康复脑机接口与运动想象疗法在卒中弛缓性瘫痪期上肢运动功能康复中的疗效对照研究

doi:10.3969/j.issn.1673-5765.2025.10.003

中国卒中杂志 ›› 2025, Vol. 20 ›› Issue (10): 1222-1228.DOI: 10.3969/j.issn.1673-5765.2025.10.003

康复脑机接口与运动想象疗法在卒中弛缓性瘫痪期上肢运动功能康复中的疗效对照研究

贺新源^1，2，王正辉¹，夏俊博¹，吴理剑³，张海娜¹，王玉昌^1，4，贾杰^1，5

1 新乡 453000 河南医药大学第一附属医院康复医学科
2 河南医药大学第三附属医院康复医学科
3 福建医科大学附属泉州第一医院康复医学科
4 新乡市神经康复与数字疗法工程技术研究中心
5 复旦大学附属华山医院康复医学科

收稿日期:2025-07-16 修回日期:2025-09-25 接受日期:2025-10-02 出版日期:2025-10-20 发布日期:2025-10-20
通讯作者: 贾杰 shannonjj@126.com
基金资助:
上海市2024年度“科技创新行动计划”养老科技支撑专项项目（24YL1900200）
中国康复医学会科技发展项目（KFKT-2023-049）

Comparative Study on the Efficacy of Rehabilitation Brain-Computer Interface versus Motor Imagery Therapy in Upper Limb Motor Function Rehabilitation during the Flaccid Paralysis Phase of Stroke

HE Xinyuan^1,2, WANG Zhenghui¹, XIA Junbo¹, WU Lijian³, ZHANG Haina¹, WANG Yuchang^1,4, JIA Jie^1,5

1 Department of Rehabilitation Medicine, The First Affiliated Hospital of Henan Medical University, Xinxiang 453000, China
2 Department of Rehabilitation Medicine, The Third Affiliated Hospital of Henan Medical University, Xinxiang 453000, China
3 Department of Rehabilitation Medicine, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, China
4 Xinxiang Engineering Technology Research Center of Neurological Rehabilitation and Digital Therapeutics, Xinxiang 453000, China
5 Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China

Received:2025-07-16 Revised:2025-09-25 Accepted:2025-10-02 Online:2025-10-20 Published:2025-10-20
Contact: JIA jie, E-mail: shannonjj@126.com

摘要/Abstract

摘要： 目的对比康复脑机接口（brain-computer interface，BCI）与运动想象（motor imagery，MI）疗法对患手处于弛缓性瘫痪期的卒中患者上肢运动功能的康复效果。
方法前瞻性、连续纳入2023年10月—2024年7月在河南医药大学第一附属医院、河南医药大学第三附属医院康复医学科住院，存在手功能障碍且患手处于弛缓性瘫痪期的卒中患者，按1∶1的比例将患者随机分为BCI组和MI组。BCI组在常规康复训练的基础上，接受基于MI的康复BCI训练，MI组仅接受MI训练，训练频率均为每周6 d，每日1次，每次30 min，持续2周。分别于干预前、干预1周后及干预2周后，采用Fugl-Meyer运动功能评定量表上肢部分（Fugl-Meyer motor assessment-upper extremity，FMA-UE）评估患者的上肢运动功能（肩肘、腕手），采用改良Ashworth量表（modified Ashworth scale，MAS）评估患者的上肢肌张力（肱二头肌、肱三头肌），采用改良Barthel指数（modified Barthel index，mBI）评估患者的日常生活活动能力。记录可能与康复BCI设备使用相关的不良反应，比较上述指标在干预前后的组内差异及干预后的组间差异。
结果共纳入患者37例，BCI组18例，MI组19例。干预2周后，两组的FMA-UE评分、FMA-UE肩肘部分评分、FMA-UE腕手部分评分和mBI评分较本组干预前均有改善，差异具有统计学意义。干预2周后，BCI组的FMA-UE评分（P=0.006）、FMA-UE腕手部分评分（P＜0.001）及mBI评分（P=0.022）均优于MI组，差异具有统计学意义；两组FMA-UE肩肘部分评分的差异无统计学意义（P=0.057）。在干预1周后及干预2周后的MAS分级方面，两组组内及组间比较的差异均无统计学意义。所有患者均未报告与康复BCI设备使用相关的不良反应。
结论康复BCI可改善卒中弛缓性瘫痪期患者的上肢运动功能，有效提升其日常生活活动能力，且安全性较好。与传统MI训练相比，康复BCI训练在上肢远端功能康复方面表现出一定的优势。

文章导读： 康复脑机接口通过闭环反馈可显著提升弛缓性瘫痪期卒中患者的上肢运动功能和日常生活活动能力，效果优于传统的运动想象疗法。其通过激活神经可塑性，促进“中枢-外周-中枢”环路的重塑，在手功能精细动作康复中更具优势。

