镜像疗法联合肩胛带稳定训练对脑卒中后肩痛及上肢运动功能的疗效

关键词：脑卒中  肩痛  上肢功能障碍  镜像疗法  肩胛带稳定

Keywords:stroke  shoulder pain  upper limb function disorder  mirror therapy  scapular stabilization

摘要：

      摘要 目的：探讨镜像疗法联合肩胛带稳定训练对脑卒中患者肩痛及上肢运动功能的临床疗效。 方法：选取2020年11月—2023年10月在首都医科大学宣武医院康复医学科病房和门诊接受治疗的30例脑卒中后肩痛患者，采用随机数字表法分为观察组和对照组，其中观察组14例，对照组16例。两组患者均接受常规传统康复治疗（包括理疗）和肩胛带稳定训练，前者30min/次，后者15min/次，均2次/天（理疗1次/天），5天/周，共4周。同时观察组另外进行4周的镜像疗法（mirror therapy， MT），20min/次，1次/天，5天/周，共4周。分别在患者治疗前和治疗4周后对其进行康复评定，采用静息态疼痛视觉模拟评分（resting state visual analogue scale， R-VAS）和被动运动疼痛视觉模拟评分（passive movement state visual analogue scale， P-VAS）评价患者的疼痛程度，简化Fugl-Meyer运动功能量表上肢部分（Fugl-Meyer assessment for the upper extremities， FMA-UE）和上肢Brunnstrom分期评价上肢运动功能，比较两组的疗效。 结果：①治疗前两组患者R-VAS评分、P-VAS评分、FMA-UE评分和上肢Brunnstrom分期比较，差异无显著性意义（P＞0.05）；治疗4周后，与同组治疗前比较，两组患者R-VAS评分、P-VAS评分较治疗前明显降低（P＜0.05），FMA-UE评分和上肢Brunnstrom分期与治疗前比较明显提高（P＜0.05）。②治疗4周后观察组患者R-VAS评分、P-VAS评分均低于对照组，FMA-UE评分和上肢Brunnstrom分期均高于对照组，差异有显著性意义（P＜0.05）。 结论：脑卒中患者在常规康复治疗的基础上，镜像疗法联合肩胛带稳定训练能显著减轻患者卒中后肩痛，提高上肢运动功能。

Abstract:

      Abstract Objective： To investigate the clinical effects of mirror therapy combined with scapular stabilization exercise training on shoulder pain and upper-limb motor function in patients with stroke. Method： From November 2020 to October 2023， 30 patients with post-stroke shoulder pain were enrolled continuously for rehabilitation therapy in the Department of Rehabilitation Medicine， Xuanwu Hospital， Capital Medical University. They were divided into observation group （n=14） and control group （n=16） according to the random number table. Both groups received conventional rehabilitation therapy (30 min, twice daily）plus physiotherapy (once daily） and scapular stabilization exercise training (15min, twice daily)， 5 days a week for 4 weeks. In addition， the observation group received mirror therapy (20min once daily), 5 days a week for 4 weeks. All patients were assessed before and after treatment. Resting state visual analogue scale （R-VAS） and passive movement state visual analogue scale （P-VAS） were used to evaluate the pain intensity. The simplified Fugl-Meyer assessment for the upper extremities （FMA-UE） score and Brunnstrom arm staging were used to assess upper-limb motor function. Result： There were no significant differences in the R-VAS，P-VAS，FMA-UE score and Brunnstrom arm staging before treatment among the 2 groups of patients（P＞0.05）. After 4 weeks treatment，the R-VAS and P-VAS of the patients in the 2 groups were markedly decreased compared with those in the same group before treatment（P＜0.05），the FMA-UE score and Brunnstrom arm staging of the patients in the 2 groups were significantly improved compared with those before treatment（P＜0.05）; the R-VAS and P-VAS in observation group were lower than those of the control group， while the FMA-UE score and Brunnstrom arm staging in the patients of the observation group were higher than those in control group（P＜0.05）. Conclusion： On the basis of conventional rehabilitation treatment， the mirror therapy combined with scapular stabilization exercise training may effectively reduce post-stroke shoulder pain and enhance the upper-limb motor function in patients with stroke.