|
|
脑卒中后运动功能障碍的早期康复治疗现状
|
Abstract:
脑卒中是一种常见的脑血管疾病，也是全球成年人的主要残疾原因之一，常遗留有不同程度的肢体运动功能障碍，给患者、家庭乃至社会都带来了沉重的负担。早期康复介入有助于患者改善功能障碍、提高生活质量、提升社会生产力。目前，仍有部分脑卒中后运动障碍患者及家属未完全意识到早期康复的意义和价值，阻碍了患者回归家庭和社会的康复进程。本文将重点从卒中后运动障碍早期康复的介入时间、病理生理机制、相关康复治疗手段等方面予以综述，希望为脑卒中后运动功能障碍患者的治疗提供科研新资料和临床新思路。
Stroke is a common cerebrovascular disease and one of the main causes of disability in adults around the world. It often leaves behind different degrees of limb motor dysfunction, which brings a heavy burden to patients, families and society. Early rehabilitation intervention can help patients improve dysfunction, improve quality of life and enhance social productivity. At present, there are still some patients with post-stroke motor dysfunction and their families are not fully aware of the significance and value of early rehabilitation, which hinders the rehabilitation process of patients returning to family and society. This article will focus on the intervention time, pathophysiological mechanism and related rehabilitation treatment methods of early rehabilitation of post-stroke motor dysfunction, hoping to provide new scientific research data and clinical new ideas for the treatment of patients with post-stroke motor dysfunction.
| [1] | Tsao, C.W., Aday, A.W., Almarzooq, Z.I., Anderson, C.A.M., Arora, P., Avery, C.L., Baker-Smith, C.M., Beaton, A.Z., Boehme, A.K., Buxton, A.E., Commodore-Mensah, Y., Elkind, M.S.V., Evenson, K.R., Eze-Nliam, C., Fugar, S., Generoso, G., Heard, D.G., Hiremath, S., Ho, J.E., Kalani, R., Kazi, D.S., Ko, D., Levine, D.A., Liu, J., Ma, J., Magnani, J.W., Michos, E.D., Mussolino, M.E., Navaneethan, S.D., Parikh, N.I., Poudel, R., Rezk-Hanna, M., Roth, G.A., Shah, N.S., St-Onge, M.P., Thacker, E.L., Virani, S.S., Voeks, J.H., Wang, N.Y., Wong, N.D., Wong, S.S., Yaffe, K., Martin, S.S. and American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee (2023) Heart Disease and Stroke Statistics-2023 Update: A Report from the American Heart Association. Circulation, 147, e93-e621. https://doi.org/10.1161/CIR.0000000000001123 |
| [2] | Tu, W., Wang, L., Yan, F., Peng, B., Hua, Y., Liu, M., et al. (2023) China Stroke Surveillance Report 2021. Military Medical Research, 10, Article No. 33. https://doi.org/10.1186/s40779-023-00463-x |
| [3] | Nogueira, N.G.D.H.M., Parma, J.O., Leão, S.E.S.D.A., Sales, I.D.S., Macedo, L.C., Galvão, A.C.D.R., et al. (2021) Mirror Therapy in Upper Limb Motor Recovery and Activities of Daily Living, and Its Neural Correlates in Stroke Individuals: A Systematic Review and Meta-Analysis. Brain Research Bulletin, 177, 217-238. https://doi.org/10.1016/j.brainresbull.2021.10.003 |
| [4] | Coleman, E.R., Moudgal, R., Lang, K., Hyacinth, H.I., Awosika, O.O., Kissela, B.M., et al. (2017) Early Rehabilitation after Stroke: A Narrative Review. Current Atherosclerosis Reports, 19, Article No. 59. https://doi.org/10.1007/s11883-017-0686-6 |
| [5] | Ramamoorthy, V., Chan, K., Roy, M., Saxena, A., Ahmed, M.A., Zhang, Z., et al. (2023) Healthcare Expenditure Trends among Adult Stroke Patients in the United States, 2011-2020. Journal of Stroke and Cerebrovascular Diseases, 32, Article 107333. https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.107333 |
