Study On The Appropriate Rehabilitation Technology Scheme Of Integrated Traditional Chinese And Western Medicine For Motor Dysfunction After Stroke Based On Brunnstrom Theory

ObjectiveStroke is also a common acute cerebrovascular disease in the middle and old age.The mortality rate accounts for about 30% of the total number of patients.Among them,motor dysfunction,as the most common sequela after stroke,has been troubling the lives of patients and their families.With the deepening of clinical research,the combination of traditional Chinese and western medicine has been widely recognized for its excellent efficacy in the treatment of motor dysfunction after stroke.Based on the different characteristics of Brunnstrom in different phases and the characteristics of rehabilitation with integrated traditional Chinese and western medicine in China,this project will formulate the appropriate technical scheme for rehabilitation of motor dysfunction after stroke and evaluate the path efficacy.Methods1.CNKI,Wanfang,Pub Med,EMBASE,and Cochrane databases were searched from inception to Jan 2022.We independently searched and screened randomized controlled trials(RCTs)of rehabilitation techniques for motor dysfunction after stroke treatment,evaluated the quality,and analyzed the data using Stata 14.0.2.Search database: CNKI,Wanfang Wanfang,and VIP.The retrieval time range is from the database establishment to March 2022.A randomized controlled trial(RCT)of acupuncture and moxibustion for the treatment of motor dysfunction after stroke was searched and screened,and its acupoints were extracted.All acupoint names and meridians are standardized according to the "acupoint names and positioning".If multiple syndrome differentiation points are involved in the literature,only the main points are entered;Enter single syndrome type into main acupoint+matching acupoint,establish Excel database,and conduct frequency analysis.Use SPSS 24.0 to conduct Ward clustering and draw a cluster analysis tree diagram,and use SPSS Modeler 18.0 to conduct association rule analysis(Apriori analysis)and draw a complex network diagram.3.A research group consisting of five people was established.Through literature analysis and combining with clinical needs,an initial questionnaire item pool was established.Conduct expert correspondence through Delphi method,and carry out two rounds of correspondence from April to May 2022,Statistical indicators: core item importance score(the retention conditions of the items in the questionnaire of experts on rehabilitation technology of integrated traditional Chinese and western medicine for motor dysfunction after stroke in the first round(need to be met simultaneously: the average of item importance>4;the coefficient of variation of the items is less than 0.3;the experts have not put forward clear modification opinions),if not all the conditions are met at the same time,the research group will determine the experts’ enthusiasm,authority Coordination degree of expert opinions.It is reflected by the coefficient of variation and Kendall’s coordination coefficient.SPSS 24.0 software was used for statistical analysis.Measurement data is expressed by mean ±standard deviation;The counting data is expressed by frequency and rate.4.Patients with motor dysfunction after stroke who received rehabilitation treatment in Rehabilitation Department of Sichuan Provincial People’s Hospital from May 2022 to February 2023 were included.The selected patients were divided into routine rehabilitation group and rehabilitation path group according to the random number method.The patients in the two groups were evaluated before and after treatment(FMA,BBS,FIM,MBI),and compared between groups and within groups by SPSS;The patients in the two groups were treated with infra-red brain function imaging(Zilian Hongkang)before and after treatment,and the intra-group comparison of relevant indicators was made: global indicators: small world attribute,cluster coefficient,shortest path length,global efficiency and local efficiency;Node indicators: median centrality,centrality,node clustering coefficient,node efficiency,and node local efficiency,and number of connection edges.Results1.Seventy-four RCTs involving nine rehabilitation techniques and 5128 patients were included.The results of network meta-analysis showed the following orders regarding improvement of the total scores of Fugl Meyer assessment,action research arm test,and Berg Balance Scale: BT > MT > rTMS > AT > tDCS > Taichi > CT,VR > tDCS > rTMS > MT > CT,and AT > VR > NMES > MT > CT > tDCS,respectively.2.A total of 951 documents were retrieved and 33 were finally included.25 acupuncture prescriptions were included in the soft paralysis period,involving 57 acupoints,and the total frequency of acupoint use was 237 times;The period of paraplegia includes 26 acupuncture prescriptions,involving 73 acupoints,and the total frequency of acupoint use is 278 times;The separation exercise period includes12 acupuncture prescriptions,involving 53 acupoints,and the total frequency of acupoint use is 148 times.The acupoint association network diagram was made for the acupoints and the association rule analysis was carried out.The core acupoint combination for acupuncture treatment of motor dysfunction after stroke and soft paralysis stage was "Zusanli-Jianyu-Quchi";The core acupoint combination in the period of paraplegia is "Waiguan-Sanyinjiao";The core acupoint combination during the separation movement period is "Quchi-Hegu".Using Ward clustering method to cluster the acupoints with frequency>5,the high-frequency selection of acupoints for the treatment of motor dysfunction after