The Effect Of Low-Frequency Acupoint Electrical Stimulation Combined With Action Observation Therapy On Upper Limb Motor Function After Stroke

Objective:To observe the effect of low-frequency acupoint electrical stimulation combined with action observation therapy(AOT)on upper limb motor function after stroke,optimize the rehabilitation treatment plan,and explore the possible mechanism of action of this study from the perspective of electrophysiology with the help of EEG and s EMG,so as to provide objective basis for improving clinical efficacy.Methods:A total of 72 patients who met the inclusion criteria were recruited from March to September 2022 in the third ward of Acupuncture,the Second Affiliated Hospital of Heilongjiang University of Chinese Medicine,and divided into test group(low-frequency acupoint electrical stimulation +AOT group),control group 1(AOT group)and control group 2(low-frequency acupoint electrical stimulation group)by random number table method,with 24 patients in each group.On the basis of receiving conventional treatment,the test group was given low-frequency acupoint electrical stimulation combined with AOT treatment,the control group 1 was given only AOT treatment,and the control group 2 was given only low-frequency acupoint electrical stimulation.Each treatment was 30 min,once a day,one day off a week for 3 weeks.Selection of stimulating acupoints: Naohui acupoint,Xiaoluo acupoint,The midpoint of the connection between Tianquan and Quze,and the midpoint of the connection between Tianquan and Quchi,Shousanli acupoint,Waiguan acupoint,Ximen acupoint,Neiguan acupoint;The stimulation frequency is 50 Hz,the p ulse width is 0.3ms,and the flexion extension stimulation ratio is 1:2.AOT video:All actions were demonstrated by the same model,and 20 commonly used actions were selected to be filmed from the front and side in the first person.The 3 action videos with similar difficulty were divided into 18 groups,and the patients were asked to sit and watch the video.After the video was over,the actions were imitated.Evaluation indicators: Fugl meyer assessment of upper limb(FMA-UE),Wolf motor function test(WMFT),and modified Barthel index(MBI)were used before and after treatment to evaluate the upper limb motor function and daily living ability of patients;Collect surface electromyography(s EMG)signals before and after treatment,analyze and compare the root mean square(RMS)values of biceps brachii(BB),triceps brachii(TB),extensor carpi ulnaris(ECU),and flexor carpi radialis(FCR)in the affected upper limb,and calculate the co activation ratio of BB and FCR under MIVC.The electroencephalogram(EEG)signals of the patients were collected before and after treatment,and the average power of β and δ waves at FC1,FC2,F3,F4,C3 and C4 leads were analyzed and compared.All data in this study were analyzed using statistical software SPSS26.0.Results:1 Of the 72 patients included in this study,2 patients fell off in the test group,3 in control group 1 and 2 in control group 2,for a total of 65 patients who finally completed the trial.The differences in the general conditions(gender,age and duration of disease)between the three groups were not statistically significant(P>0.05)and were comparable.2 Analysis of the results of the upper limb motor function and activities of daily living scores:There was no statistically significant difference in FMA-UE,WMFT,and MBI scores among the three groups of patients before treatment(P>0.05),indicating comparability;After treatment,the FMA-UE,WMFT,and MBI scores of the three groups of patients improved compared to before treatment,indicating an improvement in upper limb motor function and daily living ability.There was a statistically significant difference within the group(P<0.05).The increase in FMA-UE,WMFT,and MBI scores in the test group was greater than that in the control group 1,and there was a statistically significant difference between the groups(P<0.05);The increase in scores in the test group was greater than that in the control group 2,and there was a statistically significant difference between the groups(P<0.05);There was no statistically significant difference between control group 1 and control group 2(P>0.05).3 s EMG index analysis :There was no statistically significant difference in the RMS values of BB,TB,ECU,and FCR among the three groups of patients before treatment(P>0.05),indicating comparability;After treatment,the RMS values of BB,TB,ECU,and FCR in the three groups of patients increased to varying degrees(P<0.05),indicating a continuous improvement in upper limb muscle strength.And the increase in the test group was more than that in the control group 1,with a statistically significant difference between the groups(P<0.05);The increase in the test group was greater than that in the control