本文選題：動作觀察療法　切入點：腦卒中　出處：《鄭州大學》2017年博士論文

【摘要】：第一部分基于鏡像神經(jīng)元理論的動作觀察療法對腦卒中患者神經(jīng)功能缺損程度和運動功能康復的影響目的:探討基于鏡像神經(jīng)元理論的動作觀察療法對腦卒中患者神經(jīng)功能缺損程度和運動功能的影響。方法:選取腦卒中偏癱患者136例,隨機分為動作觀察組和常規(guī)康復治療組,兩組患者均給予相同的常規(guī)康復治療措施,另外給予動作觀察組患者動作觀察療法,給予常規(guī)康復組與動作觀察療法相似的安慰治療,每天2次,每次30min,每周10次,共治療8周。采用美國國立衛(wèi)生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)、簡化Fugl-Meyer運動功能評分(Simplified Fugl-Meyer Assessment,FMA)、改良Ashwoth痙攣評定量表(Modified Ashworth scale,MAS)、Brunnstrom運動功能分期評定量表(Brunstrom motor function assessment),分別于入組時、治療4周后、8周后、12周隨訪時,評定患者的神經(jīng)功能缺損程度和運動功能,并進行統(tǒng)計學分析。結果:動作觀察組和常規(guī)康復治療組在入組時的一般情況、NIHSS評分、FMA評分、MAS評分、Brunnstrom分期評定均無統(tǒng)計學差異(P0.05),在治療4周后、8周后、12周隨訪時,兩組患者NIHSS、FMA評分、MAS評分、Brunnstrom運動功能分期評分,隨時間的進展,均較治療前顯著改善,差異具有統(tǒng)計學差異(P0.05);組間比較,動作觀察組患者評分以及治療前后差值均顯著高于常規(guī)康復治療組,差異具有統(tǒng)計學意義(P0.05)。結論:動作觀察療法,可以改善腦卒中患者神經(jīng)功能缺損程度,促進神經(jīng)功能恢復;可以提高患者運動功能評分,降低腦卒中患者關鍵肌肉的肌張力,促進患者運動功能的恢復。第二部分基于鏡像神經(jīng)元理論的動作觀察療法對腦卒中患者日常生活活動能力的影響目的:探討基于鏡像神經(jīng)元理論的動作觀察療法對腦卒中患者日常生活活動能力(activities of daily living,ADL)和獨立性的影響。方法:選取腦卒中偏癱患者136例,隨機分為動作觀察組和常規(guī)康復治療組,兩組患者均給予相同的常規(guī)康復治療措施,另外給予動作觀察組患者動作觀察療法,給予常規(guī)康復組與動作觀察療法相似的安慰治療,每天2次,每次30min,每周10次,共治療8周。采用改良巴士指數(shù)量表(Modified Barthel Index,MBI)、改良Rankin量表(modified Rankin Scale,m RS),分別于入組時、治療4周后、8周后、12周隨訪時,評定患者的日常生活活動能力和獨立生活能力,并進行統(tǒng)計學分析。結果:動作觀察組患者治療前MBI評分為(27.88±5.35),治療后為MBI評分(75.48±4.51),MBI改善值為(48.12±5.56);常規(guī)康復治療組治療前MBI評分(27.36±5.28),治療后MBI評分為(66.72±3.21),MBI改善值為(38.85±4.81)。組內比較,治療后兩組患者MBI評分均較治療前有顯著改善,具有顯著性差異(P0.05);兩組間比較,兩組患者治療前MBI評分無統(tǒng)計學差異(P0.05),而治療動作觀察組患者MBI評分及MBI改善值均高于常規(guī)康復治療組,差異具有統(tǒng)計學意義(P0.05)。治療前動作觀察組患者m RS評分為(4.41±0.61),治療后為(2.08±0.54),治療前常規(guī)康復治療組患者m RS評分為(4.25±0.56),治療后為(2.31±0.46),兩組患者治療前m RS評分無統(tǒng)計學差異(P0.05),治療后動作觀察組患者m RS評分顯著低于常規(guī)康復治療組,差異具有統(tǒng)計學意義(P0.05)。結論:基于鏡像神經(jīng)元理論的動作觀察療法有助于提高腦卒中患者ADL能力,降低致殘率,改善腦卒中患者預后。第三部分基于鏡像神經(jīng)元理論的動作觀察療法對腦卒中患者實時腦功能成像的影響目的:探討基于鏡像神經(jīng)元理論的動作觀察療法對腦卒中偏癱患者實時腦功能成像的影響。方法:選取腦卒中偏癱患者31例,隨機分為動作觀察組和常規(guī)康復治療組,兩組患者均給予相同的常規(guī)康復治療措施,另外給予動作觀察組患者動作觀察療法,給予常規(guī)康復組與動作觀察療法相似的安慰治療,每天2次,每次30min,每周10次,共治療8周。分別在入組時、8周后時,行實時功能磁共振(real time functional Magnetic Resonance Imaging,rtf MRI)檢查,選擇初級運動區(qū)(primary motor cortex,M1)、運動前區(qū)(premotor cortex,PMC)、輔助運動區(qū)(supplementary motor area,SMA)為感興趣區(qū)域(region of interest,ROI),然后做相應的數(shù)據(jù)處理,觀察患者腦功能成像情況、激活體積,并進行統(tǒng)計學分析。結果:rtf MRI數(shù)據(jù)分析結果顯示,治療后兩組患者在M1區(qū)、SMA區(qū)、PMC區(qū)的激活體素數(shù)均較治療前有顯著增加,動作觀察組患者治療前激活體素為M1(153.94±15.93)、PMV(97.75±17.28)、SMA(90.38±18.11),治療后激活體素數(shù)為M1(416.81±64.42)、PMC(199.50±30.06)、SMA(189.94±23.35),治療后激活體積顯著高于治療前(P0.05),常規(guī)康復治療組治療前激活體素數(shù)分別為M1(161.53±17.66)、PMC(95.13±19.10)、SMA(92.33±19.61),治療后為M1(334.13±36.69)、PMC(162.27±28.89)、SMA(152.20±23.21),治療后激活體積顯著高于治療前激活體積(P0.05)。兩組比較,動作觀察組患者ROI區(qū)激活區(qū)體積與增加值,均顯著高于常規(guī)康復治療組,差異具有統(tǒng)計學意義(P0.05)。結論:動作觀察療法可以影響患者實時腦功能成像,增加M1區(qū)、PMC區(qū)、SMA區(qū)等運動區(qū)激活體積,改變運動功能重組,促使患者偏癱肢體運動功能恢復。