| [6] | 袁文超, 张颖, 杨坚, 等. 区域三级康复网络服务体系对脑卒中患者生活自理能力及生存质量的影响[J]. 中国康复, 2016, 31(4): 290-291. |
| [7] | 王福东. 急性脑卒中早期康复治疗与运动功能预后评估相关性研究[D]: [硕士学位论文]. 沈阳: 中国医科大学, 2019. |
| [8] | 钟迪, 张舒婷, 吴波. 《中国急性缺血性脑卒中诊治指南2018》解读[J]. 中国现代神经疾病杂志, 2019, 19(11): 897-901. |
| [9] | Mariana de Aquino Miranda, J., Mendes Borges, V., Bazan, R., José Luvizutto, G. and Sabrysna Morais Shinosaki, J. (2021) Early Mobilization in Acute Stroke Phase: A Systematic Review. Topics in Stroke Rehabilitation, 30, 157-168. https://doi.org/10.1080/10749357.2021.2008595 |
| [10] | Feigin, V.L., Stark, B.A., Johnson, C.O., Roth, G.A., Bisignano, C., Abady, G.G., et al. (2021) Global, Regional, and National Burden of Stroke and Its Risk Factors, 1990-2019: A Systematic Analysis for the Global Burden of Disease Study 2019. The Lancet Neurology, 20, 795-820. https://doi.org/10.1016/s1474-4422(21)00252-0 |
| [11] | Short, H.B. (2019) Royal College of Physicians of London: A 1793 Entrant, Fabled Fellow or Member Malcontent. Internal Medicine Journal, 49, 265-268. https://doi.org/10.1111/imj.14206 |
| [12] | 孙留峰. 住院脑卒中患者早期康复治疗依从性的现状调查及影响因素分析[D]: [硕士学位论文]. 洛阳: 河南科技大学, 2015. |
| [13] | 程桂玲, 迟兆富. 出血性脑梗死的病因、发病机制及临床分析[J]. 脑与神经疾病杂志, 2001(2): 100-101. |
| [14] | Marín-Medina, D.S., Arenas-Vargas, P.A., Arias-Botero, J.C., Gómez-Vásquez, M., Jaramillo-López, M.F. and Gaspar-Toro, J.M. (2023) New Approaches to Recovery after Stroke. Neurological Sciences, 45, 55-63. https://doi.org/10.1007/s10072-023-07012-3 |
| [15] | 缪鸿石. 中枢神经系统(CNS)损伤后功能恢复的理论(一) [J]. 中国康复理论与实践, 1995(1): 1-4. |
| [16] | 李飞, 邓时慧, 谷德祥, 等. 早期康复治疗对脑梗塞患者脑血流量等的影响[J]. 中国康复理论与实践, 1996(4): 151-153. |
| [17] | 甘照儒, 石丽华, 蔡超群, 等. 早期康复介入对急性脑梗死炎症反应的影响[J]. 中国康复理论与实践, 2010, 16(9): 807-808. |
| [18] | 丁新华, 尤春景. 脑卒中患者Brunnstrom分期及其运动功能恢复[J]. 中国康复, 1996(3): 110-111. |
| [19] | 黄佳, 陈洪沛, 郭敏, 等. 脑卒中患者运动功能评定的方法及其研究进展与问题[J]. 中国临床康复, 2006(28): 120-122. |
| [20] | 张宇. 运动障碍患者康复评定指标与步态病症诊断方法的研究[D]: [硕士学位论文]. 北京: 清华大学, 2007. |
| [21] | Biswas, P., Dodakian, L., Wang, P.T., Johnson, C.A., See, J., Chan, V., et al. (2024) A Single-Center, Assessor-Blinded, Randomized Controlled Clinical Trial to Test the Safety and Efficacy of a Novel Brain-Computer Interface Controlled Functional Electrical Stimulation (BCI-FES) Intervention for Gait Rehabilitation in the Chronic Stroke Population. BMC Neurology, 24, Article No. 200. https://doi.org/10.1186/s12883-024-03710-3 |
| [22] | Choy, C.S., Fang, Q., Neville, K., Ding, B., Kumar, A., Mahmoud, S.S., et al. (2023) Virtual Reality and Motor Imagery for Early Post-Stroke Rehabilitation. Bio Medical Engineering Online, 22, Article No. 66. https://doi.org/10.1186/s12938-023-01124-9 |
| [23] | Khan, M.A., Das, R., Iversen, H.K. and Puthusserypady, S. (2020) Review on Motor Imagery Based BCI Systems for Upper Limb Post-Stroke Neurorehabilitation: From Designing to Application. Computers in Biology and Medicine, 123, Article 103843. https://doi.org/10.1016/j.compbiomed.2020.103843 |
| [24] | 冉茂胜, 叶建军, 马东兵, 等. 运动想象疗法对急性脑梗死患者上肢瘫痪的效果及脑功能MRI的改变[J]. 临床神经病学杂志, 2013, 26(2): 102-104. |