group 2,and there was a statistically significant difference between the groups(P<0.05);The RMS value of control group 2 increased more than that of control group1,and the difference between groups was statistically significant(P<0.05).After treatment,the co-activation ratios of BB and FCR in the three groups of patients decreased to varying degrees,and there was a statistically significant difference within the group(P<0.05),indicating an improvement in the coordination of abnormal flexor muscles between the elbow and wrist.There was no statistically significant difference in the co activation ratio of BB and FCR between control group 1 and control group 2(P>0.05);The decrease in the co activation ratio of BB and FCR in the test group was greater than that in the control group 1,and the difference between the groups was statistically significant(P<0.05);The decrease in the co activation ratio of BB and FCR in the test group was greater than that in the control group 2,and the difference between the groups was statistically significant(P<0.05).4 EEG index analysis:Before treatment,there was no significant difference in the average β-wave power values of FC1,FC2,F3,F4,C3 and C4 leads in the three groups(P>0.05),which was comparable.After treatment,the average β-wave power of FC1,FC2,F3,F4,C3 and C4 leads in the three groups were decreased,and the difference in the test group was statistically significant(P<0.05).The average β-wave power of FC1,FC2 and F3 leads in control group 1 decreased slightly,and the difference was not statistically significant(P>0.05),while the average β-wave power of F4,C3 and C4 leads was statistically significant(P<0.05).The β-wave average power of C3 leads in control group 2 decreased slightly,and the difference was not statistically significant(P>0.05),while the β-wave average power of FC1,FC2,F3,F4 and C4 leads had statistically significant differences within groups(P<0.05).After treatment,the average β-wave power of FC1,FC2,F3,F4,C3 and C4 leads in tast group decreased more than that in control group 1,and the difference between groups was statistically significant(P<0.05).After treatment,the average β-wave power of FC1,FC2,F3,F4,C3 and C4 leads in test group decreased more than that in control group 2,and the difference between groups was statistically significant(P<0.05).There was no significant difference between control group 1and control group 2(P>0.05).The differences between the mean power values of EEG FC1,FC2,F3,F4,C3 and C4 leads in the three groups before treatment were not statistically significant(P>0.05)and were comparable;the mean power values of EEG FC1,FC2,F3,F4,C3 and C4 leads in the three groups decreased after treatment,and the differences within the test group were statistically significant(P<0.05);the differences within the control group 1 There was no statistically significant difference(P>0.05)in the intra-group comparison of FC1 lead δ-wave mean power values,and there was a statistically significant difference(P<0.05)in the intra-group comparison of FC2,F3,F4,C3,C4 lead δ-wave mean power values;there was a statistically significant difference(P<0.05)in the intra-group comparison of FC1,FC2,F3,F4,C3,C4 lead δ-wave mean power values in control group 2.The decrease in the mean power values of FC1,FC2,F3,F4,C3 and C4 lead δ waves in the test group was greater than that in control group 1,and the difference between groups was statistically significant(P<0.05);the decrease in the mean power values of FC1,FC2,F3,F4,C3 and C4 lead δ waves in the test group was greater than that in control group 2,and the difference between groups was statistically significant(P<0.05);The difference between control group 1 and control group 2 was not statistically significant(P>0.05).Conclusion:1.Low-frequency acupoint electrical stimulation,AOT and collaborative therapy can improve the upper limb motor function and daily living ability score of patients,but low-frequency acupoint electrical stimulation combined with AOT can improve the upper limb motor function and daily living ability more significantly.2 From the perspective of s EMG,low-frequency acupoint electrical stimulation,AOT and collaborative treatment can all increase the recruitment of muscle motor unit and improve the upper limb muscle strength of patients,but collaborative treatment is more helpful to the improvement of muscle strength,which can better correct abnormal flexion movement patterns and in duce the emergence of normal movement patterns.3 From the perspective of EEG,low-frequency acupoint electrical stimulation,AOT,and synergistic therapy can all improve brain electrical activity,but synergistic therapy can significantly activate the primary motor area,auxiliary motor area,and premotor area,promoting the reorganization of motor center function.