具身认知视角下运动想象疗法对初发脑梗死偏瘫患者上肢运动功能障碍的治疗效果

关键词：具身认知  运动想象  运动诱发电位  表面肌电图  脑梗死

Keywords:embodied cognition  motor imagery  motor evoked potential  surface electromyography  cerebral infarction

摘要：

      摘要 目的：探讨具身认知视角下运动想象疗法对初发脑梗死偏瘫患者上肢运动功能障碍的治疗效果。 方法：将30例病程1个月以内且Brunnstrom分期在Ⅲ—Ⅴ期的初发脑梗死偏瘫患者随机分为治疗组（n=15）和对照组（n=15），对照组仅给予常规康复治疗，治疗组在对照组基础上进行具身运动想象疗法，疗程共4周，每周5次，每次治疗30min，每天1次。两组患者治疗前后分别行上肢运动皮质诱发电位（MEP）检测，检测治疗组及对照组患者治疗前后的MEP皮质潜伏期和MEP中枢运动传导时间（CMCT）；采集患者患侧肱二头肌、腕屈肌表面肌电图（sEMG）均方根值(RMS)和积分肌电值(iEMG)；用Fugl-Meyer评定法（FMA）评定患者上肢、手和腕运动功能积分以及上肢总运动积分。 结果：治疗前两组患者MEP皮质潜伏期和CMCT、iEMG、RMS、FMA积分无明显差异（P均>0.05）。对照组治疗后与治疗前相比，MEP皮质潜伏期和CMCT缩短，sEMG值和FMA积分均有所增高（P均<0.05）；治疗组的治疗后与治疗前以及对照组同期水平比较，治疗后治疗组MEP皮质潜伏期和CMCT明显缩短，sEMG值和FMA积分明显增高（P均<0.05）。 结论：单纯运动想象疗法可以改善脑梗死偏瘫患者上肢运动功能，且具身认知视角下运动想象疗法对脑梗死偏瘫患者上肢运动功能改善更加明显。

Abstract:

      Abstract Objective: To explore the therapeutic effect of motor imagination therapy on upper limb motor dysfunction in hemiplegic patients with primary cerebral infarction from the perspective of embodied cognition. Method: Thirty patients with primary cerebral infarction with a course of less than one month and Brunnstrom stages of stage Ⅲ to Ⅴ were randomly divided into treatment group (n=15) and control group (n=15). The control group was only given routine rehabilitation treatment， and the treatment group was treated with embodied motor imagination therapy on the basis of the control group. The course of treatment was 4 weeks， 5 times a week， 30 minutes each time， once a day. The motor cortex evoked potential (MEP) of the upper limb was detected before and after treatment in the two groups， which was used to detect the cortical latency of MEP and the central motor conduction time (CMCT) of MEP. The (sEMG) root mean square value (RMS) and integral EMG value (iEMG) of the surface EMG of biceps brachii and wrist flexor muscle in the two groups were collected. Meanwhile，the motor function scores of upper limbs， hands and wrists were evaluated by Fugl-Meyer assessment(FMA). Result: There was no significant difference in the cortical latency of MEP and the scores of CMCT， iEMG， RMS and FMA between the two groups before treatment. After treatment， the cortical latency of MEP and CMCT in the control group were shorter than those in the control group， and the SEMG value and FMA score were higher than those in the control group before treatment (all P<0.05).Compared with the levels before treatment and in the control group， the latency of MEP cortex and CMCT were significantly shortened， and the SEMG and FMA scores were significantly increased in the treatment group (P<0.05). Conclusion: Motor imagination therapy from the perspective of embodied cognition can significantly improve the motor function of upper limbs in hemiplegic patients with cerebral infarction.