镜像疗法结合全身振动训练对脑卒中后单侧空间忽略的影响CSCD

目的:探讨镜像疗法结合全身振动训练对脑卒中后单侧空间忽略患者的康复疗效。方法:根据纳入标准,选取2019年10月—2020年12月就诊于黑龙江中医药大学附属第二医院康复中心的脑卒中后单侧空间忽略患者90例,按照随机分组法分为镜像组、振动组和结合组,每组30例。镜像组采用镜像疗法专用镜盒进行上肢和手部镜像训练,根据患者功能情况的差异,选择不同的动作任务,如修饰、进食、系扣子、翻书、持物训练等,每次30 min,1次/d,每周6 d,持续8周;振动组采用全身振动训练,应用德国SVG公司生产的Wellengang振动治疗仪,振动频率30 Hz,振动幅度3 mm,总时间30 min,1次/d,每周6 d,持续8周;结合组采用镜像疗法(20 min)+全身振动训练(10 min)的方式,每周6 d,持续8周。3组分别于治疗前后采用凯瑟琳-波哥量表(CBS)测评患者存在空间忽略的严重程度;采用简易智能精神状态量表(MMSE)测评患者认知功能障碍;采用简化的Fugl-Meyer评定量表(FMA)测评患者的上肢运动功能;采用Barthel指数量表(BI指数)测评患者的生活自理能力。结果:治疗前3组CBS评分、MMSE评分、FMA评分、BI评分比较,差异均无统计学意义(P>0.05);治疗8周后,3组的CBS评分均较治疗前明显降低,MMSE评分、FMA评分、BI评分均较治疗前明显升高,但结合组优于镜像组和全身振动组,差异均有统计学意义(P<0.05)。结论:镜像疗法结合全身振动训练能更有效地改善脑卒中后单侧空间忽略患者的空间忽略程度、认知功能障碍,提高上肢运动功能和生活自理能力。

Effect of Mirror Image Therapy Combined with Whole Body Vibration Training on Unilateral Spatial Neglect after Stroke

Objective:To explore the effect of mirror image therapy combined with whole body vibration training on the rehabilitation of patients with unilateral spatial neglect after stroke.Methods:According to the inclusion criteria,patients with unilateral spatial neglect after stroke who attended the rehabilitation center of the Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine from October 2019 to December 2020 were selected.After the hospital ethics committee approvaled,90 eligible patients were included.According to the random grouping method,participants were divided into mirror image therapy group,whole body vibration training group and combination group,with 30 cases in each group.There was no statistically significant difference in the general data of the three groups.The mirror image therapy group used a mirror box dedicated to mirror therapy for upper limb and hand mirror training.According to the differences in the patient’s functional status,different movement tasks were selected,such as grooming,eating,buttoning,turning books,and holding objects.The whole body vibration training group adopted whole body vibration training,using the Wellengang vibration therapy instrument developed by SVG company in Germany,the vibration frequency with 30 Hz,the vibration amplitude with 3 mm,the total treatment time was 30 minutes,1 time/d,6 days a week for 8 weeks.The combined group used both mirror image therapy(20 min)+whole body vibration training(10 min)for 6 days once a week for 8 weeks.All three groups were treated with the Catherine Bogor scale(CBS)before treatment and at the time of treatment for 8 weeks,respectively,to assess the severity of the spatial neglect of the patients.The mini-mental status examination(MMSE)was used to evaluate the cognitive dysfunction of patients.The simplified Fugl-Meyer Assessment scale(FMA)was used to evaluate the patient’s upper limb motor function.The Barthel index(BI)was used to measure the self-care ability of patients.Results:Before treatment,there was no significant difference in CBS,MMSE,FMA and BI scores among the three groups(P>0.05).After 8 weeks of treatment,the CBS scores of the three groups were significantly lower than those before treatment,however MMSE,FMA and BI scores were significantly higher than those before the treatment,but the combined group was better than the mirror image group and the whole body vibration training group,and the difference was statistically significant respectively(P<0.05).Conclusion:Mirror image therapy combined with whole body vibration training can effectively improve the degree of spatial neglect and cognitive dysfunction in patients with unilateral spatial neglect after stroke,and enhance upper limb motor function and self-care ability.