S. Touching the phantom limb[J]. Nature,1995,377(6549):489-490.
[19] RIZZOLATTI G,FOGASSI L,GALLESE V. Neurophysiological mechanisms underlying the understanding and imitation of action[J]. Nat Rev Neurosci,2001,2(9):661-670.
[20] ROSSITER H E,BORRELLI M R,BORCHERT R J,et al.Cortical Mechanisms of mirror therapy after stroke[J].Neurorehabil Neural Repair,2015,29(5):444-452.
[21] ZENG W,GUO Y,WU G,et al. Mirror therapy for motor function of the upper extremity in patients with stroke:A meta-analysis[J]. J Rehabil Med,2018,50(1):8-15.
[22] PEREZ CRUZADO,DAVID,MERCHAN BAEZA,et al.Systematic review of mirror therapy compared with conventional rehabilitation in upper extremity function in stroke survivors[J]. Aust Occup Ther J,2016,64(2):91-112.
[23] DECONINCK F J A,SMORENBURG A R P,BENHAM A,et al. Reflections on mirror therapy:A systematic review of the effect of mirror visual feedback on the brain[J]. Neurorehabil Neural Repair,2015,29(4):349-361.
[24] BEOM J, KOH S, NAM H S, et al. Robotic mirror therapy system for functional recovery of hemiplegic arms[J]. J Vis Exp,2016(114):54521.
[25]陈洪淼，冯嘉诚，黄千树，等.一种基于镜像原理的神经-肌肉康复训练器设计[J].中国康复医学杂志，2018,33(7):850-851,860.
[26]黄冬枚，陆敏灵，王韵，等.改良镜像疗法对脑卒中患者患侧上肢康复与焦虑、抑郁的影响[J].中国康复医学杂志，2019,34(6):699-701,721.
[27]许明，张泓，谭洁，等.基于现代康复医学理论体系对中医康复的应用与研究之思考[J].湖南中医药大学学报，2017,37(10):1161-1165.
基本信息:
DOI：10.16295/j.cnki.0257-358x.2021.02.009
中图分类号:R743.3;R493
引用信息:
[1]张宁,郄淑燕,郑广昊,等.针刺联合镜像视觉反馈训练对卒中偏瘫患者上肢功能及日常生活能力的影响[J],2021,40(02):157-161.DOI:10.16295/j.cnki.0257-358x.2021.02.009.
基金信息:
国家自然科学基金面上项目（编号：81972148）
2019-10-09
2019
2019-11-11
2019
1