| Objective: To observe and evaluate the clinical effect of motor imagery therapy combined with conventional exercise rehabilitation to improve upper limb function of stroke patients,and using functional near-infrared spectroscopy imaging technology(fNIRs)to explore the brain function mechanism of motor imagery therpy to improve the upper limb function of stroke patients,finally,it provides the basis for the study of the clinical application and effect mechanism of the motor imagery therpy.Methods: According to the random number table,46 patients with upper limb dysfunction after stroke were randomly divided into treatment group and control group,with 23 patients in each group.Control group: in addition to the application of basic drug therapy,regular exercise rehabilitation training was adopted,including :(1)good limb position of hemiplegic patients;(2)active or passive rehabilitation function training for upper limbs;(3)turn over training;(4)seating training;(5)stand training;(6)auxiliary walking training;(7)stair training up and down.All the above training sessions were conducted by professional rehabilitation therapists.The training time was 20 minutes/time,2 times/day,4 days/week,and lasted 8 weeks.Treatment group: on the basis of the above treatment,exercise imagination training was conducted by professional rehabilitation therapists,15 minutes/time,2 times/day,4 days/week,lasting 8 weeks.Both groups were evaluated by simplified fugl-meyer scale and FIM functional independence rating scale;the concentration of Oxy-Hb,Deoxy-Hb,and Total-Hb in the brain tissues of the two groups was detected by fNIRs acquisition system(mainly with the change of Oxy-Hb concentration),evaluated the functional changes of neuron activity,cell energy metabolism and hemodynamics.We further constructed the cerebral cortex optical three-dimensional brain imaging map,and analyzed the activation mode and corresponding characteristics of brain functional area after stroke in patients motor imagery therpy.Results:(1)Comparison of FIM and FMA scores between the two groups before and after treatment.Compared with pre-treatment,the scores of FIM and FMA were significantly increased in both groups during the treatment of 4 weeks and 8 weeks,and the difference wasstatistically significant(P<0.05);compared with the control group,the scores of FIM and FMA were significantly increased in the treatment group for 4 weeks and 8 weeks,and the difference was statistically significant(P<0.05).(2)Effective comparison of the two groups of patientsThe overall effective rate of the treatment group was 86.96%,and the total effective rate of the control group was 73.91%,and the difference between the two groups was statistically significant(P=0.002<0.05).(3)The time series of Oxy-Hb and Deoxy-Hb concentrations were compared between the two groups in C4/C5/C14channelWith the change of time,the relative value of Oxy-Hb concentration in the treatment group and the control group increased significantly,and the difference between the two groups was statistically significant(P<0.05).The relative value of Deoxy-Hb concentration decreased significantly,and the difference between the two groups was statistically significant(P<0.05).(4)Comparison of the relative changing values of Oxy-Hb,Deoxy-Hb and Total-Hb in the two groupsAfter 4 weeks and 8 weeks of treatment,the changes in Oxy-Hb concentration in both groups increased,and there was a significant difference compared to before treatment between the two groups(P<0.01).However,there was no statistically significant difference between week 8 and week 4(P=0.068>0.05).After 8 weeks of treatment,the change values of Oxy-Hb and Total-Hb in the treatment group were significantly higher than that in the control group,and the change value of Deoxy-Hb concentration was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).(5)Comparison of three-dimensional brain imaging images detected by fNIRsThree-dimensional brain imaging: the main parts of the brain activation of the two groups of patients were the upper and middle sections of the cortical motor region,corresponding to Brodmann 4.In addition,other parts of the frontal lobe,such as the premotor cortex(Brodmann 6),the frontal lobe(Brodmann8),and the local sensorimotor area(upper segment of Brodmann 1,2,3)were also activated.The activation area and activation intensityof cerebral cortex were different in two groups of patients.The activation intensity and activation area of the related brain regions in the treatment group were larger than those in the control group.Conclusion:(1)Motor imagery therpy in combination with conventional movement rehabilitation can significantly improve the functional disorder of upper limb after stroke,and the effect is significantly better than that of simple exercise rehabilitation.(2)Cerebral cortex motor area and premotor cortex activity were significantly inhibited in patients with upper limb dysfunction after stroke;motor imagery therpy can significantly change the concentration of Oxy-Hb,Deoxy-Hb and Total-Hb in cerebral apoplexy patients,activation of cerebral cortex function activity in related brain regions,which may be one of the functional mechanisms of motor imagery therpy to effectively intervene in the functional disorder of upper extremity after stroke. |
PDF Full Text Request