| As one of the major diseases threatening human health,stroke has the characteristics of high prevalence,high disability,high mortality,high recurrence rate and high economic burden.Although the medical level in China has been continuously improved and the survival rate of patients with acute stroke has increased,most stroke patients with hemiplegia have different degrees of dysfunction [1-2],which brings a heavy burden to families and society.Promoting the recovery of upper limb function through rehabilitation training is of great significance to the improvement of daily living activities and the return to society [3],but the upper limb function rehabilitation is not effective.In recent years,with the development of rehabilitation therapy technology,rehabilitation methods such as motor imagery(MI),mirror therapy,and bilateral training have received more and more clinical attention.However,there is no research at home and abroad for the combination of motor imaging therapy and bilateral training for rehabilitation,and there is no objective evaluation method for the treatment effect.Objective: To explore the effect of motor imaging therapy combined with bilateral training on upper limb function recovery in stroke patients.Methods: 1.A total of 90 stroke patients with hemiplegia were randomly divided into the conventional group(A group),the motor imaging group(B group)and the combined group(C group),with 30 cases in each group.2.The three groups of patients were given corresponding rehabilitation training according to the results of rehabilitation assessment.B group was supplemented with motor imaging therapy on the basis of routine rehabilitation therapy,and C group was combined with bilateral limbs on the basis of routine rehabilitation training and motor imaging training.Before the treatment and after 4 weeks of treatment,The root mean square value(RMS),median frequency(MF)and integral electromyogram(iEMG)of middle fascicle of deltoid muscle,biceps brachii,triceps brachii and extensor in three groups were measured by surface electromyography.At the same time,Fugl-Meyer assessment(FMA)upper limb part,hemiplegia Brunnstrom staging upper limb and hand part,modified Barthel Index(MBI),upper limb function and activities of daily living were used.The ability was assessed and the results of the pre-treatment and post-treatment evaluations were compared.Results: sEMG in the upper limbs and hand part of the hemiplegic side: After 4 weeks of treatment,the RMS of middle fascicle of deltoid in A group increased from the initial 16.00±3.55 uv to 21.40±2.30 uv,and the MF increased from the initial 67.43±3.48 Hz to 76.07±3.79 Hz,iEMG increased from the initial 50.77±5.06 mv to 67.86±4.85 mv,the RMS of the B group increased from 16.37±3.45 uv to 28.07±3.65 uv,the MF increased from the initial 66.37±3.35 Hz to 80.73±3.86 Hz,and the iEMG increased from the initial 61.20±5.46 mv to 75.80±5.50 mv.The RMS of middle fascicle of deltoid in C group increased from the initial 15.83±4.56 uv to 34.13±4.75 uv,the MF increased from the initial 67.57±3.21 Hz to 86.67±3.22 Hz,and the iEMG increased from the initial 60.53±4.32 mv to 83.50±3.62 mv.After 4 weeks of treatment,the RMS of biceps brachii in A group increased from the initial 9.63±2.46 uv to 14.07±2.40 uv,the MF increased from the initial 67.83±2.90 Hz to 75.43±3.00 Hz,and the iEMG increased from the initial 36.97±3.73 mv to 44.80±4.64 mv.The RMS of biceps brachii in B group increased from the initial 10.67±2.22 uv to 23.60±2.91 uv,the MF increased from the initial 66.67±3.89 Hz to 81.73±3.75 Hz,the iEMG increased from the initial 35.83±3.06 mv to 50.23±2.90 mv.The RMS of biceps in C group increased from the initial 10.17±2.91 uv to 32.27±5.58 uv,the MF increased from the initial 67.10±2.95 Hz to 88.27±3.23Hz,and the iEMG increased from the initial 37.13±2.90 mv to 59.70±2.52 mv.After 4 weeks of treatment,the RMS of triceps in A group increased from the initial 8.77±2.24 uv to 14.87±2.92 uv,the MF increased from the initial 49.70±2.73 Hz to 56.37±3.80 Hz,and the iEMG increased from the initial 11.37± 3.20 mv to 19.27±3.31 mv.The RMS of triceps in B group increased from the initial 9.33±2.14 uv to 23.40±2.89 uv,the MF increased from the initial 49.40±3.20 Hz to 62.60±3.50 Hz,the iEMG increased from the initial 12.03±2.67 mv to 25.37±3.08 mv.The RMS of triceps in C group increased from the initial 9.03±2.25 uv to 28.73±3.97 uv,the MF increased from the initial 48.83±4.00 Hz to 75.43±3.91 Hz,and the iEMG increased from the initial 10.93±2.44 mv to 31.83±3.85 mv.After 4 weeks of treatment,the RMS of extensor in A group increased from the initial 8.07±2.20 uv to 12.73±3.25 uv,the MF increased from the initial 28.10±2.44 Hz to 36.30±3.48 Hz,and the iEMG increased from the initial 15.00±2.80 mv to 21.97±2.82 mv.The RMS of the extensor in B group increased from the initial 7.83±1.72 uv to 16.67±2.50 uv,the MF increased from the initial 27.90±2.50 Hz to 43.90±3.96 Hz,the iEMG increased from the initial 13.77±2.63 mv to 29.80±3.37 mv,the RMS of extensor in C group initial 8.63±2.34 uv increased to 26.50±2.81 uv,the MF increased from the initial 27.93±1.82 Hz to 50.63±3.12 Hz,and the iEMG increased from the original 15.13±2.80 mv to 37.70±3.48 mv.After 4 weeks of treatment,the FMA upper limb score in A group increased from the initial 9.93±2.33 points to 16.00±3.51 points,the B group increased from the initial 11.03±2.74 points to 22.93±4.14 points,and the C group increased from the initial 10.40±2.20 points.To 28.87±3.01 points.Brunnstrom grading: before and after treatment,There are 4 person having a significant effect on upper limb function treatment in A group(13.3%),11 having a significant effect in B group(36.7%),and 19 having a significant effect in C group(63.3%).Before and after treatment,There be 1person had a significant effect on upper limb function treatment in A group(3%),the B group had a significant effect of 8(26.7%),and the C group had a significant effect of 17(56.7%).After 4 weeks of treatment,the modified Barthel index in A group increased from the initial 45.70±7.58 to 53.60±5.87,the B group increased from the initial 46.87±12.60 to 59.47±12.03,and the C group increased from the initial 46.40±11.38 To 65.73±10.34 points.sEMG value(RMS,MF,iEMG),FMA(upper limbs),Brunnstrom staging scale(upper limb and hand),and improved Barthel index scale(MBI)scores were measured in the first three groups.There were no significant differences between the groups(P>0.05).After treatment,the six indicators in B group were superior to the A group,and the differences between the groups were statistically significant(P<0.05).The indicators were also significantly better than the A group and the B group.The differences between the groups were statistically significant(P<0.05).In the group,the six indexes of the three groups were significantly improved compared with those before treatment(P<0.05).Conclusion: The results of this study show that the combination of motor imaging therapy and bilateral training is more effective in the recovery of upper limb function in patients with hemiplegia than in conventional rehabilitation or motor imaging therapy.The method is safe and effective. |
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