运动想象疗法对急性脑梗死患者上肢瘫痪的效果及脑功能MRI的改变

摘要

Objective To investigate the effects and changes of brain functional MRI (fMRI) of motor imagery therapy on acute cerebral infarction ( ACI) patients with upper limb paralysis. Methods Seventy cases of ACI patients with hemiplegia were randomly divided into the control group (drug therapy + exercise) and motor imagery therapy group, each group had 35 cases. The treatment of motor imagery therapy group was on the basis of control group, add into motor imagery therapy, 2 times a day, for 30 d. Before and 30 d after treatment, the patients were scored by Fugl-Meyer scale (FMA) and functional independence measure scale (FIM) , the active range of motion ( AROM) of ipsilateral wrist was measured by a protractor, and the brain movement activation range was measured by blood oxygen level dependent fMRI. Results After treatment, the FMA, FIM scores of paralysis upper extremity, the AROM and range of brain activation were significantly higher or bigger than before treatment in the two groups (P<0. 05 -0.01). And these indicators of motor imagery therapy group were significantly higher or bigger than those in the control group (P<0. 05 —0.01). Conclusions Motor imagery therapy can promote the recovery of the upper limb motor function in acute cerebral infarction patients with hemiplegia, and expand the brain movement activation range on fMRI.%目的 研究运动想象疗法对急性脑梗死患者上肢瘫痪的效果及脑功能MRI(fMRI)的改变.方法 70例脑梗死偏瘫患者,随机分为对照组(药物治疗+运动)和运动想象治疗组,每组35例.运动想象治疗组在对照组的治疗基础上,进行运动想象疗法,每天2次,连续30 d.在治疗前和治疗后30 d,给患者进行Fugl-Meyer量表(FMA)、功能独立性评定量表(FIM)评分,用量角器测定患侧手腕主动活动范围(AROM)；用血氧水平依赖性fMRI测定脑运动激活区范围.结果 两组患者治疗后瘫痪上肢的FMA、FIM评分、AROM及脑激活区的范围均明显高于或大于治疗前(P＜0.05 ～0.01)；而运动想象治疗组治疗后上述指标又显著高于或大于对照组(P ＜0.05 ～0.01).结论 运动想象疗法可以促进急性脑梗死偏瘫患者上肢运动功能的恢复,以及fMRI脑运动激活区的扩大.