运动想象疗法在脑卒中后运动功能康复中的研究进展

林志强; 王安妮; 高润; 刘莉

doi:10.16766/j.cnki.issn.1674-4152.003345

运动想象疗法在脑卒中后运动功能康复中的研究进展

doi: 10.16766/j.cnki.issn.1674-4152.003345

林志强¹,
王安妮¹,
高润²,
刘莉^2, ,

1.
南京体育学院研究生部，江苏南京 210014
2.
南京医科大学附属脑科医院康复医学科，江苏南京 210029

基金项目:

江苏省卫生健康委员会2022年度医学科研重点项目 ZD2022030

江苏省研究生科研与实践创新计划项目 KYCX22_2255

详细信息

通讯作者:
刘莉，E-mail：liulicao1976@163.com

中图分类号: R743.3
计量
- 文章访问数: 622
- HTML全文浏览量: 274
- PDF下载量: 38
- 被引次数: 0
出版历程
- 收稿日期: 2023-07-03
- 网络出版日期: 2024-03-09

Research progress of motor imagery therapy in motor function rehabilitation after stroke

LIN Zhiqiang¹,
WANG Anni¹,
GAO Run²,
LIU Li^{2
, ,}

1.
Graduate Department of Nanjing Sports Institute, Nanjing, Jiangsu 210014, China

摘要

摘要: 脑卒中作为一种严重威胁中国国民健康的慢性非传染性疾病，具有高患病率、高病残率、高致死率、高复发性、高经济压力性五大特性。全球疾病负担研究(global burden of disease study，GBD)数据显示，中国脑卒中患病人数高居世界首位，脑卒中已经成为伤残致死的第一位发病原因。脑卒中会导致多种功能障碍，如运动、言语、吞咽障碍等，其中运动功能障碍最为常见。近年来，越来越多的治疗方法被应用于实践中，有关资料建议应及早介入脑卒中康复，早期康复已经被证实对脑卒中患者功能预后具有改善作用。在早期康复中，运动想象(motor imagery, MI)疗法作为一种新型的治疗方式，因其实施受限制程度较小、操作简单、经济便捷，目前已在脑卒中患者的康复治疗中表现出积极的作用。然而，当前主流的MI解释模型对其具体的神经作用机制仍存在较大的模糊性，特别是在分子和细胞水平。此外，单纯的运动想象疗法主要应用于脑卒中后超早期和早期康复，治疗效果有限，但随着MI与心理学中第二代具身认知理论的融合与深入，新的具身化运动想象疗法也开始逐渐引起关注。因此，很有必要对MI进行梳理整合与探讨，本文将结合近些年的相关研究，阐述运动想象疗法在脑卒中后运动功能康复中的研究进展，以期为未来相关问题的深入研究及解决提供一定的参考。
- 脑卒中 /
- 运动想象 /
- 运动功能康复
Abstract: As a chronic non-communicable disease, stroke poses a serious threat to the health of Chinese people, and has five major characteristics: high prevalence, high disability, high mortality, high recurrence, and high economic pressure. According to the global burden of disease (GBD) study, the number of people suffering from stroke in China is the highest in the world, and stroke has already become the first cause of disability and death. Strokes cause a variety of functional disorders, such as motor, speech, and swallowing disorders, among which motor dysfunction is the most common. In recent years, more and more therapeutic methods have been applied in practice, and relevant data suggest that early intervention in stroke rehabilitation is needed, and early rehabilitation has been shown to improve the functional prognosis of stroke patients. In early rehabilitation, motor imagery (MI) therapy, as a new and innovative therapeutic modality, has been shown to play a positive role in the rehabilitation of stroke patients due to its less restrictive implementation, simple operation, and economic convenience. However, the current mainstream explanatory model of MI still has a large ambiguity about its specific neurological mechanism of action, especially at the molecular and cellular levels. In addition, pure motor imagery therapy is mainly applied to ultra-early and early post-stroke rehabilitation with limited therapeutic effects, but with the integration and deepening of MI with second-generation embodied cognition theories in psychology, new embodied motor imagery therapies have begun to be gradually compelling. Therefore, it is very necessary to sort out, integrate and explore MI. In this paper, we will elaborate the research progress of motor imagery therapy in post-stroke motor function rehabilitation by combining the relevant studies in recent years, with a view to providing certain reference value for the depth of research and even the solution of the relevant problems in the future.
- Stroke /
- Motor imagery /
- Motor function rehabilitation

