运动想象疗法结合四肢联动治疗脑卒中偏瘫患者的疗效观察

目的探讨运动想象疗法结合四肢联动对脑卒中偏瘫患者下肢运动功能的影响。方法将60例脑卒中偏瘫患者分成观察组30例和对照组30例,两组患者均接受基础疾病药物治疗及常规康复治疗,对照组加以四肢联动训练,观察组在四肢联动基础上进行运动想象疗法。对每例患者分别在治疗前和治疗4周后进行偏瘫侧下肢FuglMeyer（FMA-L）和功能独立性测定（FIM）的评估。结果治疗4周后,每组治疗前后下肢功能比较差异有统计学意义（P〈0.01）,且观察组FMA-L评分与FIM评分优于对照组,差异有统计学意义（P〈0.05）。结论运动想象疗法有助于改善脑卒中偏瘫患者下肢的运动功能。     

双侧训练联合运动想象疗法对老年脑卒中患者上肢功能恢复的效果

目的探讨双侧训练联合运动想象疗法对老年脑卒中患者上肢功能恢复的疗效。方法选取60例老年脑卒中偏瘫患者,按随机数字法分为常规组、运动想象组和联合组,每组20例。3组均根据康复评定结果给予相应常规康复训练,运动想象组在常规康复治疗的基础上辅以运动想象治疗,联合组在常规康复训练、运动想象训练的基础上联合双侧肢体训练。于治疗前及治疗后4 w,应用表面肌电图仪测试3组偏瘫侧三角肌、肱二、三头肌、腕伸肌的中位频率(MF)、均方根值(RMS)。同时采用Fugl-meyer运动功能量表(FMA)上肢部分、改良Barthel指数量表(MBI)对各组上肢功能运动进行评估,并对治疗前后评估结果进行对比。结果治疗后,3组三角肌、肱二、三头肌、腕伸肌MF、RMS及上肢FMA评分、MBI评分均较治疗前显著提高(P0.05),且联合组改善程度均明显优于其他两组(均P0.05)。结论双侧训练联合运动想象能更好改善老年脑卒中偏瘫患者的上肢功能。     

镜像疗法结合运动想象训练对脑卒中患者的影响研究

目的探讨镜像疗法结合运动想象训练对脑卒中患者的影响。方法选取2018年5月—2019年5月哈尔滨医科大学附属第一医院收治的脑卒中患者98例,按照住院床位单双号分为对照组和观察组,各49例。在规范化治疗基础上,对照组患者给予单纯运动想象训练,观察组患者在对照组基础上给予镜像疗法;两组患者均持续干预8周。比较两组患者干预前后Fugl-Meyer评定量表下肢部分(FMA-LE)评分、Brunnstrom分期、改良Barthel指数(mBI)评分、Berg平衡量表(BBS)评分及健康状况调查简表(SF-36)评分。结果两组患者干预前FMA-LE评分、Brunnstrom分期比较,差异无统计学意义(P0.05);观察组患者干预后FMA-LE评分高于对照组,Brunnstrom分期优于对照组(P0.05)。两组患者干预前mBI评分、BBS评分、SF-36评分及干预后BBS评分比较,差异无统计学意义(P0.05);观察组患者干预后mBI评分、SF-36评分高于对照组(P0.05)。结论镜像疗法结合运动想象训练能有效促进脑卒中患者患侧下肢功能恢复,提高患者日常生活能力及生活质量。     

体感模拟训练系统结合运动想象治疗对脑卒中患者偏瘫上肢功能的作用

目的观察体感模拟训练系统结合运动想象治疗对脑卒中患者偏瘫上肢功能恢复的临床效果。方法选取40例脑卒中后偏瘫患者,按照随机数字表法分为两组,每组20例。对照组在常规康复训练基础上给予运动想象疗法,研究组在对照组训练基础上给予体感模拟训练疗法。分析两组患者训练前、训练3个月后的Fugl-Meyer运动功能评分法(FMA)评分、Barthel指数、Berg平衡功能量表(BBS)评分、Brunnstrom评分情况。结果训练前,两组上下肢及运动FMA评分、上下肢及肩Brunnstrom评分、Barthel评分、BBS评分比较均无显著差异(P>0.05);康复训练3个月后,两组上下肢与运动FMA评分、上下肢与肩Brunnstrom评分、Barthel评分、BBS评分均显著提高(P<0.05),研究组以上指标均明显高于对照组(P<0.05)。结论脑卒中偏瘫患者进行体感模拟训练系统结合运动想象疗法可以明显改善患者的上肢运动功能,日常生活能力及躯干平衡能力。     

