| 朱栩栋,周珠琪,葛飞飞,等.镜像疗法联合对侧控制功能性电刺激间隔与同步干预对脑卒中后上肢功能障碍的影响[J].中华物理医学与康复杂志,2026,48(7):598-605 |
| 镜像疗法联合对侧控制功能性电刺激间隔与同步干预对脑卒中后上肢功能障碍的影响 |
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| DOI：10.3760/cma.j.cn421666-20250817-00702 |
| 中文关键词: 镜像神经元 脑卒中 近红外 皮质脊髓束 |
| 英文关键词: Mirror neuron networks Stroke Functional near infrared spectroscopy Corticospinal tract |
| 基金项目:宁波市鄞州区农业与社会发展类项目（2023AS020）；浙江省医师协会临床工程师分会青年基金项目（YS2024-41-1-005)；宁波市鄞州区农业与社会发展类项目（2024AS038） |
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| 中文摘要: |
| 目的 观察镜像疗法（MT）联合对侧控制功能性电刺激（CCFES）间隔与同步干预对脑卒中后上肢功能障碍的影响，并探讨其神经作用机制。 方法 募集脑卒中后上肢功能障碍患者61例，按随机数字表法随机分为实验组30例和对照组31例。2组患者均接受常规康复治疗，在此基础上实验组先进行30 min的MT治疗，间隔30 min后再进行30 min的CCFES，对照组则采用MT与CCFES同步治疗30 min。2组患者均每日治疗1次，每周治疗5 d，连续治疗4周。治疗前和治疗4周后（治疗后）采用Fugl-Meyer评定量表（FMA）评估2组患者上肢和手的运动功能，采用改良Barthel指数（MBI）评估其日常生活活动能力，采用运动诱发电位（MEP）检测2组患者皮质-脊髓束通路（CST）的恢复程度，并于治疗2周后采用近红外光谱成像（fNIRS）观察2组患者镜像任务时大脑皮质的脑血流变化。 结果 治疗后，2组的FMA-UE、FMA-H和MBI评分均显著优于组内治疗前（P<0.05），且实验组的FMA-UE、FMA-H和MBI评分分别为（47.00±14.87）分、（16.43±5.43）分和（69.04±23.83）分，均显著优于对照组（P<0.05）。治疗后，2组患者13个靶点的MEP波幅较组内治疗前均显著上升（P＜0.05），且实验组2#、4#、5#、8#、9#靶点的MEP波幅亦显著优于对照组（P＜0.05）。fNIRS结果显示，镜像任务时，患者双侧初级运动皮质（M1）、健侧额叶眼动区（FEF）及背外侧前额叶(DLPFC)的激活程度均显著强于休息任务时（P<0.05），且镜像任务时健侧与患侧M1间的功能连接较休息任务时亦显著增强（P<0.05）。 结论 MT联合CCFES间隔干预可更有效地促进脑卒中后上肢功能障碍患者上肢功能和日常生活活动能力的恢复，其作用机制可能与间隔干预模式可减少多模态感觉竞争、充分激活镜像神经元网络（MNN）并重塑皮质脊髓束（CST）有关。 |
| 英文摘要: |
| Objective To test the effects of delivering mirror therapy (MT) and contralaterally controlled functional electrical stimulation (CCFES) in different temporal sequences when treating upper limb dysfunction after stroke, and to explore the underlying neural mechanisms. Methods Sixty-one stroke survivors with upper limb dysfunction were randomly assigned to either the experimental group (n=30) or the control group (n=31). Both groups received conventional rehabilitation therapy. In addition, the experimental group received 30min of MT followed after a 30-minute interval by 30min of CCFES. The control group received simultaneous MT and CCFES for 30min. Both interventions were administered once daily, 5 days per week for 4 consecutive weeks. Before and after the 4 weeks of treatment, motor function was assessed using the Fugl-Meyer upper extremity assessment (FMA-UE) and the FMA-hand (FMA-H) assessment. Ability in the activities of daily living (ADL)_was assessed using the modified Barthel Index (MBI). Motor evoked potentials (MEPs) were recorded to evaluate recovery of the corticospinal tract. Furthermore, functional near-infrared spectroscopy (fNIRS) was performed after 2 weeks of the treatments to observe any changes in cortical hemodynamics during the mirror task. Results Everyone′s FMA-UE, FMA-H and MBI scores had improved significantly after the treatments. The experimental group then had significantly higher average FMA-UE (47.00±14.87), FMA-H (16.43±5.43), and MBI (69.04±23.83) scores than the control group. MEP amplitudes at 13 target sites had increased significantly in both groups. Notably, the amplitudes at target sites 2#, 4#, 5#, 8# and 9# were significantly greater in the experimental group than in the control group. The fNIRS results indicated that during the mirror task, activation in the bilateral primary motor cortex (M1), the frontal eye field on the unaffected side, and the dorsolateral prefrontal cortex was significantly stronger than at rest. Functional connectivity between the unaffected and affected M1 areas was also significantly enhanced during the mirror task compared with the resting state. Conclusions Following MT with CCFES with an interval between the interventions may be more effective than simultaneous application in promoting the recovery of upper limb function and ADL ability post-stroke. The underlying mechanism may involve reduced multimodal sensory competition through temporal separation, sufficient activation of the mirror neuron network, and corticospinal tract remodeling. |
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