镜像理论指导下的运动联合康复机器人对脑卒中患者手功能恢复的影响

Efficacy of mirror therapy combined with robotic rehabilitation in hand function recovery after stroke

摘要:

目的 探讨镜像理论指导下的运动联合康复机器人对脑卒中患者手功能恢复的影响。方法 选取2020年1月—2022年1月广州医科大学附属第二医院收治的122例脑卒中手功能障碍患者作为研究对象。以随机数字表法分为对照组、研究组，每组61例。对照组患者给予康复机器人治疗，研究组患者在对照组患者基础上另给予镜像理论指导下的运动。两组患者持续治疗4周后评价疗效。对比两组患者治疗前后手最大握力、捏力及手指总主动活动情况，比较两组患者治疗前后腕关节等速肌力及手屈曲、背伸动作下屈指浅肌、伸指肌的积分肌电值情况，统计两组患者治疗前后上肢功能及日常生活活动功能变化。结果 研究组治疗前后的最大握力、捏力的差值高于对照组（P <0.05）。研究组手指总主动活动度优良率高于对照组（P <0.05）。研究组治疗前后的腕关节屈肌肌群手、腕关节伸肌肌群峰值力矩、最大总用功的差值高于对照组（P <0.05）。研究组治疗前后的手屈曲、手背伸动作下屈指浅肌、伸指肌的积分肌电值的差值高于对照组（P <0.05）。研究组治疗前后Fugl-Meyer运动功能量表、Barthel指数的差值高于对照组（P <0.05）。结论 镜像理论指导下的运动结合康复机器人可改善脑卒中患者手功能、手腕部肌力及肌群，提高其上肢功能及日常生活活动功能。

Abstract:

Objective To investigate the efficacy of mirror therapy combined with robotic rehabilitation in hand function recovery after stroke.Methods A total of 122 patients with hand dysfunction after stroke admitted to our hospital from January 2020 to January 2022 were selected and divided into control group and study group by random number table method, with 61 cases in each group. The control group was treated with rehabilitation robots, and the study group was additionally given mirror therapy. The therapeutic efficacy in the two groups was evaluated after 4 weeks of continuous treatment. The maximum hand grip strength, pinch strength and total active motion (TAM) were compared between the two groups before and after the treatment. The isokinetic muscle strength of wrist flexor and extensor muscles, and integrated electromyogram of hand muscles at flexion and dorsiflexion movements were compared between the two groups before and after treatment. The changes of upper limb function and activities of daily living before and after treatment were analyzed in the two groups.Results The differences of maximum grip strength and pinch strength before and after the treatment in the study group were higher than those in the control group (P < 0.05). The excellent and good rate of TAM in the study group was higher than that in the control group (P < 0.05). The differences of peak torque (PT) and total work (TW) of wrist flexor muscles as well as hand and wrist extensor muscles before and after treatment in the study group were higher than those in the control group (P < 0.05). The differences of the integrated electromyogram of flexor digitorum superficialis and extensor digitorum communis at flexion and dorsiflexion movements before and after the treatment in the study group were higher than those in the control group (P < 0.05). The differences of Fugl-Meyer Assessment (FMA) and Barthel Index (BI) before and after treatment in the study group were higher than those in the control group (P < 0.05).Conclusions Mirror therapy combined with robotic rehabilitation can improve the hand function, wrist muscle strength and muscle group function, upper limb function and activities of daily living of stroke patients.