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动作观察训练联合基于脑机接口的功能性电刺激对脑卒中患者患侧上肢运动恢复的影响:一项随机对照试验

Effects of Action Observational Training Plus Brain-Computer Interface-Based Functional Electrical Stimulation on Paretic Arm Motor Recovery in Patient with Stroke: A Randomized Controlled Trial.

作者信息

Kim TaeHoon, Kim SeongSik, Lee ByoungHee

机构信息

The Post-Professional DPT Program, Stockton University, 101 Vera King Farris Drive, Galloway, NJ, 08205, USA.

Graduate School of Physical Therapy, Sahmyook University, 815 Hwarang-ro, Nowon-gu, Seoul, 139-742, Korea.

出版信息

Occup Ther Int. 2016 Mar;23(1):39-47. doi: 10.1002/oti.1403. Epub 2015 Aug 24.

Abstract

The purpose of this study was to investigate whether action observational training (AOT) plus brain-computer interface-based functional electrical stimulation (BCI-FES) has a positive influence on motor recovery of paretic upper extremity in patients with stroke. This was a hospital-based, randomized controlled trial with a blinded assessor. Thirty patients with a first-time stroke were randomly allocated to one of two groups: the BCI-FES group (n = 15) and the control group (n = 15). The BCI-FES group administered to AOT plus BCI-FES on the paretic upper extremity five times per week during 4 weeks while both groups received conventional therapy. The primary outcomes were the Fugl-Meyer Assessment of the Upper Extremity, Motor Activity Log (MAL), Modified Barthel Index and range of motion of paretic arm. A blinded assessor evaluated the outcomes at baseline and 4 weeks. All baseline outcomes did not differ significantly between the two groups. After 4 weeks, the Fugl-Meyer Assessment of the Upper Extremity sub-items (total, shoulder and wrist), MAL (MAL-Activity of Use and Quality of Movement), Modified Barthel Index and wrist flexion range of motion were significantly higher in the BCI-FES group (p < 0.05). AOT plus BCI-based FES is effective in paretic arm rehabilitation by improving the upper extremity performance. The motor improvements suggest that AOT plus BCI-based FES can be used as a therapeutic tool for stroke rehabilitation. The limitations of the study are that subjects had a certain limited level of upper arm function, and the sample size was comparatively small; hence, it is recommended that future large-scale trials should consider stratified and lager populations according to upper arm function.

摘要

本研究旨在调查动作观察训练(AOT)加基于脑机接口的功能性电刺激(BCI-FES)对中风患者患侧上肢运动恢复是否有积极影响。这是一项基于医院的随机对照试验,评估者为盲法。30例首次中风患者被随机分为两组:BCI-FES组(n = 15)和对照组(n = 15)。BCI-FES组在4周内每周对患侧上肢进行5次AOT加BCI-FES治疗,同时两组均接受常规治疗。主要结局指标为上肢Fugl-Meyer评估、运动活动日志(MAL)、改良Barthel指数和患侧手臂的活动范围。一名盲法评估者在基线和4周时对结局进行评估。两组的所有基线结局均无显著差异。4周后,BCI-FES组的上肢Fugl-Meyer评估子项目(总分、肩部和腕部)、MAL(MAL-使用活动和运动质量)、改良Barthel指数和腕部屈曲活动范围均显著更高(p < 0.05)。AOT加基于BCI的FES通过改善上肢功能,对患侧手臂康复有效。运动功能的改善表明,AOT加基于BCI的FES可作为中风康复的治疗工具。本研究的局限性在于受试者的上臂功能有一定的有限水平,且样本量相对较小;因此,建议未来的大规模试验应根据上臂功能考虑分层和更大的人群。

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