本文選題：動(dòng)作觀察療法　切入點(diǎn)：腦卒中　出處：《鄭州大學(xué)》2017年博士論文

【摘要】：第一部分基于鏡像神經(jīng)元理論的動(dòng)作觀察療法對(duì)腦卒中患者神經(jīng)功能缺損程度和運(yùn)動(dòng)功能康復(fù)的影響目的:探討基于鏡像神經(jīng)元理論的動(dòng)作觀察療法對(duì)腦卒中患者神經(jīng)功能缺損程度和運(yùn)動(dòng)功能的影響。方法:選取腦卒中偏癱患者136例,隨機(jī)分為動(dòng)作觀察組和常規(guī)康復(fù)治療組,兩組患者均給予相同的常規(guī)康復(fù)治療措施,另外給予動(dòng)作觀察組患者動(dòng)作觀察療法,給予常規(guī)康復(fù)組與動(dòng)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(yùn)動(dòng)功能評(píng)分(Simplified Fugl-Meyer Assessment,FMA)、改良Ashwoth痙攣評(píng)定量表(Modified Ashworth scale,MAS)、Brunnstrom運(yùn)動(dòng)功能分期評(píng)定量表(Brunstrom motor function assessment),分別于入組時(shí)、治療4周后、8周后、12周隨訪時(shí),評(píng)定患者的神經(jīng)功能缺損程度和運(yùn)動(dòng)功能,并進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:動(dòng)作觀察組和常規(guī)康復(fù)治療組在入組時(shí)的一般情況、NIHSS評(píng)分、FMA評(píng)分、MAS評(píng)分、Brunnstrom分期評(píng)定均無統(tǒng)計(jì)學(xué)差異(P0.05),在治療4周后、8周后、12周隨訪時(shí),兩組患者NIHSS、FMA評(píng)分、MAS評(píng)分、Brunnstrom運(yùn)動(dòng)功能分期評(píng)分,隨時(shí)間的進(jìn)展,均較治療前顯著改善,差異具有統(tǒng)計(jì)學(xué)差異(P0.05);組間比較,動(dòng)作觀察組患者評(píng)分以及治療前后差值均顯著高于常規(guī)康復(fù)治療組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:動(dòng)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(jìn)神經(jīng)功能恢復(fù);可以提高患者運(yùn)動(dòng)功能評(píng)分,降低腦卒中患者關(guān)鍵肌肉的肌張力,促進(jìn)患者運(yùn)動(dòng)功能的恢復(fù)。第二部分基于鏡像神經(jīng)元理論的動(dòng)作觀察療法對(duì)腦卒中患者日常生活活動(dòng)能力的影響目的:探討基于鏡像神經(jīng)元理論的動(dòng)作觀察療法對(duì)腦卒中患者日常生活活動(dòng)能力(activities of daily living,ADL)和獨(dú)立性的影響。方法:選取腦卒中偏癱患者136例,隨機(jī)分為動(dòng)作觀察組和常規(guī)康復(fù)治療組,兩組患者均給予相同的常規(guī)康復(fù)治療措施,另外給予動(dòng)作觀察組患者動(dòng)作觀察療法,給予常規(guī)康復(fù)組與動(dòng)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(shí)、治療4周后、8周后、12周隨訪時(shí),評(píng)定患者的日常生活活動(dòng)能力和獨(dú)立生活能力,并進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:動(dòng)作觀察組患者治療前MBI評(píng)分為(27.88±5.35),治療后為MBI評(píng)分(75.48±4.51),MBI改善值為(48.12±5.56);常規(guī)康復(fù)治療組治療前MBI評(píng)分(27.36±5.28),治療后MBI評(píng)分為(66.72±3.21),MBI改善值為(38.85±4.81)。組內(nèi)比較,治療后兩組患者M(jìn)BI評(píng)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(píng)分無統(tǒng)計(jì)學(xué)差異(P0.05),而治療動(dòng)作觀察組患者M(jìn)BI評(píng)分及MBI改善值均高于常規(guī)康復(fù)治療組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。治療前動(dòng)作觀察組患者m RS評(píng)分為(4.41±0.61),治療后為(2.08±0.54),治療前常規(guī)康復(fù)治療組患者m RS評(píng)分為(4.25±0.56),治療后為(2.31±0.46),兩組患者治療前m RS評(píng)分無統(tǒng)計(jì)學(xué)差異(P0.05),治療后動(dòng)作觀察組患者m RS評(píng)分顯著低于常規(guī)康復(fù)治療組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:基于鏡像神經(jīng)元理論的動(dòng)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(yù)后。第三部分基于鏡像神經(jīng)元理論的動(dòng)作觀察療法對(duì)腦卒中患者實(shí)時(shí)腦功能成像的影響目的:探討基于鏡像神經(jīng)元理論的動(dòng)作觀察療法對(duì)腦卒中偏癱患者實(shí)時(shí)腦功能成像的影響。方法:選取腦卒中偏癱患者31例,隨機(jī)分為動(dòng)作觀察組和常規(guī)康復(fù)治療組,兩組患者均給予相同的常規(guī)康復(fù)治療措施,另外給予動(dòng)作觀察組患者動(dòng)作觀察療法,給予常規(guī)康復(fù)組與動(dòng)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(shí)、8周后時(shí),行實(shí)時(shí)功能磁共振(real time functional Magnetic Resonance Imaging,rtf MRI)檢查,選擇初級(jí)運(yùn)動(dòng)區(qū)(primary motor cortex,M1)、運(yùn)動(dòng)前區(qū)(premotor cortex,PMC)、輔助運(yùn)動(dòng)區(qū)(supplementary motor area,SMA)為感興趣區(qū)域(region of interest,ROI),然后做相應(yīng)的數(shù)據(jù)處理,觀察患者腦功能成像情況、激活體積,并進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:rtf MRI數(shù)據(jù)分析結(jié)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?cái)?shù)均較治療前有顯著增加,動(dòng)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?cái)?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(fù)治療組治療前激活體素?cái)?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(dòng)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(fù)治療組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:動(dòng)作觀察療法可以影響患者實(shí)時(shí)腦功能成像,增加M1區(qū)、PMC區(qū)、SMA區(qū)等運(yùn)動(dòng)區(qū)激活體積,改變運(yùn)動(dòng)功能重組,促使患者偏癱肢體運(yùn)動(dòng)功能恢復(fù)。
[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(hào)：1690313