| [25] | 王春雨, 张蓉. 脑机接口在脑卒中运动功能障碍的应用[J]. 临床医学进展, 2022, 12(6): 5108-5113. |
| [26] | Francisco, G., Chae, J., Chawla, H., Kirshblum, S., Zorowitz, R., Lewis, G., et al. (1998) Electromyogram-Triggered Neuromuscular Stimulation for Improving the Arm Function of Acute Stroke Survivors: A Randomized Pilot Study. Archives of Physical Medicine and Rehabilitation, 79, 570-575. https://doi.org/10.1016/s0003-9993(98)90074-0 |
| [27] | Yang, Y., Mi, P., Huang, S., Chiu, S., Liu, Y. and Wang, R. (2018) Effects of Neuromuscular Electrical Stimulation on Gait Performance in Chronic Stroke with Inadequate Ankle Control—A Randomized Controlled Trial. PLOS ONE, 13, e0208609. https://doi.org/10.1371/journal.pone.0208609 |
| [28] | Kim, S., Park, J., Jung, M. and Yoo, E. (2016) Effects of Task-Oriented Training as an Added Treatment to ElectromyOgram-Triggered Neuromuscular Stimulation on Upper Extremity Function in Chronic Stroke Patients. Occupational Therapy International, 23, 165-174. https://doi.org/10.1002/oti.1421 |
| [29] | Wang, Q., Zhang, D., Zhao, Y., Hai, H. and Ma, Y. (2020) Effects of High-Frequency Repetitive Transcranial Magnetic Stimulation over the Contralesional Motor Cortex on Motor Recovery in Severe Hemiplegic Stroke: A Randomized Clinical Trial. Brain Stimulation, 13, 979-986. https://doi.org/10.1016/j.brs.2020.03.020 |
| [30] | Yin, M., Liu, Y., Zhang, L., Zheng, H., Peng, L., Ai, Y., et al. (2020) Effects of rTMS Treatment on Cognitive Impairment and Resting-State Brain Activity in Stroke Patients: A Randomized Clinical Trial. Frontiers in Neural Circuits, 14, Article 563777. https://doi.org/10.3389/fncir.2020.563777 |
| [31] | Hofmeijer, J., Ham, F. and Kwakkel, G. (2023) Evidence of rTMS for Motor or Cognitive Stroke Recovery: Hype or Hope? Stroke, 54, 2500-2511. https://doi.org/10.1161/strokeaha.123.043159 |
| [32] | Ahmed, I., Mustafaoglu, R., Rossi, S., Cavdar, F.A., Agyenkwa, S.K., Pang, M.Y.C., et al. (2023) Non-Invasive Brain Stimulation Techniques for the Improvement of Upper Limb Motor Function and Performance in Activities of Daily Living after Stroke: A Systematic Review and Network Meta-Analysis. Archives of Physical Medicine and Rehabilitation, 104, 1683-1697. https://doi.org/10.1016/j.apmr.2023.04.027 |
| [33] | Longo, V., Barbati, S.A., Re, A., Paciello, F., Bolla, M., Rinaudo, M., et al. (2022) Transcranial Direct Current Stimulation Enhances Neuroplasticity and Accelerates Motor Recovery in a Stroke Mouse Model. Stroke, 53, 1746-1758. https://doi.org/10.1161/strokeaha.121.034200 |
| [34] | Hsu, S., Lu, C., Lin, B., Tang, C., Kuo, I., Tsai, Y., et al. (2023) Effects of Bihemispheric Transcranial Direct Current Stimulation on Motor Recovery in Subacute Stroke Patients: A Double-Blind, Randomized Sham-Controlled Trial. Journal of Neuro Engineering and Rehabilitation, 20, Article No. 27. https://doi.org/10.1186/s12984-023-01153-4 |
| [35] | Chamorro-Hinojosa, J.A., Molina-Rueda, F. and Carratalá-Tejada, M. (2023) Transcranial Direct Current Stimulation in the Treatment of Gait Disturbance in Post-Stroke Patients: An Overview of Systematic Reviews. Sensors, 23, Article 9301. https://doi.org/10.3390/s23239301 |