强化桥式运动及视觉反馈平衡训练对卒中患者下肢运动功能恢复的影响

目的观察强化桥式运动及视觉反馈平衡训练对卒中患者下肢运动功能的影响。方法前瞻性纳入2010年7月—2012年12月在暨南大学医学院第四附属医院接受康复治疗的卒中后偏瘫患者43例,按接诊时奇偶数将患者分为强化训练组(22例)和常规训练组(21例)。对两组患者均进行常规康复训练,1次/d,45 min/次,5 d/周,共治疗4周;强化训练组每天增加桥式运动及视觉反馈平衡训练1次,20 min/次。比较两组训练前,训练后2、4周的Fugl-Meyer量表(FMA)中下肢部分(FMA-L)评分、Berg平衡量表(BBS)评分及起立-行走计时测试(TUGT)的差异。结果 (1)与治疗前比较,随治疗时间延长,两组患者FMA-L、BBS评分均呈逐渐提高趋势,而TUGT测评时间呈加快趋势,差异均有统计学意义(P0.05)。(2)训练前及训练后2周,两组各量表评分差异无统计学意义(P0.05)。训练后4周后,强化训练组FMA-L、BBS量表评分,TUGT测评时间分别为(21.2±4.6)分、(19.4±2.6)分、(44.8±10.1)s;常规训练组分别为(18.7±3.3)分、(17.4±2.8)分、(57.6±7.7)s,两组各评分比较,差异均有统计学意义(P0.05)。结论强化桥式运动及视觉反馈平衡训练较常规康复训练能更明显改善卒中偏瘫患者下肢运动功能。随着强化训练时间的延长,其效果更加明显。     

运动想象和肌电生物反馈治疗对卒中患者上肢运动功能的影响

目的探讨运动想象和肌电生物反馈治疗对卒中患者上肢运动功能的影响。方法前瞻性纳入2013年8月至2015年12月在广州市红十字会医院接受康复治疗的卒中偏瘫患者95例,按接诊序号将患者分为运动想象治疗组(A组,33例)、肌电生物反馈治疗组(B组,30例)和运动想象+肌电生物反馈治疗组(C组,32例)。3组患者均接受常规康复训练3周,5 d/周,1次/d,30~45 min/次。A组另加运动想象治疗1次/d,30 min/次;B组另加肌电生物反馈治疗1次/d,20 min/次;C组则另加运动想象治疗1次/d,30 min/次+肌电生物反馈治疗1次/d,20 min/次。比较3组治疗前、治疗后3周的偏瘫上肢功能测试香港版(FTHUE-HK)、改良Barthel指数(MBI)和Fugl-Meyer上肢运动功能评分(FMA)的差异。组内康复前后比较采用配对t检验,组间差异比较采用单因素方差分析。结果 (1)治疗后3周,3组患者的FTHUE-HK、MBI和FMA评分均明显提高,分别为A组(3.8±0.6)、(74±4)、(35±5)分,B组(3.7±0.4)、(73±5)、(35±4)分,C组(4.1±0.3)、(77±4)、(38±4)分,与治疗前评分[A组(2.6±0.4)、(51±5)、(25±4)分,B组(2.5±0.4)、(52±4)、(24±3)分,C组(2.6±0.3)、(51±4)、(24±3)分]比较,差异均有统计学意义(均P0.01)。(2)治疗后3周,C组的FTHUE-HK、MBI和FMA评分均明显优于A、B两组评分,差异均有统计学意义(均P0.05);而A、B两组间的评分比较,差异无统计学意义(P0.05)。结论运动想象和肌电生物反馈治疗能显著改善卒中偏瘫患者上肢运动功能和日常生活活动能力,二者联合应用疗效更佳。     