stroke can be divided into five categories: the first category is Chize,Weizhong,Jiquan,Neiguan and Fengshi;The second category is Sanyinjiao,Taichong and Zusanli;The third category is Waiguan and Futu;The fourth category is Yanglingquan and Huantiao;The fifth major category is Shousanli,Liangqiu and Jianyu.The high-frequency acupoint selection for acupuncture treatment of motor dysfunction after stroke in the period of stiff paralysis can be divided into five categories: the first category is Sanyinjiao,Yinlingquan,Shousanli,Xuehai,Waiguan,Quchi and Hegu;The second major category is Zusanli,Liangqiu,and Jianyu;The third category is Taichong and Xuanzhong;The fourth category is Yanglingquan,Huantiao and Weizhong;The fifth category is Chize,Neiguan and Biguan.The high-frequency selection of acupuncture points for the treatment of motor dysfunction after stroke during the separation exercise period can be divided into three categories: the first category is Quchi,Hegu,Zusanli and Sanyinjiao;The second category is Xuehai,Liangqiu and Waiguan;The third major category is Taichong,Yanglingquan,Huantiao,and Jianyu.3.After the first round of questionnaire modification,the average importance of all items in the second round of motor dysfunction after stroke rehabilitation technology expert questionnaire with integrated traditional Chinese and western medicine was>4;The coefficient of variation of the entries is less than 0.3;And the experts did not put forward clear modification suggestions.In the first round,there were 16 experts with bachelor’s degree,10 with master’s degree and 3 with doctor’s degree,accounting for55.2%,34.5% and 10.3% respectively;In the second round,there were 15 experts with bachelor’s degree,11 with master’s degree and 1 with doctor’s degree,accounting for 55.6%,40.7% and 3.7% respectively.The authority coefficients of the first and second rounds of the questionnaire are 0.78 and 0.833 respectively,indicating that the results of the two rounds of research are reliable and experts have a high degree of authority.The recovery rates of the two rounds of expert questionnaires in this study were 94% and 90% respectively.The Kendall coordination coefficient of the first round of expert correspondence was 0.367,and the second round was 0.432,indicating the high degree of expert coordination in the two rounds of expert correspondence.4.The results of clinical research suggest that the average change of FMA,BBS,FIM and MBI after rehabilitation path treatment is significantly higher than that after conventional treatment;After the rehabilitation path treatment,the improvement of motor function of brunnstrom patients in each stage was higher than that in the conventional group,with the most obvious improvement in brunnstrom(Ⅰ-Ⅱ,Ⅲ-Ⅳ)patients in the upper and lower limbs;FNIRS results showed that there was no significant difference in the intra-group main effect,inter-group main effect,interaction and post-test of global indicators.Node index: Node indicators: median centrality index of patients in the pathway group after treatment is in PreM＿and＿SMC-R brain area is higher than that before treatment.After treatment,the centrality index in DLPFC-L brain area of patients in the pathway group is higher than that before treatment.After treatment,the node clustering coefficient index in the conventional group is in PreM and The SMC-L brain area was lower than that before treatment,the node efficiency index in DLPFC-L brain area was higher in the pathway group after treatment than that before treatment,and the node local efficiency index in PreM in the routine group after treatment and SMC-L brain area was significantly lower than that before treatment.The results showed that the number of Short1 connection variables in the middle path group increased significantly after treatment compared with that before treatment.According to the Brodmann partition,the data were processed by partition.Compared with the routine group before and after treatment and the path group before and after treatment,the comparison results of the two groups before and after treatment were not significant.ConclusionsIn this study,the relevant efficacy of physical rehabilitation technology for motor dysfunction after stroke was ranked by the network meta-analysis method,and the acupoint application rules of acupuncture and moxibustion for treatment of motor dysfunction after stroke by stages were analyzed by using data mining technology.After combining with relevant literature and expert recommendations,the appropriate technical rehabilitation path for motor dysfunction after stroke was preliminarily developed by combining traditional Chinese and western medicine.After two rounds of Delphi correspondence,The relevant items were supplemented and modified to finally determine the core items of the rehabilitation technology path of Chinese and Western medicine for motor dysfunction after stroke,and the motor function and brain function of patients with motor dysfunction after stroke were evaluated by FMA,BERG,FIM,MBI related indicators and FNIRS,and the clinical effectiveness of the finally confirmed appropriate technology path of integrated Chinese and Western medicine for motor dysfunction after stroke was evaluated,The results showed that the average change values of FMA,BBS,FIM and MBI after the rehabilitation path treatment were significantly higher than those in the conventional group.At the same time,the combination of FNIRS also well verified that the established rehabilitation path of integrated traditional Chinese and western medicine can improve the functional connection of relevant brain areas to a certain extent.