关键词: 康复脑机接口; 运动想象; 卒中; 上肢运动功能康复

Abstract: Objective To compare the clinical efficacy of rehabilitation brain-computer interface (BCI) and motor imagery (MI) therapy on upper limb motor function in stroke patients with the affected hand in the flaccid paralysis phase.
Methods Stroke patients with hand dysfunction in the flaccid paralysis phase who were admitted to the Department of Rehabilitation Medicine, The First Affiliated Hospital of Henan Medical University and The Third Affiliated Hospital of Henan Medical University from October 2023 to July 2024, were prospectively and consecutively enrolled and randomly divided into the BCI group and the MI group at a 1∶1 ratio. In addition to conventional rehabilitation training, the BCI group underwent MI-based rehabilitation BCI training, while the MI group received MI training. The training frequency for both groups was six days per week, one session per day, and 30 minutes per session, for two consecutive weeks. Before intervention, one week after intervention, and two weeks after intervention, the Fugl-Meyer motor assessment-upper extremity (FMA-UE) was used to evaluate the patients’ upper limb motor function (shoulder/elbow, wrist/hand), the modified Ashworth scale (MAS) was used to assess the muscle tone of patients’ upper limb (biceps brachii and triceps brachii), and the modified Barthel index (mBI) was used to evaluate the patients’ activities of daily living. Adverse reactions possibly related to rehabilitation BCI device use were recorded. Within-group differences across the assessment time points and between-group differences following the intervention were compared for all outcome measures.
Results A total of 37 patients were enrolled, including 18 in the BCI group and 19 in the MI group. After two weeks of intervention, the total FMA-UE score, FMA-UE shoulder/elbow subscore, FMA-UE wrist/hand subscore, and mBI score in both groups were significantly improved compared with those before intervention, with statistically significant differences. After two weeks of intervention, the BCI group demonstrated better outcomes than the MI group in the total FMA-UE score (P=0.006), FMA-UE wrist/hand subscore (P<0.001), and mBI score (P=0.022), with statistically significant differences.
However, no statistically significant difference was found in the FMA-UE shoulder/elbow subscore between the two groups (P=0.057). Regarding MAS grades at one week and two weeks after intervention, there were no statistically significant differences either within each group or between the two groups. No adverse reactions related to the use of the rehabilitation BCI device were reported by any patient.
Conclusions Rehabilitation BCI can improve upper limb motor function and effectively enhance the activities of daily living in stroke patients during the flaccid paralysis phase, with good safety. Compared with conventional MI training, rehabilitation BCI training demonstrates superior efficacy in rehabilitating distal upper limb function.

Key words: Rehabilitation brain-computer interface; Motor imagery; Stroke; Upper limb motor function rehabilitation

中图分类号:

贺新源, 王正辉, 夏俊博, 吴理剑, 张海娜, 王玉昌, 贾杰. 康复脑机接口与运动想象疗法在卒中弛缓性瘫痪期上肢运动功能康复中的疗效对照研究[J]. 中国卒中杂志, 2025, 20(10): 1222-1228.

HE Xinyuan, WANG Zhenghui, XIA Junbo, WU Lijian, ZHANG Haina, WANG Yuchang, JIA Jie. Comparative Study on the Efficacy of Rehabilitation Brain-Computer Interface versus Motor Imagery Therapy in Upper Limb Motor Function Rehabilitation during the Flaccid Paralysis Phase of Stroke[J]. Chinese Journal of Stroke, 2025, 20(10): 1222-1228.