HTML全文

参考文献(38)

[1]	王陇德, 彭斌, 张鸿祺, 等. 《中国脑卒中防治报告2020》概要[J]. 中国脑血管病杂志, 2022, 19(2): 136-144. https://www.cnki.com.cn/Article/CJFDTOTAL-NXGB202202011.htm WANG L D, PENG B, ZHANG H Q, et al. Summary of the China Stroke Prevention and Treatment Report 2020[J]. Chinese Journal of Cerebrovascular Diseases, 2022, 19(2): 136-144. https://www.cnki.com.cn/Article/CJFDTOTAL-NXGB202202011.htm
[2]	江滨. 现阶段我国脑卒中流行特征及防治现状对全科医疗服务的启示和建议[J]. 中国全科医学, 2019, 22(30): 3653-3661. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX201930004.htm JIANG B. Implications and suggestions for general medical services from the prevalent characteristics of stroke and the current situation of prevention and treatment at this stage in China[J]. Chinese General Practice, 2019, 22(30): 3653-3661. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX201930004.htm
[3]	吴近仪, 吴敏杰, 魏鹏, 等. 早期综合康复治疗对改善中老年脑卒中偏瘫患者运动功能及日常生活能力的临床疗效观察[J]. 中华全科医学, 2022, 20(12): 2123-2126. doi: 10.16766/j.cnki.issn.1674-4152.002784 WU J Y, WU M J, WEI P, et al. Clinical efficacy of early comprehensive rehabilitation therapy on improving motor function and daily life ability of middle-aged and elderly stroke patients with hemiplegia[J]. Chinese Journal of General Practice, 2022, 20(12): 2123-2126. doi: 10.16766/j.cnki.issn.1674-4152.002784
[4]	张通. 脑卒中早期康复[J]. 中华神经科杂志, 2020, 53(4): 312-316. https://cpfd.cnki.com.cn/Article/CPFDTOTAL-HNHL201304001061.htm ZHANG T. Early rehabilitation of stroke[J]. Chinese Journal of Neurology, 2020, 53(4): 312-316. https://cpfd.cnki.com.cn/Article/CPFDTOTAL-HNHL201304001061.htm
[5]	韩晴, 徐宁, 庄贺, 等. 运动想象疗法在卒中后运动功能障碍康复的研究进展[J]. 中国康复, 2021, 36(6): 372-375. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLKF202106016.htm HAN Q, XU N, ZHUANG H, et al. Progress of motor imagery therapy in the rehabilitation of motor dysfunction after stroke[J]. China Rehabilitation, 2021, 36(6): 372-375. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLKF202106016.htm
[6]	OLDRADI V, FINISGUERRA A, AVENANTI A, et al. Differential influence of the dorsal premotor and primary somatosensory cortex on corticospinal excitability during kinesthetic and visual motor imagery: a low-frequency repetitive transcranial magnetic stimulation study[J]. Brain Sci, 2021, 11(9): 1196. doi: 10.3390/brainsci11091196
[7]	夏小迪, 王鹤玮, 王传凯, 等. 运动想象疗法在脑卒中全周期上肢功能康复中的应用进展[J]. 上海预防医学, 2023, 35(5): 508-512. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYI202305017.htm XIA X D, WANG H W, WANG C K, et al. Progress of motor imagery therapy in the full cycle of upper extremity functional rehabilitation in stroke[J]. Shanghai Journal of Preventive Medicine, 2023, 35(5): 508-512. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYI202305017.htm
[8]	程欣欣, 高润, 刘莉. 基于运动想象疗法的神经机制在脑卒中后运动功能障碍中的研究进展[J]. 中国康复, 2019, 34(6): 324-327. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLKF201906020.htm CHENG X X, GAO R, LIU L. Research progress in neural mechanisms based on motor imagery therapy in post-stroke motor dysfunction[J]. China Rehabilitation, 2019, 34(6): 324-327. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLKF201906020.htm
