动作观察疗法对亚急性期脑卒中患者上肢运动功能的影响

关键词：动作观察疗法  镜像神经元系统  脑卒中  上肢运动功能  康复  效度

Keywords:action observation therapy  mirror neuron system  stroke  upper extremity motor function  rehabilitation  validity

摘要：

      摘要 目的：探讨动作观察疗法对亚急性期脑卒中患者上肢运动功能的影响。 方法：将31例脑卒中患者按随机数字表法分为观察组（16例）和对照组（15例）。对照组采用常规康复治疗，观察组在对照组基础上辅以动作观察疗法，每周6次，每次20min，共治疗4周。分别于治疗前、治疗4周后对两组患者采用上肢Fugl-Meyer运动功能评分法（FMA）并使用量角器对肩关节前屈、肘关节伸展和腕背伸主动活动度进行测量，以评定患者的上肢运动功能；并分别检测治疗前后FMA与肩关节前屈、肘关节伸展和腕背伸主动活动度之间的相关性。 结果：治疗前，两组患者的FMA评分及肩关节前屈、肘关节伸展和腕背伸主动活动度评定差异无显著性意义（P＞0.05）；治疗4周后，两组患者上述指标较治疗前均有所改善（P＜0.05），且与对照组相比，观察组的FMA评分（44.81±8.86）、肩关节前屈（150.88°±21.32°）、肘关节伸展（135.56°±17.22°）主动活动度的改善程度显著（P＜0.05）；两组患者，除治疗后的对照组FMA评分与肩关节主动前屈活动度、FMA评分与肘关节主动伸展活动度不相关（P＞0.05）外，其余FMA评分均与肩关节主动前屈活动度、肘关节主动伸展活动度及腕主动背伸活动度之间存在正相关性（P＜0.05）。 结论：基于镜像神经元理论的动作观察疗法可改善亚急性期脑卒中患者的上肢运动功能，且FMA与肩关节前屈、肘关节伸展和腕背伸主动活动度存在相关性。

Abstract:

      Abstract Objective: To explore the effects of action observation therapy on motor function of upper-extremity in subacute stroke patients. Method: Thirty-one stroke survivors were randomly assigned to an observation group (16 patients) or a control group (15 patients). The conventional rehabilitation treatments were applied in both groups. But the observation group received action observation therapy in addition for 4 weeks, 6 times per week, 20 mins per time. Both groups were assessed by Fugl-Meyer assessment (FMA) and the active range of motion of shoulder, elbow and wrist joint pre-treatment and after 4 weeks of treatment. The correlation among FMA and active joint range of motion was tested. Result: The FMA, active motion ranges of shoulder, elbow and wrist after 4 weeks increased significantly compared with pre-treatment in both groups. Compared with control group, the FMA (44.81±8.86), active motion ranges of shoulder joint (150.88°±21.32°), elbow joint (135.56°±17.22°) in observation group improved significantly. The correlations separately between FMA and active joint ranges of shoulder, elbow and wrist were observed in both groups. However, there was no correlation between FMA and the active motion range of shoulder, between FMA and elbow action range after treatment in control group. Conclusion: The action observation therapy could improve the upper extremity motor function in subacute stroke patients, and the active motion ranges of shoulder, elbow and wrist joint were correlated with FMA.