团体改良限制-诱导运动疗法对脑卒中后上肢功能障碍的疗效研究
|
摘要
目的:探讨4周的团体改良限制-诱导运动疗法(gmCIMT)对脑卒中后上肢功能障碍的疗效。方法:选取29例符合入选标准的脑卒中患者,随机分为gmCIMT组(14例)及常规治疗组(15例),2组均以团体治疗的形式在作业治疗科进行;gmCIMT组每天使用限制手板限制健侧5h,患肢训练3h(gm CIMT治疗1h和病房管理ADL活动2h);常规治疗组在不限制健侧的前提下患肢每天进行3h的训练(团体作业治疗1h和自我管理活动2h)。在治疗前、治疗4周后分别使用Fugl-Meyer评定上肢部分(FMA-UE)、上肢动作研究量表(ARAT),偏瘫上肢功能测试香港版(FTHUE-HK)评估偏瘫上肢的运动功能;使用运动活动日志(motor activity log,MAL)评定患手使用频率(AOU)和动作完成质量(QOM);用改良Barthel指数(MBI)评估患者的日常生活能力。结果:治疗4周后,2组患者在FMA-UE、ARAT、FTHUE-HK、MAL-AOU、MAL-QOM、MBI评分均较治疗前明显提高(P<0.05),而gmCIMT组患者除MBI评分与常规治疗组无统计学差异外,其他各项得分均优于常规治疗组(P<0.05)。结论:gmCIMT和常规团体作业治疗都能够显著提高脑卒中后的偏瘫上肢运动功能,gmCIMT可以更加有效改善偏瘫上肢的运动控制及日常使用频率与质量。
Objective:To investigate the effect of a 4-week group modified Constraint-Induced Movement Therapy(gmCIMT)on hemiplegic upper limb functions after stroke.Methods:Twenty-nine inpatients with chronic stroke were recruited and randomly assigned into gmCIMT group(n=14)and control group(n=15).In gmCIMT group,the non-affected hand was restricted for 5 hevery day and the affected hand underwent a 3 hprogram(1 hgmCIMT and 2 hward-based ADL)per day for 4 weeks,6 days per week.In control group,the non-affected hand was un-restricted,and the affected hand received a 3 hprogram(1 hgroup occupational therapy and 2 hself-management activities)per day for 4 weeks,6 days per week.All patients were evaluated by the Fugl-Meyer Assessment-Upper Extremity(FMA-UE),Action Research Arm Test(ARAT),Functional Test of Hemiplegic Upper ExtremityHong Kong(FTHUE-HK),MAL-AOU(Amount of Use)and MAL-QOM(Quality of Movement),and Modified Barthel Index(MBI)pretreatment and immediate posttreatment.Results:After treatment for 4 weeks,there were significant differences in the changes of all outcomes in both gmCIMT group and control group(P<0.05).Except the score of MBI,patients in gmCIMT group showed much more increase on all the other outcome measures than those in the control group(P<0.05).Conclusion:Both gmCIMT and conventional group occupational therapy program were effective to improve upper limb motor functions in patients with chronic stroke.The gmCIMT demonstrated more benefit on motor control and increase the amount and quality of hand use in daily life.
Objective:To investigate the effect of a 4-week group modified Constraint-Induced Movement Therapy(gmCIMT)on hemiplegic upper limb functions after stroke.Methods:Twenty-nine inpatients with chronic stroke were recruited and randomly assigned into gmCIMT group(n=14)and control group(n=15).In gmCIMT group,the non-affected hand was restricted for 5 hevery day and the affected hand underwent a 3 hprogram(1 hgmCIMT and 2 hward-based ADL)per day for 4 weeks,6 days per week.In control group,the non-affected hand was un-restricted,and the affected hand received a 3 hprogram(1 hgroup occupational therapy and 2 hself-management activities)per day for 4 weeks,6 days per week.All patients were evaluated by the Fugl-Meyer Assessment-Upper Extremity(FMA-UE),Action Research Arm Test(ARAT),Functional Test of Hemiplegic Upper ExtremityHong Kong(FTHUE-HK),MAL-AOU(Amount of Use)and MAL-QOM(Quality of Movement),and Modified Barthel Index(MBI)pretreatment and immediate posttreatment.Results:After treatment for 4 weeks,there were significant differences in the changes of all outcomes in both gmCIMT group and control group(P<0.05).Except the score of MBI,patients in gmCIMT group showed much more increase on all the other outcome measures than those in the control group(P<0.05).Conclusion:Both gmCIMT and conventional group occupational therapy program were effective to improve upper limb motor functions in patients with chronic stroke.The gmCIMT demonstrated more benefit on motor control and increase the amount and quality of hand use in daily life.
引文
[1]Merians AS,Jack D,Boian R,et al.Virtual reality-augmented rehabilitation for patients following stroke[J].Phys Ther,2002,82(9):898-915.
[2]Catherine EL,Marghuretta DB,Ryan RB,et al.Assessment of upper extremity impairment,function,and activity after stroke:foundations for clinical decision making[J].Journal of Hand Therapy,2013,26(2):104-115.
