智能镜像手套对脑卒中患者上肢功能的影响

关键词：智能镜像手套  任务导向性训练  脑源性神经营养因子  脑卒中  上肢功能

Keywords:intelligent mirror gloves  task-oriented training  brain-derived neurotrophic factor  stroke  upper limb function

摘要：

      摘要 目的：分析智能镜像手套对脑卒中患者上肢功能康复的影响，以及脑源性神经营养因子（brain-derived neurotrophic factor， BDNF）在其中的作用，为促进卒中后上肢功能恢复提供高效的治疗策略。 方法：50例脑卒中患者随机分成两组，每组各25例。对照组给予常规康复方法治疗，镜像组则在此基础上联合智能镜像手套任务导向性训练治疗。在治疗前和治疗1个疗程后对偏瘫侧手功能采用Fugl-Meyer上肢运动功能评定量表（Fugl-Meyer assessment-upper extremity，FMA-UE）、Wolf运动功能测定量表、功能独立性量表（functional independence measure， FIM）进行评分，对偏瘫侧手腕力量采用前臂伸、屈肌群表面肌电振幅（ratio of surface EMG amplitude， RMS）比值（患侧/健侧）进行评定；采用Elisa法检测患者治疗前后血清BDNF浓度。 结果：治疗后两组患者的FMA-UE、Wolf、FIM评分和前臂伸、屈肌群RMS比值均较治疗前有明显提高（P＜0.05）；且镜像组各评分均高于对照组（P＜0.05）；治疗1个疗程后镜像组患者血清中BDNF表达增加（P＜0.05），而对照组无明显变化（P＞0.05）。 结论：脑卒中早期康复中辅以智能镜像手套任务导向性训练可有效促进患者上肢功能的恢复并提高其生活质量，且BDNF可能参与其中。

Abstract:

      Abstract Objective： To evaluate the impact of intelligent mirror gloves on the rehabilitation of upper limb function in stroke patients and the role of brain-derived neurotrophic factor （BDNF）， to provide an efficient treatment strategy for promoting the recovery of upper limb function after stroke. Method： Fifty patients with stroke were randomly divided into two groups (n=25 per group). The control group was given routine rehabilitation treatment，while the mirror group was combined with intelligent mirror glove task-oriented training. Before and after one course of treatment， the hand function of hemiplegic side was scored by Fugl-Meyer Assessment Upper Extremity (FMA-UE)， the Wolf Motor Function Test (Wolf) and Functional Independence Measure (FIM)， and the hand strength of hemiplegic side was evaluated by the ratio of surface EMG amplitude（RMS） of forearm extensor and flexor muscle group（affected side/healthy side）. Elisa method was used to detect the concentration of serum BDNF before and after treatment. Result： After treatment， both groups showed significant improvements in FMA-UE， Wolf， FIM and the RMS ratio of forearm extensor and flexor muscles（P<0.05）. The mirror group exhibited significantly greater improvements in all these measures compared to the control group (P<0.05). After one course of treatment， the expression of serum BDNF in the mirror group significantly increased， but there was no significant change in the control group （P>0.05）. Conclusion： Intelligent mirror glove task-oriented training can effectively promote the recovery of upper limb function and improve the quality of life of patients in the early rehabilitation of stroke. The mechanism may involve the role of BDNF in promoting neural recovery.