| [36] | Darekar, A. (2023) Virtual Reality for Motor and Cognitive Rehabilitation. In: Current Topics in Behavioral Neurosciences, Springer, 337-369. https://doi.org/10.1007/7854_2023_418 |
| [37] | Llorens, R., Fuentes, M.A., Borrego, A., Latorre, J., Alcañiz, M., Colomer, C., et al. (2021) Effectiveness of a Combined Transcranial Direct Current Stimulation and Virtual Reality-Based Intervention on Upper Limb Function in Chronic Individuals Post-Stroke with Persistent Severe Hemiparesis: A Randomized Controlled Trial. Journal of Neuro Engineering and Rehabilitation, 18, Article No. 108. https://doi.org/10.1186/s12984-021-00896-2 |
| [38] | Thieme, H., Morkisch, N., Mehrholz, J., Pohl, M., Behrens, J., Borgetto, B., et al. (2018) Mirror Therapy for Improving Motor Function after Stroke. Cochrane Database of Systematic Reviews, 2018, CD008449. https://doi.org/10.1002/14651858.cd008449.pub3 |
| [39] | Wen, X., Li, L., Li, X., Zha, H., Liu, Z., Peng, Y., et al. (2022) Therapeutic Role of Additional Mirror Therapy on the Recovery of Upper Extremity Motor Function after Stroke: A Single-Blind, Randomized Controlled Trial. Neural Plasticity, 2022, 1-9. https://doi.org/10.1155/2022/8966920 |
| [40] | Hsu, H., Kuo, L., Lin, Y., Su, F., Yang, T. and Lin, C. (2022) Effects of a Virtual Reality-Based Mirror Therapy Program on Improving Sensorimotor Function of Hands in Chronic Stroke Patients: A Randomized Controlled Trial. Neurorehabilitation and Neural Repair, 36, 335-345. https://doi.org/10.1177/15459683221081430 |
| [41] | Cui, W., Huang, L., Tian, Y., Luo, H., Chen, S., Yang, Y., et al. (2022) Effect and Mechanism of Mirror Therapy on Lower Limb Rehabilitation after Ischemic Stroke: A fMRI Study. Neuro Rehabilitation, 51, 65-77. https://doi.org/10.3233/nre-210307 |
| [42] | Klamroth-Marganska, V. (2018) Stroke Rehabilitation: Therapy Robots and Assistive Devices. In: Advances in Experimental Medicine and Biology, Springer, 579-587. https://doi.org/10.1007/978-3-319-77932-4_35 |
| [43] | Grosmaire, A., Pila, O., Breuckmann, P. and Duret, C. (2022) Robot-Assisted Therapy for Upper Limb Paresis after Stroke: Use of Robotic Algorithms in Advanced Practice. Neuro Rehabilitation, 51, 577-593. https://doi.org/10.3233/nre-220025 |
| [44] | Zhang, Q., Wang, Y., Zhou, M., Li, D., Yan, J., Liu, Q., et al. (2023) Ankle Rehabilitation Robot Training for Stroke Patients with Foot Drop: Optimizing Intensity and Frequency. Neuro Rehabilitation, 53, 567-576. https://doi.org/10.3233/nre-230173 |
| [45] | Lin, Y., Li, Q., Qu, Q., Ding, L., Chen, Z., Huang, F., et al. (2022) Comparative Effectiveness of Robot-Assisted Training versus Enhanced Upper Extremity Therapy on Upper and Lower Extremity for Stroke Survivors: A Multi-Centre Randomized Controlled Trial. Journal of Rehabilitation Medicine, 54, jrm00314. https://doi.org/10.2340/jrm.v54.882 |
| [46] | Dehem, S., Gilliaux, M., Stoquart, G., Detrembleur, C., Jacquemin, G., Palumbo, S., et al. (2019) Effectiveness of Upper-Limb Robotic-Assisted Therapy in the Early Rehabilitation Phase after Stroke: A Single-Blind, Randomized, Controlled Trial. Annals of Physical and Rehabilitation Medicine, 62, 313-320. https://doi.org/10.1016/j.rehab.2019.04.002 |