经颅直流电刺激联合运动想象疗法改善脑卒中偏瘫病人上肢运动功能及认知功能的效果

目的 观察经颅直流电刺激(tDCS)联合运动想象疗法(MIT)改善脑卒中偏瘫病人上肢运动功能、认知功能的效果。方法 将84例脑卒中偏瘫病人按随机数表法分为tDCS组、MIT组和联合组,每组28例。治疗前和治疗4周后,分别采用Fugl-Meyer功能评分上肢部分(FMA-UE)、Wolf运动功能评价量表(WMFT)、MMSE、MoCA及改良Barthel指数(MBI)对3组病人进行疗效评定。结果 治疗4周后,3组病人的FMA-UE、WMFT、MMSE、MoCA及MBI评分均较治疗前改善(均P<0.05),且联合组显著优于tDCS组和MIT组(P<0.05)。结论 tDCS联合MIT可显著改善脑卒中偏瘫病人上肢运动功能和认知功能,提高日常生活活动能力及生存质量。     

姿势控制训练结合核心肌群训练对脑卒中患者运动功能的影响

目的:探讨姿势控制结合核心肌群训练对脑卒中患者下肢运动功能、平衡功能及步行能力的影响。方法:选择2015年12月到2017年12月我院收治的94例脑卒中偏瘫恢复期患者。患者被随机均分为常规康复组和联合训练组(在常规康复组基础上接受姿势控制和核心肌群训练),两组均治疗4周。观察比较两组治疗前后Fugl-Meyer运动功能量表(FMA)评分、Berg平衡量表(BBS)评分以及Holden步行功能分级(FAC)。结果:与治疗前比较,两组治疗4周后下肢FMA评分、BBS评分及FAC分级均显著升高,P均=0.001。与常规康复组比较,治疗4周后,联合训练组下肢FMA评分[(22.61±1.84)分比(25.84±1.67)分]、BBS评分[(23.28±1.92)分比(28.82±1.36)分]以及FAC分级[(2.96±0.71)级比(4.02±0.46)级]升高更显著,P均=0.001。结论:姿势控制训练结合核心肌群训练可明显促进脑卒中偏瘫患者下肢运动功能的恢复,改善平衡,提高步行能力,值得临床推广。     

下肢机器人对脑梗死偏瘫患者运动功能的疗效观察

目的观察Loko Help下肢机器人配合常规康复对脑梗死偏瘫患者的治疗效果。方法采用随机(1∶1)对照研究方法,将2014年1月至2015年1月在内蒙古包头市中心医院神经内科住院的发病在3个月以内的50例脑梗死偏瘫患者随机分为治疗组及对照组。均符合经头颅CT或MRI证实为基底节区脑梗死,初次发病或既往有发作但未遗留神经功能障碍,年龄在35~75岁,意识清楚,可服从指导,无合并认知功能障碍。治疗组在进行常规康复治疗基础上加做德国进口的Loko Help下肢机器人的训练,对照组只应用常规康复方法进行训练,训练4周后对两组治疗前后Fugl-Meyer下肢运动功能、Berg平衡量表评分、Barthel指数进行比较。结果治疗组训练4周后FuglMeyer下肢运动功能评分(24.65±6.58 vs.10.26±2.47)、Berg平衡量表评分(35.16±8.67 vs.7.26±3.46)、Barthel指数评分(74.85±8.65 vs.23.16±7.35)与治疗前比较差异有统计学意义(P0.05),经过4周训练后对照组Fugl-Meyer下肢运动功能评分(15.68±4.79 vs.9.56±2.08)、Berg平衡量表评分(21.78±10.43 vs.8.07±3.75)、Barthel指数评分(60.34±13.78 vs.20.36±9.23)与治疗前比较差异有统计学意义(P0.05),训练4周后治疗组Fugl-Meyer下肢运动功能评分、Berg平衡量表评分、Barthel指数评分与对照组比较差异均有统计学意义(P0.05)。结论 Loko Help下肢机器人的训练对脑梗死偏瘫患者运动功能、平衡及日常生活能力方面有显著的疗效。     

