基于动作观察疗法的运动想象对延髓背外侧综合征吞咽困难的影响及机制：一项随机对照试验
The effect and mechanism of motor imagery based on action observation treatment on dysphagia in Wallenberg Syndrome: a randomized controlled trial.
作者信息
Wang Le, Li Yi, Liu Ruyao, Li Heping, Wang Liugen, Yuan Yongkang, Li Wenjian, Song Yunyun, Zeng Xi
机构信息
Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Academy of Medical Science, Zhengzhou University, Zhengzhou, China.
出版信息
Eur J Phys Rehabil Med. 2024 Dec;60(6):938-948. doi: 10.23736/S1973-9087.24.08471-5. Epub 2024 Oct 7.
BACKGROUND
The effect of motor imagery applied to dysphagia patients with Wallenberg syndrome has not yet been reported.
AIM
This trial aimed to investigate the effect and mechanism of motor imagery based on action observation treatment in the rehabilitation of patients with dysphagia in Wallenberg syndrome.
DESIGN
A randomized controlled trial.
SETTING
The setting was in-patient.
POPULATION
Thirty patients with dysphagia of Wallenberg syndrome.
METHODS
The patients were divided into the experimental group and the control group. Both groups received conventional dysphagia treatment, and the experimental group underwent the addition of motor imagery based on action observation treatment to the control group once a day for 14 days. Overall swallowing function was assessed with specific scales before and after intervention. Meanwhile, the functional near infrared spectroscopy was used to detect changes in cerebral hemodynamics during the execution of volitional swallowing task and swallowing motor imagery.
RESULTS
The standardized swallowing assessment score (P=0.030), Murray secretion scale score (P=0.044) and swallowing quality of life score (P=0.011) of the experimental group improved better than those of the control group. In addition, multiple brain regions of the cortical presented extensive activation (P<0.05) during the execution of swallowing motor imagery. Moreover, there were significant differences (P<0.05) in brain regions pre-motor and supplementary motor cortex, right primary motor cortex, and right primary somatosensory cortex of the experimental group before and after treatment.
CONCLUSIONS
The present study indicated that motor imagery based on action observation treatment could improve swallowing function for patients with dysphagia of Wallenberg syndrome as an add-on training. As a top-down rehabilitation training, the mechanism of this therapy may be related to the selective activation of mirror neuron system.
CLINICAL REHABILITATION IMPACT
Motor imagery based on action observation treatment can be implemented as part of the therapeutic for dysphagia of Wallenberg syndrome.
背景
运动想象应用于延髓背外侧综合征吞咽困难患者的效果尚未见报道。
目的
本试验旨在探讨基于动作观察治疗的运动想象在延髓背外侧综合征吞咽困难患者康复中的作用及机制。
设计
一项随机对照试验。
地点
住院环境。
研究对象
30例延髓背外侧综合征吞咽困难患者。
方法
将患者分为实验组和对照组。两组均接受常规吞咽困难治疗，实验组在对照组基础上增加基于动作观察治疗的运动想象训练，每天1次，共14天。干预前后用特定量表评估整体吞咽功能。同时，采用功能性近红外光谱技术检测自主吞咽任务和吞咽运动想象执行过程中脑血流动力学的变化。
结果
实验组标准化吞咽评估评分（P = 0.030）、默里分泌量表评分（P = 0.044）和吞咽生活质量评分（P = 0.011）改善情况优于对照组。此外，在执行吞咽运动想象时，皮质的多个脑区出现广泛激活（P < 0.05）。而且，实验组治疗前后在运动前区和辅助运动区、右侧初级运动皮层及右侧初级躯体感觉皮层的脑区存在显著差异（P < 0.05）。
结论
本研究表明，基于动作观察治疗的运动想象作为一种附加训练可改善延髓背外侧综合征吞咽困难患者的吞咽功能。作为一种自上而下的康复训练，该疗法的机制可能与镜像神经元系统的选择性激活有关。
临床康复影响
基于动作观察治疗的运动想象可作为延髓背外侧综合征吞咽困难治疗的一部分实施。
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