镜像疗法对脑卒中后I型复杂区域性疼痛综合征患者上肢功能及大脑皮质活动效果的随机对照试验

doi:10.3969/j.issn.1006-9771.2024.10.011

Abstract

Abstract:

Objective To investigate the effect of mirror therapy on upper limb function and cortical activity in patients with type I complex regional pain syndrome (CRPS) after stroke.

Methods A total of 72 post-stroke patients with type I CRPS were recruited at the Third Rehabilitation Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from October, 2017 to February, 2022. They were randomly divided into control group (n = 36) and mirror therapy group (n = 36). The control group received conventional rehabilitation training, while the mirror therapy group received mirror therapy in addition. Before treatment, as well as at three and six weeks after treatment, they were evaluated using the Visual Analog Scale (VAS) for pain, modified Barthel Index (MBI), edema volume and Brunnstrom stage. Resting-state data were collected for 440 seconds using a 32-channel functional near-infrared spectroscopy (fNIRS) system.

Results After treatment, VAS scores significantly improved in each group, showing better after six weeks than after three weeks (P < 0.01). The mirror therapy group was better than the control group after six weeks (P < 0.05). MBI scores also significantly improved in each group, showing better after six weeks than after three weeks (P < 0.001). Edema volume significantly decreased in each group (Z > 30.113, P < 0.001), while the mirror therapy group was better than the control group after six weeks (Z = -3.347, P = 0.001). Edema volume in the mirror therapy group significantly reduced at both three and six weeks (Z < -0.667, P < 0.01), with a stronger effect observed after six weeks (Z = -0.667, P = 0.005). Brunnstrom stages improved significantly in each group (Z > 29.714, P < 0.001), while the mirror therapy group was better than the control group after six weeks (Z = -2.046, P = 0.041). After treatment, the control group showed strong connectivity between right M1 and right primary somatosensory cortex, while the mirror therapy group demonstrated stronger connectivity between left M1 and right M1, right primary somatosensory cortex, right pre-motor and supplementary motor cortex. Connectivity between left and right primary somatosensory cortex increased in mirror therapy group, as well as the connectivity between left pre-motor-supplementary motor cortex and right M1, right pre-motor-supplementary motor cortex and left primary somatosensory cortex, left M1 and left primary somatosensory cortex, and left primary somatosensory cortex and right M1 (∣t∣ > 3.402, P < 0.01).

Conclusion Mirror therapy may relieve pain and edema, and improve upper limb motor function in post-stroke patients with type I CRPS, which may associate with stonger connectivity between sensory regions on the unaffected side and sensory-motor regions on the affected side, promoting sensorimotor cortical reorganization.

Key words: stroke, complex regional pain syndrome, mirror therapy, upper limb, cerebral cortex, randomized controlled trial

CLC Number:

R743.3

WEN Cuifeng, YA Ru, HUANG Hao, LIAO Xuemei, BAI Yulong. Effect of mirror therapy on upper limb function and cerebral cortex activity in patients with type I complex regional pain syndrome after stroke: a randomized controlled trial[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(10): 1203-1214.

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References 44

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组别	n	性别(男/女)/n	年龄/岁	病程/月	卒中类型(出血/梗死)/n	偏瘫侧/(左/右)/n
对照组	36	24/12	60.33±12.059	2.481(1.00,3.75)	22/14	15/21
镜像组	36	28/8	61.39±9.237	2.494(1.15,3.80)	28/8	19/17
χ²/t/Z值		1.108^a	0.167^b	-0.256^c	2.356^a	8.920^a
P值		0.293	0.868	0.798	0.125	0.345

变量	组别	n	治疗前	治疗3周后	治疗6周后
VAS	对照组	36	5.003±1.962	3.961±1.858	3.319±2.102
VAS	镜像组	36	5.611±1.596	3.856±1.598	2.186±1.644
MBI	对照组	36	47.92±16.535	55.14±13.705	59.03±13.407
MBI	镜像组	36	47.64±11.494	56.67±9.411	64.44±9.620

变量	变量	平方和	自由度	均方	F值	P值
VAS	组内	235.565	1	149.800	184.572	< 0.001
	组间	2.386	2	2.386	0.281	0.598
	组内×组间	27.596	2	17.549	21.622	< 0.001
MBI	组内	7077.083	1	5106.064	134.446	< 0.001
	组间	266.667	2	266.667	0.628	0.431
	组内×组间	304.861	2	219.955	5.792	0.010

变量	组别/时间	组别/时间	组别/时间	平均值差	P值	95%CI
变量	组别/时间	组别/时间	组别/时间	平均值差	P值	上限	下限
VAS	对照组	治疗前	治疗3周后	1.042	< 0.001	0.667	1.416
		治疗前	治疗6周后	1.683	< 0.001	1.115	2.251
		治疗3周后	治疗6周后	0.642	< 0.001	0.221	1.062
	镜像组	治疗前	治疗3周后	1.756	< 0.001	1.381	2.130
		治疗前	治疗6周后	3.425	< 0.001	2.857	3.993
		治疗3周后	治疗6周后	1.669	0.001	1.249	2.090
	治疗前	对照组	镜像组	-0.608	0.153	-1.449	0.232
	治疗3周后	对照组	镜像组	0.106	0.797	-0.709	0.920
	治疗6周后	对照组	镜像组	1.133	0.013	0.246	2.020
MBI	对照组	治疗前	治疗3周后	-7.222	< 0.001	-9.904	-4.540
		治疗前	治疗6周后	-11.111	< 0.001	-14.916	-7.306
		治疗3周后	治疗6周后	-3.889	< 0.001	-6.062	-1.716
	镜像组	治疗前	治疗3周后	-9.028	< 0.001	-11.710	-6.346
		治疗前	治疗6周后	-16.806	< 0.001	-20.610	-13.001
		治疗3周后	治疗6周后	-7.778	< 0.001	-9.951	-5.605
	治疗前	对照组	镜像组	0.278	0.934	-6.416	6.972
	治疗3周后	对照组	镜像组	-1.528	0.583	-7.054	3.999
	治疗6周后	对照组	镜像组	-5.417	0.053	-10.902	0.068