强化姿势控制对伴高血压病AIS患者运动功能的影响

目的 观察分析早期强化姿势控制训练对伴有高血压病的急性缺血性脑卒中(AIS)偏瘫患者的疗效。方法 选取2020年10月至2021年9月于内蒙古自治区人民医院神经内科收治的伴高血压病的急性缺血性脑卒中偏瘫患者104例为研究对象,分为常规训练组(n=52)和联合训练组(n=52)。两组患者均给予早期常规康复治疗,联合训练组在常规训练组基础上给予强化姿势控制训练,两组均治疗4周。4周后分别采用FugI-Meyer运动量表(FMA)、Berg平衡量表(BBS)、Barthel指数表(MBI)以及Holden步行功能分级(FAC)评估并比较两组治疗前后肢体运动功能、平衡能力、日常生活能力和步行能力差异,并分析治疗后两组的差异。结果 与治疗前比较,两组治疗4周后FMA、BBS、MBI评分和FAC分级均显著提高(P均<0.001),且联合训练组FMA、BBS、MBI评分显著高于常规训练组(P<0.001),但治疗后联合训练组FAC分级较常规训练组无显著性差异(P=0.199)。结论 早期康复能明显改善伴有高血压病的急性缺血性脑卒中偏瘫患者的运动功能恢复,强化姿势控制训练对其运动功能提高更...     

Graded motor imagery training as a home exercise program for upper limb motor function in patients with chronic stroke: A randomized controlled trial

Purpose:Although several types of occupational therapy for motor recovery of the upper limb in patients with chronic stroke have been investigated, most treatments are performed in a hospital or clinic setting. We investigated the effect of graded motor imagery (GMI) training, as a home exercise program, on upper limb motor recovery and activities of daily living (ADL) in patients with stroke.Methods:This prospective randomized controlled trial recruited 42 subjects with chronic stroke. The intervention group received instruction regarding the GMI program and performed it at home over 8 weeks (30 minutes a day). The primary outcome measure was the change in motor function between baseline and 8 weeks, assessed the Manual Function Test (MFT) and Fugl-Meyer Assessment (FMA). The secondary outcome measure was the change in ADL, assessed with the Modified Barthel Index (MBI).Results:Of the 42 subjects, 37 completed the 8-week program (17 in the GMI group and 20 controls). All subjects showed significant improvements in the MFT, FMA, and MBI over time (P < .05). However, the improvements in the total scores for the MFT, FMA, and MBI did not differ between the GMI and control groups. The MFT arm motion score for the GMI group was significantly better than that of the controls (P < .05).Conclusions:The GMI program may be useful for improving upper extremity function as an adjunct to conventional rehabilitation for patients with chronic stroke.     

The effects of additional electrical stimulation combined with repetitive transcranial magnetic stimulation and motor imagery on upper extremity motor recovery in the subacute period after stroke: A preliminary study

Background:To evaluate the therapeutic effects of additional electrical stimulation (ES) combined with low frequency (LF)-repetitive transcranial magnetic stimulation (rTMS) and motor imagery (MI) training on upper extremity (UE) motor function following stroke.Methods:The participants with subacute stroke in the experimental group (n = 8) received LF rTMS + MI + active ES interventions, and those in control group (n = 9) received LF rTMS + MI + sham ES interventions. Interventions were performed 5 days a week for 2 weeks, for a total of 10 sessions. All participants were given the same dosage of conventional rehabilitation during the study period. The primary outcome measure was the UE Fugl-Meyer Assessment (FMA). The secondary outcome measures were the shoulder abduction and finger extension scores, modified Barthel Index, Purdue Pegboard Test, and finger tapping test. All scores were measured before and just after the intervention.Results:After the 2-week intervention period, the FMA and modified Barthel Index scores were improved in both groups compared to baseline assessment (P < .001 in the experimental group and P = .008 in the control group). Of note, the change in FMA scores was significantly higher in the experimental group compared with that of the control group (P = .04).Conclusion:These results suggest that the use of LF rTMS + MI combined with additional ES lead to greater improvement of UE motor function after stroke. As such, this intervention may be a promising adjuvant therapy in UE motor training.     

