强制性运动训练对脑卒中患者上肢运动功能康复疗效的研究
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摘要
目的评估强制性运动训练(Constraint-induced movement therapy,CIMT)对促进脑卒中患者上肢运动功能康复的疗效。方法连续纳入60例于2015年1月～2017年12月期间在丽水市人民医院康复医学科住院治疗的脑卒中患者,随机分为普通训练组与CIMT组。普通训练组采用常规康复治疗技术,2 h/d,每周5 d,连续3周;CIMT组采用强制性运动训练疗法,6 h/d,5次/周,连续3周。评估两组患者治疗前后的Wolf运动功能试验(Wolf motor function test,WMFT)与日常活动能力量表(Barthel index,BI)改善情况。结果 CIMT组患者的Wolf运动功能试验(WMFT)评估分值和BI评估分值改善情况均优于普通训练组,差异具有统计学意义(P<0.05)。结论强制性运动训练能够有效促进脑卒中患者的上肢运动功能康复,值得运用推广。
Objective To evaluate the effect of constraint-induced movement therapy(CIMT) on the rehabilitation of upper extremity motor function in stroke patients. Methods Sixty stroke patients who were hospitalized in the rehabilitation department of Lishui People's Hospital from January 2015 to December 2017 were randomly divided into the general training group and the CIMT group. The general training group used conventional rehabilitation techniques, 2 h/d,5 days per week for 3 weeks. The CIMT group used constraint-induced movement therapy, 6 h/d, 5 times/week for 3 weeks. The improvement of the Wolf motor function test(WMFT) and the Barthel index(BI) before and after treatment between two groups was evaluated. Results In the CIMT group, the improvement of the Wolf motor function test(WMFT) and the BI assessment scores was better than that of the general training group, and the difference was statistically significant(P<0.05). Conclusion Constraint-induced movement therapy can effectively promote the recovery of upper limb motor function in stroke patients, which is worthy of promotion.
Objective To evaluate the effect of constraint-induced movement therapy(CIMT) on the rehabilitation of upper extremity motor function in stroke patients. Methods Sixty stroke patients who were hospitalized in the rehabilitation department of Lishui People's Hospital from January 2015 to December 2017 were randomly divided into the general training group and the CIMT group. The general training group used conventional rehabilitation techniques, 2 h/d,5 days per week for 3 weeks. The CIMT group used constraint-induced movement therapy, 6 h/d, 5 times/week for 3 weeks. The improvement of the Wolf motor function test(WMFT) and the Barthel index(BI) before and after treatment between two groups was evaluated. Results In the CIMT group, the improvement of the Wolf motor function test(WMFT) and the BI assessment scores was better than that of the general training group, and the difference was statistically significant(P<0.05). Conclusion Constraint-induced movement therapy can effectively promote the recovery of upper limb motor function in stroke patients, which is worthy of promotion.
引文
[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.
[2]Park JH,Lee NY,Cho YH,et al.Modified constraintinduced movement therapy for clients with chronic stroke:Interrupted time series(ITS)design[J].Journal of Physical Therapy Science,2015,27(3):963-966.
[3]Richards L,Gonzalez Rothi LJ,Davis S,et al.Limited dose response to constraint-induced movement therapy in patients with chronic stroke[J].Clinical Rehabilitation,2006,20(12):1066-1074.
[4]Taub E,Miller NE,Novack TA,et al.Technique to improve chronic motor deficit after stroke[J].Archives of Physical Medicine&Rehabilitation,1993,74(4):347.
[5]张情,潘世琴,王丽.改良强制性运动疗法在脑卒中后上肢功能恢复中应用的研究进展[J].中国康复理论与实践,2016,22(12):1395-1398.
[6]Dobkin BH.Clinicalpractice.Rehabilitation after stroke[J].New England Journalof Medicine,2005,352(16):1677.
[7]Wolf SL,Lecraw DE,Barton LA,et al.Forced use of hemiplegic upper extremities to reverse the effect of learned nonuse among chronic stroke and head-injured patients[J].Experimental Neurology,1989,104(2):125-132.
[8]Sterr A,Elbert T,Berthold I,et al.Longer versus shorter daily constraint-induced movement therapy of chronic hemiparesis:An exploratory study[J].Archives of Physical Medicine&Rehabilitation,2002,83(10):1374-1377.
[9]Wolf SL,Lecraw DE,Barton LA,et al.Forced use of hemiplegic upper extremities to reverse the effect of learned nonuse among chronic stroke and head-injured patients[J].Experimental Neurology,1989,104(2):125-132.
[10]王文清,段一娜,徐利,等.改良强制性使用运动疗法对脑卒中偏瘫患者上肢功能影响的临床研究[J].中华物理医学与康复杂志,2008,30(5):320-323.(下转第94页)
[11]寇程,刘小燮,毕胜.三种上肢运动功能评定量表的标准效度及其相关性研究[J].中国康复理论与实践,2013,(4):371-374.
[12]李贺,柴文刚,徐国兴,等.改良强制性使用运动疗法对亚急性期脑卒中患者日常生活活动能力康复疗效的评价[J].吉林大学学报(医学版),2016,42(6):1183-1188.