[Abstract]:The first part of the theory of mirror neurons action observation therapy based on degree of functional impairment and motor nerve function rehabilitation of stroke patients Objective: To investigate the influence of mirror neuron theory of action observation therapy and motor nerve function defect in patients with cerebral stroke based on function. Methods: 136 cases of stroke patients were randomly divided into the observation of action group and routine rehabilitation therapy group, two patients were given routine rehabilitation treatment measures are the same, in addition to the action of patients in the observation group received action observation therapy, rehabilitation group and action observation therapy similar to placebo treatment, 2 times a day, 30min each time, 10 times a week, a total of 8 weeks of treatment. The National Institutes of health stroke research hospital scale (National Institute of Health Stroke Scale, NIHSS), simplified Fugl-Meyer motor function score (Simplified Fugl-Meyer Assessment, FMA), modified As Hwoth spasm scale (Modified Ashworth, scale, MAS, Brunnstrom) staging assessment of motor function scale (Brunstrom motor function assessment), respectively, in the group, after 4 weeks of treatment, after 8 weeks, 12 weeks of follow-up, the degree of neural function defect were evaluated and the movement function, and statistical analysis. Results: the observation group and routine rehabilitation therapy group in general, in the group of NIHSS score, FMA score, MAS score, Brunnstrom staging evaluation showed no statistical difference (P0.05), in the 4 weeks after treatment, after 8 weeks, 12 weeks, two patients in group NIHSS, FMA score, MAS score. Brunnstrom staging of motor function score, as time progressed, were significantly improved compared with before treatment, a statistically significant difference (P0.05); comparison between groups, patients in the observation group action score and the difference between before and after treatment were significantly higher than the conventional rehabilitation treatment group, the difference was statistically significant (P 0.05). Conclusion: the action observation therapy, can improve the degree of neurological impairment, promote the recovery of nerve function; can improve motor function in patients with muscle tension score, the key to reduce muscle of stroke patients, promote patients recovery of motor function. The second part is based on the theory of mirror neurons action observation therapy effects on brain activity life ability of stroke patients Objective: To investigate the ability of mirror neuron theory of action observation therapy on the activity of daily life of stroke patients based on (activities of daily living, ADL) and independent effects. Methods: 136 cases of stroke patients were randomly divided into observation group action and routine rehabilitation therapy group, two groups of patients to measure the same conventional rehabilitation therapy, the patients in the observation group were also given action action observation therapy, given conventional rehabilitation group and action observation therapy similar. 鎱版不鐤，

本文編號：1690313