Cortical activity during motor execution,motor imagery,and imagery-based online feedback

Imagery of motor movement plays an important role in learning of complex motor skills, from learning to serve in tennis to perfecting a pirouette in ballet. What and where are the neural substrates that underlie motor imagery-based learning? We measured electrocorticographic cortical surface potentials in eight human subjects during overt action and kinesthetic imagery of the same movement, focusing on power in “high frequency” (76–100 Hz) and “low frequency” (8–32 Hz) ranges. We quantitatively establish that the spatial distribution of local neuronal population activity during motor imagery mimics the spatial distribution of activity during actual motor movement. By comparing responses to electrocortical stimulation with imagery-induced cortical surface activity, we demonstrate the role of primary motor areas in movement imagery. The magnitude of imagery-induced cortical activity change was ∼25% of that associated with actual movement. However, when subjects learned to use this imagery to control a computer cursor in a simple feedback task, the imagery-induced activity change was significantly augmented, even exceeding that of overt movement.     

运动想像疗法对急性脑梗死患者上肢运动功能恢复的影响

目的 探讨运动想像疗法对急性期脑梗死偏瘫患者上肢功能恢复的影响.方法 随机选取50例脑梗死偏瘫患者,采用单盲法分为对照治疗组(药物治疗+早期运动疗法)和运动想像治疗组(药物+早期运动疗法+运动想像疗法),每组各25例.治疗前和治疗40 d时,采用Fugt-Meyer量表(FMA)评价患侧上肢运动功能,使用量角器测定患侧手腕主动活动范围(AROM),应用功能独立性评定量表(FIM)评价进食、梳洗、穿脱上衣等功能.结果 2组患者FMA、AROM和FIM评分均较治疗前显著提高(P<0.05),治疗后运动想像治疗组各项评分均优于对照组(P<0.05)(FMA28.33±8.63对15.93±5.39;AROM 19.55-I-8.30对11.97±6.59;FIM 16.83±5.43对12.51±3.36).结论 急性期常规运动康复训练+运动想像疗法可促进脑梗死偏瘫患者的运动功能恢复.     

对侧抑制性rTMS联合运动想象对脑卒中偏瘫患者肢体功能的康复效果

目的探讨对侧抑制性重复经颅磁刺激（rTMS）联合运动想象（MI）对脑卒中偏瘫患者肢体功能的康复效果。 方法选取廊坊市第四人民医院神经内科自2017年1月至2019年10月收治的108例脑卒中偏瘫患者为研究对象,按照随机数字表法将其分为常规组、MI组和联合组,每组36例。常规组接受常规药物治疗及康复治疗,MI组在常规组治疗基础上进行MI训练,联合组在MI组基础上进行对侧抑制性rTMS治疗;3组疗程均为4周。比较3组患者的临床疗效、治疗前后患侧运动诱发电位潜伏期（MEP-CL）、中枢运动传导时间（CMCT）、平衡量表（BBS）评分、起立-行走计时测试（TUGT）时间、修订版跌倒效能量表（MFES）评分、简化Fugl-Meyer评测法（FMA）评分、手部精细动作评估量表（MAS）评分、改良Barthel量表（MBI）评分。 结果常规组、MI组、联合组治疗4周后总有效率分别为50.0%、77.8%、94.1%,3组患者的临床疗效比较差异有统计学意义（P<0.05）。3组患者的治疗前MEP-CL、CMCT、TUGT时间及BBS、MFES、FMA、手部精细动作MAS、MBI评分比较,差异无统计学意义（P>0.05）。治疗4周后,3组患者的MEP-CL、CMCT、TUGT时间缩短,BBS、MFES、FMA、手部精细动作MAS、MBI评分增高（P<0.05）;改善程度：联合组>MI组>常规组,差异具有统计学意义（P<0.05）。 结论对侧抑制性rTMS联合MI有利于脑卒中偏瘫患者的肢体功能康复,且能明显提高患者的生命质量。     