[9]	DICKSTEIN R, DEUTSCH J E. Motor imagery in physical therapist practice[J]. Phys Ther, 2007, 87(7): 942-953. doi: 10.2522/ptj.20060331
[10]	王鹤玮, 贾杰, 孙莉敏. 运动想象疗法在脑卒中患者上肢康复中的应用及其神经作用机制研究进展[J]. 中华物理医学与康复杂志, 2019, 41(6): 473-476. WANG H W, JIA J, SUN L M. Progress in the study of the application of motor imagery therapy in upper limb rehabilitation of stroke patients and its neural mechanism of action[J]. Chinese Journal of Physical Medicine and Rehabilitation, 2019, 41(6): 473-476.
[11]	SRINIVASAN N, BISHOP J, YEKOVICH R, et al. Differential activation and functional plasticity of multimodal areas associated with acquired musical skill[J]. Neuroscience, 2020, 446: 294-303. doi: 10.1016/j.neuroscience.2020.08.013
[12]	GRUSH R. The emulation theory of representation: motor control, imagery, and perception[J]. Behav Brain Sci, 2004, 27(3): 396-442. doi: 10.1017/S0140525X0422009X
[13]	STORM V, UTESCH T. Mental practice ability among stroke survivors: investigation of gender and age[J]. Front Psychol, 2019, 10: 1568. doi: 10.3389/fpsyg.2019.01568
[14]	刘华, 周军, 杨少峰, 等. 中文版运动觉-视觉想象问卷在脑卒中患者中的信度[J]. 中华物理医学与康复杂志, 2017, 39(4): 259-263. LIU H, ZHOU J, YANG S F, et al. Reliability of the Chinese version of the kinesthetic and visual imagery questionnaire in stroke patients[J]. Chinese Journal of Physical Medicine and Rehabilitation, 2017, 39(4): 259-263.
[15]	王鹤玮, 贾杰. 心理旋转实验在脑卒中患者运动想象能力评估中的应用[J]. 中国康复医学杂志, 2020, 35(10): 1260-1263. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGKF202010023.htm WANG H W, JIA J. The application of mental rotation experiments in the assessment of motor imagery abilities in stroke patients[J]. Chinese Journal of Rehabilitation Medicine, 2020, 35(10): 1260-1263. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGKF202010023.htm
[16]	HAMADA H, MATSUZAWA D, SUTOH C, et al. Comparison of brain activity between motor imagery and mental rotation of the hand tasks: a functional magnetic resonance imaging study[J]. Brain Imaging Behav, 2018, 12(6): 1596-1606. doi: 10.1007/s11682-017-9821-9
[17]	李冉, 杜巨豹. 运动想象在运动功能康复中的应用进展[J]. 中国康复医学杂志, 2022, 37(10): 1421-1425. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGKF202210024.htm LI R, DU J B. Progress in application of motor imagery in the rehabilitation of motor functions[J]. Chinese Journal of Rehabilitation Medicine, 2022, 37(10): 1421-1425. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGKF202210024.htm
[18]	MONTEIRO K B, CARDOSO M, CABRAL V, et al. Effects of motor imagery as a complementary resource on the rehabilitation of stroke patients: a meta-analysis of randomized trials[J]. J Stroke Cerebrovasc Dis, 2021, 30(8): 105876. DOI: 10.1016/j.jstrokecerebrovasdis.2021.105876.
[19]	FERNANDEZ G E, SANCHEZ C A. Motor imagery: a systematic review of its effectiveness in the rehabilitation of the upper limb following a stroke[J]. Rev Neurologia, 2018, 66(5): 137-146.