| [47] | Duret, C., Hutin, E., Lehenaff, L. and Gracies, J. (2015) Do All Sub Acute Stroke Patients Benefit from Robot-Assisted Therapy? A Retrospective Study. Restorative Neurology and Neuroscience, 33, 57-65. https://doi.org/10.3233/rnn-140418 |
| [48] | Lee, J., Chun, M.H., Seo, Y.J., Lee, A., Choi, J. and Son, C. (2022) Effects of a Lower Limb Rehabilitation Robot with Various Training Modes in Patients with Stroke: A Randomized Controlled Trial. Medicine, 101, e31590. https://doi.org/10.1097/md.0000000000031590 |
| [49] | Muir, K.W., Bulters, D., Willmot, M., Sprigg, N., Dixit, A., Ward, N., et al. (2020) Intracerebral Implantation of Human Neural Stem Cells and Motor Recovery after Stroke: Multicentre Prospective Single-Arm Study (Pisces-2). Journal of Neurology, Neurosurgery & Psychiatry, 91, 396-401. https://doi.org/10.1136/jnnp-2019-322515 |
| [50] | Chen, S., Qiu, Y., Bassile, C.C., Lee, A., Chen, R. and Xu, D. (2022) Effectiveness and Success Factors of Bilateral Arm Training after Stroke: A Systematic Review and Meta-Analysis. Frontiers in Aging Neuroscience, 14, Article 875794. https://doi.org/10.3389/fnagi.2022.875794 |
| [51] | 段毅芳, 景蓉, 董雪. 针刺联合康复治疗对脑卒中后上肢运动功能障碍的研究进展[J]. 临床医学进展, 2022, 12(10): 9111-9116. https://doi.org/10.12677/acm.2022.12101317 |
| [52] | Tao, Y.X., Wu, Y.H., Zhu, G.Q. and Wang, M. (2023) Efficacy of Acupuncture in the Treatment of Limb Dyskinesia after Stroke: A Systematic Review and Meta-Analysis. European Review for Medical and Pharmacological Sciences, 27, 10985-10993. |
| [53] | 袁慧萍, 冯小军, 蒋东生, 等. 高压氧联合互动式头针对脑卒中后偏瘫患者运动功能的效果[J]. 中国康复理论与实践, 2023, 29(10): 1208-1213. |
| [54] | Bai, Z., Fong, K.N.K., Zhang, J.J., Chan, J. and Ting, K.H. (2020) Immediate and Long-Term Effects of BCI-Based Rehabilitation of the Upper Extremity after Stroke: A Systematic Review and Meta-Analysis. Journal of Neuro Engineering and Rehabilitation, 17, Article No. 57. https://doi.org/10.1186/s12984-020-00686-2 |
| [55] | Xie, Y., Pan, J., Chen, J., Zhang, D. and Jin, S. (2023) Acupuncture Combined with Repeated Transcranial Magnetic Stimulation for Upper Limb Motor Function after Stroke: A Systematic Review and Meta-Analysis. Neuro Rehabilitation, 53, 423-438. https://doi.org/10.3233/nre-230144 |
| [56] | Li, R.Y., Chen, K., Wang, X., Yu, Q. and Xu, L. (2022) Comparison of Different Rehabilitation Techniques of Traditional Chinese and Western Medicine in the Treatment of Motor Dysfunction after Stroke Based on Frequency Method: A Network Meta-Analysis. American Journal of Physical Medicine & Rehabilitation, 102, 504-512. https://doi.org/10.1097/phm.0000000000002130 |
| [57] | Everard, G., Declerck, L., Detrembleur, C., Leonard, S., Bower, G., Dehem, S., et al. (2022) New Technologies Promoting Active Upper Limb Rehabilitation after Stroke: An Overview and Network Meta-Analysis. European Journal of Physical and Rehabilitation Medicine, 58, 530-548. https://doi.org/10.23736/s1973-9087.22.07404-4 |
