摘要
目的 探讨镜像疗法对脑卒中后I型复杂区域性疼痛综合征(CRPS)上肢功能及大脑皮质活动的影响.方法 2017年10月至2022年2月,在上海中医药大学附属第三康复医院招募脑卒中后I型CRPS患者72例,随机分为对照组(n=36)和镜像组(n=36).对照组给予常规康复训练,镜像组在对照组基础上给予镜像疗法,共6周.治疗前、治疗3周后、治疗6周后分别对患者进行疼痛视觉模拟量表(VAS)、改良Barthel指数(MBI)、水肿容积和Brunnstrom分期评定.采用NirSmart 32通道功能性近红外光谱(fNIRS)采集静息态440 s.结果 治疗后,两组VAS评分均明显改善,且治疗6周后明显优于治疗3周后(P<0.01);治疗6周后镜像组优于对照组(P<0.05).两组MBI评分均显著改善,且治疗6周后显著优于治疗3周后(P<0.001).两组水肿均显著改善(Z>30.113,P<0.001),且治疗6周后镜像组明显优于对照组(Z=-3.347,P=0.001);镜像组患者的水肿容积在治疗3周后、6周后均明显减少(Z<-0.667,P<0.01),且治疗6周后效果更优(Z=-0.667,P=0.005).两组Brunnstrom分期均显著改善(Z>29.714,P<0.001),治疗6周后镜像组优于对照组(Z=-2.046,P=0.041).治疗后对照组右侧M1与右侧初级体感皮质连接强度较强,镜像组左侧M1与右侧M1、右侧初级体感皮质、右侧皮质运动前区和辅助运动区连接强度较强.镜像组左右侧初级体感皮质、左侧皮质运动前区和辅助运动区与右侧M1区、右侧皮质运动前区和辅助运动区与左侧初级体感皮质、左侧M1区与左侧初级体感皮质、左侧初级体感皮质与右侧M1区的连接强度强于对照组(∣t∣>3.402,P<0.01).结论 镜像疗法有助于改善脑卒中后I型CRPS患者患手的疼痛、水肿和上肢运动功能.镜像疗法可加强健侧感觉区与患侧感觉运动区的连接,促进感觉运动皮质重组.
Abstract
Objective To investigate the effect of mirror therapy on upper limb function and cortical activity in patients with type I complex regional pain syndrome(CRPS)after stroke.Methods A total of 72 post-stroke patients with type I CRPS were recruited at the Third Rehabilitation Hospital Affiliat-ed to Shanghai University of Traditional Chinese Medicine from October,2017 to February,2022.They were ran-domly divided into control group(n=36)and mirror therapy group(n=36).The control group received conven-tional rehabilitation training,while the mirror therapy group received mirror therapy in addition.Before treat-ment,as well as at three and six weeks after treatment,they were evaluated using the Visual Analog Scale(VAS)for pain,modified Barthel Index(MBI),edema volume and Brunnstrom stage.Resting-state data were collected for 440 seconds using a 32-channel functional near-infrared spectroscopy(fNIRS)system.Results After treatment,VAS scores significantly improved in each group,showing better after six weeks than after three weeks(P<0.01).The mirror therapy group was better than the control group after six weeks(P<0.05).MBI scores also significantly improved in each group,showing better after six weeks than after three weeks(P<0.001).Edema volume significantly decreased in each group(Z>30.113,P<0.001),while the mirror therapy group was better than the control group after six weeks(Z=-3.347,P=0.001).Edema volume in the mirror therapy group significantly reduced at both three and six weeks(Z<-0.667,P<0.01),with a stronger effect ob-served after six weeks(Z=-0.667,P=0.005).Brunnstrom stages improved significantly in each group(Z>29.714,P<0.001),while the mirror therapy group was better than the control group after six weeks(Z=-2.046,P=0.041).After treatment,the control group showed strong connectivity between right M1 and right primary so-matosensory cortex,while the mirror therapy group demonstrated stronger connectivity between left M1 and right M1,right primary somatosensory cortex,right pre-motor and supplementary motor cortex.Connectivity be-tween left and right primary somatosensory cortex increased in mirror therapy group,as well as the connectivity between left pre-motor-supplementary motor cortex and right M1,right pre-motor-supplementary motor cortex and left primary somatosensory cortex,left M1 and left primary somatosensory cortex,and left primary somato-sensory cortex and right M1(∣t∣>3.402,P<0.01).Conclusion Mirror therapy may relieve pain and edema,and improve upper limb motor function in post-stroke patients with type I CRPS,which may associate with stonger connectivity between sensory regions on the unaffected side and sensory-motor regions on the affected side,promoting sensorimotor cortical reorganization.
基金项目
上海市静安区医学科研项目(2017QT04)
上海市静安区医学科研项目(2021MS18)
静安区卫生系统重点学科建设项目(2021PY04)
维普
万方数据