[20]	KIM H, YOO E Y, JUNG M Y, et al. The effects of mental practice combined with modified constraint-induced therapy on corticospinal excitability, movement quality, function, and activities of daily living in persons with stroke[J]. Disabil Rehabil, 2018, 40(20): 2449-2457. doi: 10.1080/09638288.2017.1337817
[21]	KANG J H, KIM M W, PARK K H, et al. The effects of additional electrical stimulation combined with repetitive transcranial magnetic stimulation and motor imagery on upper extremity motor recovery in the subacute period after stroke: a preliminary study[J]. Medicine, 2021, 100(35): e27170. DOI: 10.1097/MD.0000000000027170.
[22]	王海桥, 李鹤, 闵亮, 等. 运动想象针法改善脑卒中早期上肢偏瘫患者肌张力的优效性观察[J]. 中国针灸, 2021, 41(10): 1069-1073. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZE202110002.htm WANG H Q, LI H, MIN L, et al. Superiority of motor imagery acupuncture to improve muscle tone in patients with upper limb hemiplegia in early stroke stage[J]. Chinese Acupuncture and Moxibustion, 2021, 41(10): 1069-1073. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZE202110002.htm
[23]	张凌星. 上肢粗大与精细运动的想象与执行的脑血氧变化研究[D]. 新乡: 新乡医学院, 2021. ZHANG L X. A study of cerebral blood oxygenation changes in the imagery and execution of gross and fine upper extremity movements[D]. Xinxiang: Xinxiang Medical College, 2021.
[24]	葛晟, 尹正录, 孟兆祥, 等. 头针联合镜像疗法对缺血性卒中患者下肢运动功能和步行能力的影响[J]. 上海针灸杂志, 2021, 40(6): 647-651. https://www.cnki.com.cn/Article/CJFDTOTAL-SHZJ202106001.htm GE S, YIN Z L, MENG Z X, et al. Effects of head acupuncture combined with mirror therapy on lower limb motor function and walking ability in patients with ischemic stroke[J]. Shanghai Journal of Acupuncture and Moxibustion, 2021, 40(6): 647-651. https://www.cnki.com.cn/Article/CJFDTOTAL-SHZJ202106001.htm
[25]	肖少华, 吴夏静, 代菁, 等. 镜像治疗联合运动想象治疗对脑梗死早期患者下肢运动及平衡功能的影响[J]. 中华物理医学与康复杂志, 2019, 41(8): 575-578. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJZH202112011.htm XIAO S H, WU X J, DAI J, et al. Effects of mirror therapy combined with motor imagery therapy on lower limb motor and balance function in patients with early cerebral infarction[J]. Chinese Journal of Physical Medicine and Rehabilitation, 2019, 41(8): 575-578. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJZH202112011.htm
[26]	BOVONSUNTHONCHAI S, AUNG N, HIENGKAEW V, et al. A randomized controlled trial of motor imagery combined with structured progressive circuit class therapy on gait in stroke survivors[J]. Sci Rep, 2020, 10(1): 6945. doi: 10.1038/s41598-020-63914-8
[27]	韩晴, 徐宁, 刘浩, 等. 基于PETTLEP模型的运动想象疗法对脑卒中患者下肢运动、平衡与步行功能的影响[J]. 中华物理医学与康复杂志, 2021, 43(4): 336-339. https://www.cnki.com.cn/Article/CJFDTOTAL-SWCX202209015.htm HAN Q, XU N, LIU H, et al. Effects of PETTLEP model-based motor imagery therapy on lower limb motor, balance and walking function in stroke patients[J]. Chinese Journal of Physical Medicine and Rehabilitation, 2021, 43(4): 336-339. https://www.cnki.com.cn/Article/CJFDTOTAL-SWCX202209015.htm
[28]	杨璐萍, 钟冬灵, 胡益娟, 等. 运动想象(MI)在脑卒中患者临床康复训练中的应用进展[J]. 世界最新医学信息文摘, 2018, 18(24): 75-78. https://www.cnki.com.cn/Article/CJFDTOTAL-WMIA201824030.htm YANG L P, ZHONG D L, HU Y J, et al. Progress of Motor Imagery (MI) in Clinical Rehabilitation Training for Stroke Patients[J]. World Latest Medicine Information, 2018, 18(24): 75-78. https://www.cnki.com.cn/Article/CJFDTOTAL-WMIA201824030.htm