参考文献

[1] 中华医学会神经病学分会，中华医学会神经病学分会神经康复学组，中华医学会神经病学分会脑血管病学组. 中国脑卒中早期康复治疗指南[J]. 中华神经科杂志，2017，50（6）：405-412.
Chinese Society of Neurology；Neurorehabilitation Society，Chinese Society of Neurology；Cerebrovascular Disease Society，Chinese Society of Neurology. Guidelines for early rehabilitation of stroke in China[J]. Chin J Neurol，2017，50（6）：405-412.
[2] 贾杰. 卒中“疾病全周期”康复[J]. 中国卒中杂志，2021，16（3）：219-222.
JIA J. Full-cycle rehabilitation of stroke[J]. Chin J Stroke，2021，16（3）：219-222.
[3] 王睿月，侯兵，张晓雪，等. 运动想象疗法对脑卒中后上肢运动功能障碍及ADL疗效的meta分析[J]. 中医康复，2024，1（1）：58-64.
WANG R Y，HOU B，ZHANG X X，et al. Meta-analysis of motor imagery therapy on upper limb motor dysfunction and ADL after stroke[J]. Traditional Chinese Medicine Rehabilitation，2024，1（1）：58-64.
[4] NOJIMA I，SUGATA H，TAKEUCHI H，et al. Brain-computer interface training based on brain activity can induce motor recovery in patients with stroke：a meta-analysis[J]. Neurorehabil Neural Repair，2022，36（2）：83-96.
[5] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志，2019，52（9）：710-715.
Chinese Society of Neurology，Chinese Stroke Society. Diagnostic criteria of cerebrovascular diseases in China（version 2019）[J]. Chin J Neurol，2019，52（9）：710-715.
[6] ABDULLAHI A，TRUIJEN S，SAEYS W. Neurobiology of recovery of motor function after stroke：the central nervous system biomarker effects of constraint-induced movement therapy[J/OL]. Neural Plast，2020：9484298[2025-06-18]. https://doi.org/10.1155/2020/9484298.
[7] GABRIEL D A，KAMEN G，FROST G. Neural adaptations to resistive exercise：mechanisms and recommendations for training practices[J]. Sports Med，2006，36（2）：133-149.
[8] GROSPRÊTRE S，JACQUET T，LEBON F，et al. Neural mechanisms of strength increase after one-week motor imagery training[J]. Eur J Sport Sci，2018，18（2）：209-218.
[9] GUO N，WANG X J，DUANMU D，et al. SSVEP-based brain computer interface controlled soft robotic glove for post-stroke hand function rehabilitation[J/OL]. IEEE Trans Neural Syst Rehabil Eng，2022，30：1737-1744[2025-06-18]. https://doi.org/10.1109/TNSRE.2022.3185262.
[10] 徐硕，贾杰.“中枢-外周-中枢”闭环康复[J]. 中国康复医学杂志，2024，39（10）：1537-1541.
XU S，JIA J. Central-peripheral-central closed-loop rehabilitation[J]. Chinese Journal of Rehabilitation Medicine，2024，39（10）：1537-1541.
[11] BAQAPURI H I，ROES L D，ZVYAGINTSEV M，et al. A novel brain-computer interface virtual environment for neurofeedback during functional MRI[J/OL]. Front Neurosci，2021，14：593854[2025-06-18]. https://doi.org/10.3389/fnins.2020.593854.
[12] KIM M S，PARK H，KWON I，et al. Brain-computer interface on wrist training with or without neurofeedback in subacute stroke：a study protocol for a double-blinded，randomized control pilot trial[J/OL]. Front Neurol，2024，15：1376782[2025-06-18]. https://doi.org/10.3389/fneur.2024.1376782.
[13] YUAN K，WANG X，CHEN C，et al. Interhemispheric functional reorganization and its structural base after BCI-guided upper-limb training in chronic stroke[J]. IEEE Trans Neural Syst Rehabil Eng，2020，28（11）：2525-2536.
[14] PAGE S J，LEVINE P，LEONARD A C. Effects of mental practice on affected limb use and function in chronic stroke[J]. Arch Phys Med Rehabil，2005，86（3）：399-402.
[15] RUFFINO C，PAPAXANTHIS C，LEBON F. Neural plasticity during motor learning with motor imagery practice：review and perspectives[J/OL]. Neuroscience，2017，341：61-78[2025-06-18]. https://doi.org/10.1016/j.
neuroscience.2016.11.023.
[16] MAHROOZ M H，FATTAHZADEH F，GHARIBZADEH S. Decoding the debate：a comparative study of brain-computer interface and neurofeedback[J]. Appl Psychophysiol Biofeedback，2024，49（1）：47-53.
[17] PICHIORRI F，MATTIA D. Brain-computer interfaces in neurologic rehabilitation practice[J/OL]. Handb Clin Neurol，2020，168：101-116[2025-06-18]. https://doi.org/10.1016/B978-0-444-63934-9.00009-3.
[18] 穆秦颖，胡俊豪，马福浩，等. 肉毒毒素治疗局灶型肌张力障碍中枢神经系统机制的影像学研究进展[J]. 中国神经精神疾病杂志，2024，50（7）：440-444.
MU Q Y，HU J H，MA F H，et al. A progress in neuroimaging research on the central mechanisms of botulinum toxin in the treatment of focal dystonia[J]. Chin J Ment Dis，2024，50（7）：440-444.
[19] 马晓红，陈晓娟，周辉林. 醒脑开窍针刺法联合脑机接口治疗对脑梗死后上肢痉挛性偏瘫患者上肢功能的影响[J]. 中华中医药学刊，2025，43（8）：224-227.
MA X H，CHEN X J，ZHOU H L. Effect of consciousness-restoring and orifice-opening acupuncture combined with brain-computer interface therapy on upper limb function in patients with spastic upper limb hemiplegia after cerebral infarction[J]. Chinese Archives of Traditional Chinese Medicine，2025，43（8）：224-227.
[20] 申利坊，闫莹莹，杨文裕. 功能性电刺激恢复性治疗踏车对脑卒中早期患者上肢运动功能的影响[J]. 河南医学研究，2018，27（6）：990-992.
SHEN L F，YAN Y Y，YANG W Y. Effects of functional electrical stimulation cycling on the mobilization of upper limbs in patients with early stroke[J]. Henan Medical Research，2018，27（6）：990-992.
[21] TANG J，LEBEL A，JAIN S，et al. Semantic reconstruction of continuous language from non-invasive brain recordings[J]. Nat Neurosci，2023，26（5）：858-866.

康复脑机接口与运动想象疗法在卒中弛缓性瘫痪期上肢运动功能康复中的疗效对照研究

Comparative Study on the Efficacy of Rehabilitation Brain-Computer Interface versus Motor Imagery Therapy in Upper Limb Motor Function Rehabilitation during the Flaccid Paralysis Phase of Stroke

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