The heterogeneity of mental representation: Ending the imagery debate

The possible ways that information can be represented mentally have been discussed often over the past thousand years. However, this issue could not be addressed rigorously until late in the 20th century. Initial empirical findings spurred a debate about the heterogeneity of mental representation: Is all information stored in propositional, language-like, symbolic internal representations, or can humans use at least two different types of representations (and possibly many more)? Here, in historical context, we describe recent evidence that humans do not always rely on propositional internal representations but, instead, can also rely on at least one other format: depictive representation. We propose that the debate should now move on to characterizing all of the different forms of human mental representation.     

Noninvasive cortical stimulation enhances motor skill acquisition over multiple days through an effect on consolidation

Motor skills can take weeks to months to acquire and can diminish over time in the absence of continued practice. Thus, strategies that enhance skill acquisition or retention are of great scientific and practical interest. Here we investigated the effect of noninvasive cortical stimulation on the extended time course of learning a novel and challenging motor skill task. A skill measure was chosen to reflect shifts in the task's speed–accuracy tradeoff function (SAF), which prevented us from falsely interpreting variations in position along an unchanged SAF as a change in skill. Subjects practiced over 5 consecutive days while receiving transcranial direct current stimulation (tDCS) over the primary motor cortex (M1). Using the skill measure, we assessed the impact of anodal (relative to sham) tDCS on both within-day (online) and between-day (offline) effects and on the rate of forgetting during a 3-month follow-up (long-term retention). There was greater total (online plus offline) skill acquisition with anodal tDCS compared to sham, which was mediated through a selective enhancement of offline effects. Anodal tDCS did not change the rate of forgetting relative to sham across the 3-month follow-up period, and consequently the skill measure remained greater with anodal tDCS at 3 months. This prolonged enhancement may hold promise for the rehabilitation of brain injury. Furthermore, these findings support the existence of a consolidation mechanism, susceptible to anodal tDCS, which contributes to offline effects but not to online effects or long-term retention.     

十二指肠球部溃疡患者胃肠运动功能障碍的动力学研究

目的　观察Du患者胃肠运动功能障碍。方法　通过胃肠测压方法对Du患者进行MMC测定。结果　 49例Du患者11/4 9(2 2 4% )出现MMC3期 ;对照组则高达 14 /2 0 (70 % )出现完整MMC3期。对照组MMC3期波幅明显高于Du组 (P <0 0 1)。结论　Du组患者确实存在MMC异常 ,在其发病机理中有一定作用。     

Effects of implementation intentions and mental imagery on subjective binge eating

Objective

Binge-eating disorder (BED) and bulimia nervosa (BN) are characterised by binge eating. Changing unwanted behaviour is difficult, as intentions do not automatically lead to action. Implementation intentions (IIs) may help bridging the gap between intentions and behaviour. IIs are ‘if-then’ plans promoting goal attainment. Effects are moderated by degree of plan formation. Using mental imagery (MI) to impress IIs may strengthen plan formation and goal attainment.

Method

In a students' sample with subjective binge eating, we compared IIs without MI, IIs with MI, and a control condition regarding their ability to reduce binge eating. Participants received three II-sessions and kept food diaries for 4 weeks.

Results

Results showed a significant and medium to large reduction of binge eating in both II-conditions compared to the control condition, that was sustained for 6 months. No additional effects of MI were found.

Conclusions

Applying IIs results in long-lasting reductions in subjective binge eating. The absence of additional effects of MI may be due to floor effects. Also, participants in the IIs without MI condition may have applied MI without being instructed to do so. In future research, ideally with a clinical sample, it is recommended to prevent or control for this.