[29]	PARK C H, CHANG W H, OHN S H, et al. Longitudinal changes of resting-state functional connectivity during motor recovery after stroke[J]. Stroke, 2011, 42(5): 1357-1362. doi: 10.1161/STROKEAHA.110.596155
[30]	SAVELOV A A, SHTARK M B, KOZLOVA L I, et al. Dynamics of interactions between cerebral networks derived from fMRI data and motor rehabilitation during stokes[J]. Bull Exp Biol Med, 2019, 166(3): 399-403. doi: 10.1007/s10517-019-04359-6
[31]	庞雅杰. 用于脑机接口的运动意图和运动想象脑电数据分析研究[D]. 哈尔滨: 哈尔滨工业大学, 2021. PANG Y J. A study of motor intention and motor imagery EEG data analysis for brain-computer interfaces[D]. Harbin: Harbin Institute of Technology, 2021.
[32]	赵醇, 刘莉, 高润, 等. 具身认知视角下运动想象疗法对初发脑梗死偏瘫患者上肢运动功能障碍的治疗效果[J]. 中国康复医学杂志, 2020, 35(9): 1049-1054. doi: 10.3969/j.issn.1001-1242.2020.09.005 ZHAO C, LIU L, GAO R, et al. Therapeutic effect of motor imagery therapy on upper limb motor dysfunction in hemiplegic patients with primary cerebral infarction under embodied cognition perspective[J]. Chinese Journal of Rehabilitation Medicine, 2020, 35(9): 1049-1054. doi: 10.3969/j.issn.1001-1242.2020.09.005
[33]	赵醇. 具身认知视角下运动想象疗法对脑梗死偏瘫患者上肢运动功能、神经肌肉活动的影响[D]. 南京: 南京中医药大学, 2020. ZHAO C. The effect of motor imagery therapy on upper limb motor function and neuromuscular activity in hemiplegic patients with cerebral infarction under the perspective of embodied cognition[D]. Nanjing: Nanjing University of Traditional Chinese Medicine, 2020.
[34]	马妮, 崔小丽, 邸伟. 视觉引导运动想象神经活动对晚发性帕金森病患者的康复效果[J]. 神经损伤与功能重建, 2020, 15(10): 612-614. https://www.cnki.com.cn/Article/CJFDTOTAL-GWKF202010019.htm MA N, CUI X L, DI W. Rehabilitation effects of visually guided motor imagery neural activity in patients with late-onset Parkinson's disease[J]. Neural Injury and Functional Reconstruction, 2020, 15(10): 612-614. https://www.cnki.com.cn/Article/CJFDTOTAL-GWKF202010019.htm
[35]	郝单单, 吴玉芙, 王浩然, 等. 早-中期帕金森病患者运动想象准确性及其与认知功能的关系[J]. 北京医学, 2021, 43(9): 921-923. https://www.cnki.com.cn/Article/CJFDTOTAL-BJYX202109020.htm HAO D D, WU Y F, WANG H R, et al. Accuracy of motor imagery and its relationship to cognitive function in early-to mid-stage Parkinson's disease patients[J]. Beijing Medical Journal, 2021, 43(9): 921-923. https://www.cnki.com.cn/Article/CJFDTOTAL-BJYX202109020.htm
[36]	GURUDUT P, GODSE A N. Effectiveness of graded motor imagery in subjects with frozen shoulder: a pilot randomized controlled trial[J]. Korean J Pain, 2022, 35(2): 152-159. doi: 10.3344/kjp.2022.35.2.152
[37]	RICH T L, MARTH L A, BRIELMAIER S M, et al. Strategies for graded motor imagery for clients with phantom limb pain and cognitive impairment[J]. Prosthet Orthot Int, 2022, 46(5): 496-499. doi: 10.1097/PXR.0000000000000125
[38]	GRANDE A M, GARRIGOS P M, CUENCA M F, et al. Influence of the generation of motor mental images on physiotherapy treatment in patients with chronic low back pain[J]. Pain Physician, 2020, 23(4): E399-E408.