组别	n	测试	M(Q_L, Q_U)	Z值	P值
对照组	36	治疗前	40.00(30.00, 58.75)	30.113	< 0.001
		治疗3周后	32.50(25.00, 45.00)
		治疗6周后	30.00(25.00, 45.00)
镜像组	36	治疗前	45.00(35.00, 55.00)	55.482	< 0.001
		治疗3周后	25.00(25.00, 38.75)
		治疗6周后	20.00(15.00, 30.00)
治疗前两组差值			-5.00(-23.75, 18.75)	-1.318	0.188
3周后两组差值			2.50(-15.00, 18.75)	-1.285	0.199
6周后两组差值			15.00(0.00, 28.75)	-3.347	0.001

Effect of mirror therapy on upper limb function and cerebral cortex activity in patients with type I complex regional pain syndrome after stroke: a randomized controlled trial

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组别	时间	时间	Z值	P值	95%CI
组别	时间	时间	Z值	P值	上限	下限
对照组	治疗前	治疗3周后	-0.750	0.001	37.462	53.204
	治疗3周后	治疗6周后	-0.333	0.157	29.997	44.336
	治疗前	治疗6周后	-1.083	< 0.001	28.576	43.424
镜像组	治疗前	治疗3周后	-0.792	< 0.001	42.374	58.181
	治疗3周后	治疗6周后	-0.667	0.005	26.956	36.100
	治疗前	治疗6周后	-1.458	< 0.001	18.387	27.724

组别	n	测试	M(Q_L, Q_U)	Z值	P值
对照组	36	治疗前	2.0(1.0, 3.0)	29.714	< 0.001
		3周后	2.0(1.3, 3.0)
		6周后	3.0(2.0, 3.8)
镜像组	36	治疗前	2.0(1.3, 3.0)	51.235	< 0.001
		3周后	3.0(2.0, 3.0)
		6周后	3.0(3.0, 4.0)
治疗前两组差值			0.0(-1.0, 1.0)	-0.189	0.850
3周后两组差值			-1.0(-1.0, 1.0)	-1.654	0.098
6周后两组差值			-1.0(-2.0, 0.8)	-2.046	0.041

ROI-ROI	对照组	镜像组	t值	P值
PMC&SMA_L—PMC&SMA_R	0.170±0.096	0.242±0.074	-1.871	0.129
PMC&SMA_L—M1_L	0.132±0.133	0.272±0.089	-2.763	0.026
PMC&SMA_L—PSC_L	0.114±0.117	0.308±0.127	-3.541	0.013
PMC&SMA_L—PSC_R	0.141±0.079	0.248±0.068	-3.218	0.014
PMC&SMA_L—M1_R	0.139±0.097	0.271±0.113	-2.805	0.025
PMC&SMA_R—M1_L	0.197±0.157	0.267±0.096	-1.206	0.280
PMC&SMA_R—PSC_L	0.128±0.088	0.258±0.086	-3.328	0.014
PMC&SMA_R—PSC_R	0.239±0.186	0.251±0.09	-0.189	0.852
PMC&SMA_R—M1_R	0.183±0.132	0.238±0.098	-1.060	0.324
M1_L—PSC_L	0.132±0.112	0.283±0.073	-3.566	0.013
M1_L—PSC_R	0.171±0.123	0.249±0.078	-1.689	0.147
M1_L—M1_R	0.168±0.149	0.284±0.142	-1.784	0.136
PSC_L—PSC_R	0.087±0.064	0.259±0.084	-5.109	0.001
PSC_L—M1_R	0.119±0.088	0.259±0.112	-3.115	0.014
PSC_R—M1_R	0.173±0.132	0.244±0.123	-1.226	0.280

ROI-ROI	对照组	镜像组	t值	P值
PMC&SMA_L—PMC&SMA_R	0.080±0.114	0.223±0.107	-2.878	0.016
PMC&SMA_L—M1_L	0.091±0.113	0.215±0.108	-2.490	0.028
PMC&SMA_L—PSC_L	0.094±0.105	0.215±0.063	-3.114	0.012
PMC&SMA_L—PSC_R	0.058±0.118	0.199±0.072	-3.214	0.012
PMC&SMA_L—M1_R	0.059±0.098	0.219±0.111	-3.402	0.009
PMC&SMA_R—M1_L	0.104±0.166	0.273±0.134	-2.498	0.028
PMC&SMA_R—PSC_L	0.055±0.073	0.213±0.083	-4.528	0.001
PMC&SMA_R—PSC_R	0.123±0.177	0.271±0.115	-2.208	0.043
PMC&SMA_R—M1_R	0.105±0.123	0.246±0.157	-2.215	0.043
M1_L—PSC_L	0.084±0.062	0.222±0.075	-4.464	0.001
M1_L—PSC_R	0.102±0.155	0.273±0.113	-2.821	0.016
M1_L—M1_R	0.133±0.096	0.284±0.133	-2.899	0.016
PSC_L—PSC_R	0.059±0.073	0.204±0.050	-5.105	0.001
PSC_L—M1_R	0.040±0.099	0.201±0.084	-3.885	0.004
PSC_R—M1_R	0.124±0.134	0.225±0.115	-1.803	0.088

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