[3]J.Plantin E,Laurencikas P,Lindberg,et al.Biomarkers for prediction of hand function after stroke:The ProHandstudy protocol[J].Journal of the Neurological Sciences,2013,333(Suppl 1):555-556.
[4]Belda JM,Mena HS,Bermejo BI,et al.Rehabitation of gait after stroke:a review towards a top-down approach[J].J Neuroeng Rehabil,2011,13(1):66-80.
[5]Dromerick AW,Lang CE,Birkenmeier R,et al.Relationship between upper-limb functional limitations and self-reported disability3months after stroke[J].J Rehabil Res Develop.2006,43(3):401-408.
[6]Page SJ,Boe S,Levine P.What are the“ingredients”of modified constraint-induced therapy?An evidence-based review,recipe,and recommendations[J],Restor Neurol Neurosci,2013,31(3):299-309.
[7]Page SJ,Levine P,Leonard AC,et al.Modified constraint-induced therapy in chronic stroke:Results of a single-blinded randomized controlled trial[J].Phys Ther.2008,88(3):333-340.
[8]Fleet AB,Che ML,MacKay-Lyons M,et al.Examining utilization of constraint induced movement therapy in Canadian neurological occupational and physical therapy[J].Physiother Can.2014,66(1):60-71.
[9]中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点[J].中华神经外科杂志,1996,29(6):379-380.
[10]Fong NK,Ng B,Chan D,et al.Development of the Hong Kong version of the Functional Test for the Hemiplegic Upper Extremity(FTHUE-HK)[J].Hong Kong Journal of Occupational Therapy,2004,41(1):21-29.
[11]Bohannon R,Smith M.Interrater reliability of a modified Ashworth scale of muscle spasticity.Phys Ther 1987,67(2):206-207.
[12]Fugl-meyer AR,Jaasko L,Leyman I,et al.The post-stroke hemiplegia patient:I.A method for evaluation of physical performance[J].Stroke J Rehabil Med,1975,7(1):13-31.
[13]Lyle RC.A Performance test for assessment of upper limb function in physical rehabilitation treatment and research[J].Int J.Rehab Research,1981,4(4):483.
[14]Hsieh YW,Wu CY,Lin KC,et al.Responsiveness and validity of three outcome measures of motor function after stroke rehabilitation[J].Stroke.2009,40(4):1386-1391.
[15]李奎成,唐丹,刘晓艳,等.国内Barthel指数和改良Barthel指数应用的回顾性研究[J].中国康复医学杂志,2009,24(8):737-740.
[16]Peurala SH,Kantanen MP,Sjogren T,et al.Effectiveness of constraint-induced movement therapy on activity and participation after stroke:a systematic review and meta-analysis of randomised controlled trials[J].Clin Rehabil,2012,26(3):209-223.
[17]Page SJ,Levine P,Leonard AC.Modified constraint induced therapy in acute stroke:a randomized controlled pilot study[J].Neurorehabil Neural Repair.2005,19(1):27-32.
[18]Brogrdh C,Sj9lund BH.Constraint-induced movement therapy in patients with stroke:apilot study on effects of small group training and of extended mitt use[J].Clin Rehabil,2006,20(3):218-227.
[19]Daniel P.K.Leung,Adelina K.Y.Ng,Kenneth N.K.Fong.Effect of small group treatment of the modified constraint induced movement therapy for clients with chronic stroke in a community setting[J].Human Movement Science,2009,28(6):798-808.
[20]Morone G,Bragoni M,Iosa M,et al.Who may benefit from robotic-assisted gait training?A randomized clinical trail in patients with subacute stroke[J].Neurorehabil Neural Repair,2011,25(7):636-644.
[21]Bandura A,著.陈欣银,李伯黍,译.A social learning theory.阿尔伯特·班杜拉.社会学习理论[M].北京:中国人民大学出版社,2015:13-27.
[22]English,C.,Hillier,S.Circuit class therapy for improving mobility after stroke:A systematic review[J].Journal of Rehabilitation Medicine,2011,43(7):565-573.
[23]张艳明,胡洁,宋为群,等.目标导向式重复性运动训练对脑卒中患者上肢运动功能的效果[J].中国康复理论与实践,2016,22(12):1380-1383.
[24]Mehdizadeh,M.,Hassani Mehraban,A.,Zahediyannasab,R..The Effect of Group-Based OccupationalTherapy on Performance and Satisfaction of Stroke Survivors:Pilot Trail,Neuro-Occupational View[J].Basic and Clinical Neuroscience,2017,8(1):69-76.
[25]Takebayashi T,Koyama T,Amano S,et al.A 6-month follow-up after constraint-induced movement therapy with and without transfer package for patients with hemiparesis after stroke:apilot quasirandomized controlled trial[J].Clin Rehabil,2013,27(5):418-426.
[26]Shi YX,Tian JH,Yang KH,et al.Modified constraint-induced movement therapy versus traditional rehabilitation in patients with upperextremity dysfunction after stroke:A systematic review and meta-analysis[J].Arch Phys Med Rehabil.2011,92(6):972-982.