[13]毕胜,瓮长水,张富洪,等.强制性使用运动疗法在慢性脑卒中下肢康复中的应用[J].中国康复医学杂志,2003,18(3):187-188.
[14]郝静,李萌.强制性运动方案对脑卒中偏瘫上肢功能障碍患者的疗效[J].神经损伤与功能重建,2016,11(1):84-85.
[15]Schaechter JD,Kraft E,Hilliard TS,et al.Motor recovery and cortical reorganization after constraint-induced movement therapy in stroke patients:A preliminary study[J].Neurorehabilitation&Neural Repair,2002,16(4):326-338.
[16]何雯,王凯.脑卒中后上肢功能康复研究进展[J].中国康复理论与实践,2014(4):334-339.
[17]Kwakkel G,Veerbeek JM,Wegen EEHV,et al.Constraint-induced movement therapy after stroke[J].Lancet Neurology,2015,14(2):224-234.
[18]Knapp HD,Taub E,Berman AJ.Movements in monkeys with deafferented forelimbs[J].Experimental Neurology,1963,7(4):305-315.
[19]黄长琴,钟艳.脑卒中患者运动功能障碍康复治疗新进展[J].检验医学与临床,2017,14(3):449-451.
[20]Page SJ,Levine P,Sisto S,et al.Stroke patients'and therapists'opinions of constraint-induced movement therapy[J].Clinical Rehabilitation,2002,16(1):55.
[2]Park JH,Lee NY,Cho YH,et al.Modified constraintinduced movement therapy for clients with chronic stroke:Interrupted time series(ITS)design[J].Journal of Physical Therapy Science,2015,27(3):963-966.
[3]Richards L,Gonzalez Rothi LJ,Davis S,et al.Limited dose response to constraint-induced movement therapy in patients with chronic stroke[J].Clinical Rehabilitation,2006,20(12):1066-1074.
[4]Taub E,Miller NE,Novack TA,et al.Technique to improve chronic motor deficit after stroke[J].Archives of Physical Medicine&Rehabilitation,1993,74(4):347.
[5]张情,潘世琴,王丽.改良强制性运动疗法在脑卒中后上肢功能恢复中应用的研究进展[J].中国康复理论与实践,2016,22(12):1395-1398.
[6]Dobkin BH.Clinicalpractice.Rehabilitation after stroke[J].New England Journalof Medicine,2005,352(16):1677.
[7]Wolf SL,Lecraw DE,Barton LA,et al.Forced use of hemiplegic upper extremities to reverse the effect of learned nonuse among chronic stroke and head-injured patients[J].Experimental Neurology,1989,104(2):125-132.
[8]Sterr A,Elbert T,Berthold I,et al.Longer versus shorter daily constraint-induced movement therapy of chronic hemiparesis:An exploratory study[J].Archives of Physical Medicine&Rehabilitation,2002,83(10):1374-1377.
[9]Wolf SL,Lecraw DE,Barton LA,et al.Forced use of hemiplegic upper extremities to reverse the effect of learned nonuse among chronic stroke and head-injured patients[J].Experimental Neurology,1989,104(2):125-132.
[10]王文清,段一娜,徐利,等.改良强制性使用运动疗法对脑卒中偏瘫患者上肢功能影响的临床研究[J].中华物理医学与康复杂志,2008,30(5):320-323.(下转第94页)
[11]寇程,刘小燮,毕胜.三种上肢运动功能评定量表的标准效度及其相关性研究[J].中国康复理论与实践,2013,(4):371-374.
[12]李贺,柴文刚,徐国兴,等.改良强制性使用运动疗法对亚急性期脑卒中患者日常生活活动能力康复疗效的评价[J].吉林大学学报(医学版),2016,42(6):1183-1188.
[13]毕胜,瓮长水,张富洪,等.强制性使用运动疗法在慢性脑卒中下肢康复中的应用[J].中国康复医学杂志,2003,18(3):187-188.
[14]郝静,李萌.强制性运动方案对脑卒中偏瘫上肢功能障碍患者的疗效[J].神经损伤与功能重建,2016,11(1):84-85.
[15]Schaechter JD,Kraft E,Hilliard TS,et al.Motor recovery and cortical reorganization after constraint-induced movement therapy in stroke patients:A preliminary study[J].Neurorehabilitation&Neural Repair,2002,16(4):326-338.
[16]何雯,王凯.脑卒中后上肢功能康复研究进展[J].中国康复理论与实践,2014(4):334-339.
[17]Kwakkel G,Veerbeek JM,Wegen EEHV,et al.Constraint-induced movement therapy after stroke[J].Lancet Neurology,2015,14(2):224-234.
[18]Knapp HD,Taub E,Berman AJ.Movements in monkeys with deafferented forelimbs[J].Experimental Neurology,1963,7(4):305-315.
[19]黄长琴,钟艳.脑卒中患者运动功能障碍康复治疗新进展[J].检验医学与临床,2017,14(3):449-451.
[20]Page SJ,Levine P,Sisto S,et al.Stroke patients'and therapists'opinions of constraint-induced movement therapy[J].Clinical Rehabilitation,2002,16(1):55.