[논문]Effect of Motor Imagery Training on Somatosensory Evoked Potentials and Upper Limb Function in Stroke Patients

Choi, Jongbae; Yang, Jongeun

doi:10.20540/jiaptr.2020.11.1.2005

Effect of Motor Imagery Training on Somatosensory Evoked Potentials and Upper Limb Function in Stroke Patients 원문보기

Journal of international academy of physical therapy research, v.11 no.1, 2020년, pp.2005 - 2011

Choi, Jongbae (Kyung Hee University Medical Center) , Yang, Jongeun (Bethesda Hospital Rehabilitation Center)

Abstract ▼ AI-Helper

Background: Motor imagery is the mental representation of an action without overt movement or muscle activation. However, few previous studies have demonstrated motor imagery training effects as an objective assessment tool in patients with early stroke. Objective: To investigate the effect of motor imagery training on Somatosensory Evoked Potentials (SSEP) and upper limb function of stroke patients. Design: A quasi-experimental study. Methods: Twenty-four patients with stroke were enrolled in this study. All subjects were assigned to the experimental or control group. All participants received traditional occupational therapy for 30 minutes, 5 times a week. The experimental group performed an additional task of motor imagery training (MIT) 20 minutes per day, 5 days a week, for 4 weeks. Both groups were assessed using the SSEP amplitude, Fugl-Meyer assessment of upper extremity (FMA UE) and Wolf motor function test. Results: After the intervention, the experimental group showed significant improvement in SSEP amplitude and FMA UE than did the control group. Conclusion: These findings suggest that the MIT effectively improve the SSEP and upper limb function of stroke patients.

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문제 정의

A few studies have been conducted in patients with early stroke in previous studies, and these are the studies that showed the effect of motor imagery training a non-objective measurement tool as a limitation. The purpose of this study is to investigate the effect of motor imagery training on SSEP and upper limb function of stroke patients.
Although there have been no reports of treatment interventions for the recovery of severely impaired upper extremity stroke patients, new rehabilitation interventions have been attempted and many studies are under way.²³ This study investigated the effects of MIT on SSEP and upper limb recovery of stroke patients. After the intervention, participants in the experimental group showed significant differences in their SSEP amplitude, FMA UE and WMFT evaluations.

제안 방법

²³ This study investigated the effects of MIT on SSEP and upper limb recovery of stroke patients. After the intervention, participants in the experimental group showed significant differences in their SSEP amplitude, FMA UE and WMFT evaluations. However, the control group showed significant differences in the FMA UE evaluation.
All subjects were assessed pre-intervention for SSEP amplitude, WMFT, and FMA UE values. After the pre-test, all participants received traditional occupational therapy for 30 minutes, 5 times a week. The experimental group additionally performed MIT 20 minutes per day, 5 days a week, for 4 weeks, followed by a post-test.
All subjects were assessed pre-intervention for SSEP amplitude, WMFT, and FMA UE values. After the pre-test, all participants received traditional occupational therapy for 30 minutes, 5 times a week.
The 24 subjects who participated in this study were divided into two groups by block randomization method using randomization envelopes that contained a code specifying the group; the experimental group - motor imagery training combined with traditional occupational therapy (MIT-TOT); the control group - only traditional occupational therapy (TOT) (Figure 1).
The SSEP assessment used in this study was measured using Medelec Synergy (Viasys, Healthcare, UK) and measured by stimulating the median nerve on the left or right side of the wrist. Stimulus speed was set at 5 Hz and stimulus intensity was used to the extent that the thumb muscles moved through electrical stimulation.
Developed by Wolf18 in 1989, the WMFT assessed upper extremity motor function in stroke patients. The exercise performance and execution time of each item were measured by the score and the test consisted of simple tasks and complex operations. The initial 8 items examined the upper limb function and strength, and then, through a further 9 items, the upper limb and the hand function and the strength of the hand could be co-examined.
The exercise performance and execution time of each item were measured by the score and the test consisted of simple tasks and complex operations. The initial 8 items examined the upper limb function and strength, and then, through a further 9 items, the upper limb and the hand function and the strength of the hand could be co-examined. Overall, the WMFT consisted of 17 items, with each evaluated on a 6-points scale from 0 to 5 points.
Overall, a total score of 100 points can be achieved, with up to 66 points in the upper limb and, 34 points in the lower limb.¹⁷ This study evaluated only the upper extremity items of the FMA. The FMA has been used extensively in traditional stroke patients for upper limb functional assessments.

대상 데이터

Stimulus speed was set at 5 Hz and stimulus intensity was used to the extent that the thumb muscles moved through electrical stimulation.¹⁵ The SSEP assessment was measured by an experienced clinical pathologist.
Traditional occupational therapy mainly included muscle strength training of paralyzed upper extremity, range of motion exercise, sensory stimulation, ADL training, and hand fine motor training. The intervention of the two groups was conducted by three skilled occupational therapists over 10 years old. The MIT program selected 10 MIT tasks as meaningful ADL from the studies by Zhu et al¹³ and Dunsky et al¹⁴ which were presented as effective MIT tasks for stroke patients (Figure 2).
The study enrolled 24 stroke patients who understood the nature of the study and agreed to participate. The inclusion criteria for patients receiving rehabilitation treatment at K hospital in Dongdaemungu, Seoul are described below.
The study included 28 subjects. However, four of them dropped out and a total of 24 data were analyzed (Table 1).

데이터처리

Descriptive statistics are presented as means with standard deviations. To evaluate the intervention effects, the Wilcoxon signed-rank test was used to compare measures pre- and post-intervention in each group. The Mann-Whitney U test was used to compare the intergroup changes in outcome measures.

이론/모형

To evaluate the intervention effects, the Wilcoxon signed-rank test was used to compare measures pre- and post-intervention in each group. The Mann-Whitney U test was used to compare the intergroup changes in outcome measures. The significance level was set at P<.
The normality of the variables was assessed using the Shapiro–Wilk test.

성능/효과

²⁶ The significant association between the presence of median SSEP early after stroke and progress in motor recovery suggests that median SSEP predict the occurrence of motor recovery of upper limbs paralysis in patients.⁹ As a result of this study, it was more effective in upper limb function when combined with MIT than when only TOT was treated. Previous studies have reported that additional benefits can be obtained when combined with other therapies than alone TOT.
After the intervention, the experimental group showed greater significant changes in SSEP amplitude and FMA UE than the control group. The results of this study report that MIT combined with traditional occupational therapy is effective for upper limb recovery in stroke patients.
The results showed that early clinical measurement of motor injury was superior to neurophysiological measurement. However, incorporating the results of the SSEP into the clinical evaluation results showed better predictability.
This study demonstrated that MIT is an effective method for upper limb function in patients after stroke. Our results show that MIT combined with traditional occupational therapy may contribute to upper limb function in stroke patients.

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