[2]Catherine EL,Marghuretta DB,Ryan RB,et al.Assessment of upper extremity impairment,function,and activity after stroke:foundations for clinical decision making[J].Journal of Hand Therapy,2013,26(2):104-115.
[3]J.Plantin E,Laurencikas P,Lindberg,et al.Biomarkers for prediction of hand function after stroke:The ProHandstudy protocol[J].Journal of the Neurological Sciences,2013,333(Suppl 1):555-556.
[4]Belda JM,Mena HS,Bermejo BI,et al.Rehabitation of gait after stroke:a review towards a top-down approach[J].J Neuroeng Rehabil,2011,13(1):66-80.
[5]Dromerick AW,Lang CE,Birkenmeier R,et al.Relationship between upper-limb functional limitations and self-reported disability3months after stroke[J].J Rehabil Res Develop.2006,43(3):401-408.
[6]Page SJ,Boe S,Levine P.What are the“ingredients”of modified constraint-induced therapy?An evidence-based review,recipe,and recommendations[J],Restor Neurol Neurosci,2013,31(3):299-309.
[7]Page SJ,Levine P,Leonard AC,et al.Modified constraint-induced therapy in chronic stroke:Results of a single-blinded randomized controlled trial[J].Phys Ther.2008,88(3):333-340.
[8]Fleet AB,Che ML,MacKay-Lyons M,et al.Examining utilization of constraint induced movement therapy in Canadian neurological occupational and physical therapy[J].Physiother Can.2014,66(1):60-71.
[9]中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点[J].中华神经外科杂志,1996,29(6):379-380.
[10]Fong NK,Ng B,Chan D,et al.Development of the Hong Kong version of the Functional Test for the Hemiplegic Upper Extremity(FTHUE-HK)[J].Hong Kong Journal of Occupational Therapy,2004,41(1):21-29.
[11]Bohannon R,Smith M.Interrater reliability of a modified Ashworth scale of muscle spasticity.Phys Ther 1987,67(2):206-207.
[12]Fugl-meyer AR,Jaasko L,Leyman I,et al.The post-stroke hemiplegia patient:I.A method for evaluation of physical performance[J].Stroke J Rehabil Med,1975,7(1):13-31.
[13]Lyle RC.A Performance test for assessment of upper limb function in physical rehabilitation treatment and research[J].Int J.Rehab Research,1981,4(4):483.
[14]Hsieh YW,Wu CY,Lin KC,et al.Responsiveness and validity of three outcome measures of motor function after stroke rehabilitation[J].Stroke.2009,40(4):1386-1391.
[15]李奎成,唐丹,刘晓艳,等.国内Barthel指数和改良Barthel指数应用的回顾性研究[J].中国康复医学杂志,2009,24(8):737-740.
[16]Peurala SH,Kantanen MP,Sjogren T,et al.Effectiveness of constraint-induced movement therapy on activity and participation after stroke:a systematic review and meta-analysis of randomised controlled trials[J].Clin Rehabil,2012,26(3):209-223.
[17]Page SJ,Levine P,Leonard AC.Modified constraint induced therapy in acute stroke:a randomized controlled pilot study[J].Neurorehabil Neural Repair.2005,19(1):27-32.
[18]Brogrdh C,Sj9lund BH.Constraint-induced movement therapy in patients with stroke:apilot study on effects of small group training and of extended mitt use[J].Clin Rehabil,2006,20(3):218-227.
[19]Daniel P.K.Leung,Adelina K.Y.Ng,Kenneth N.K.Fong.Effect of small group treatment of the modified constraint induced movement therapy for clients with chronic stroke in a community setting[J].Human Movement Science,2009,28(6):798-808.
[20]Morone G,Bragoni M,Iosa M,et al.Who may benefit from robotic-assisted gait training?A randomized clinical trail in patients with subacute stroke[J].Neurorehabil Neural Repair,2011,25(7):636-644.
[21]Bandura A,著.陈欣银,李伯黍,译.A social learning theory.阿尔伯特·班杜拉.社会学习理论[M].北京:中国人民大学出版社,2015:13-27.
[22]English,C.,Hillier,S.Circuit class therapy for improving mobility after stroke:A systematic review[J].Journal of Rehabilitation Medicine,2011,43(7):565-573.
[23]张艳明,胡洁,宋为群,等.目标导向式重复性运动训练对脑卒中患者上肢运动功能的效果[J].中国康复理论与实践,2016,22(12):1380-1383.
[24]Mehdizadeh,M.,Hassani Mehraban,A.,Zahediyannasab,R..The Effect of Group-Based OccupationalTherapy on Performance and Satisfaction of Stroke Survivors:Pilot Trail,Neuro-Occupational View[J].Basic and Clinical Neuroscience,2017,8(1):69-76.
[25]Takebayashi T,Koyama T,Amano S,et al.A 6-month follow-up after constraint-induced movement therapy with and without transfer package for patients with hemiparesis after stroke:apilot quasirandomized controlled trial[J].Clin Rehabil,2013,27(5):418-426.
[26]Shi YX,Tian JH,Yang KH,et al.Modified constraint-induced movement therapy versus traditional rehabilitation in patients with upperextremity dysfunction after stroke:A systematic review and meta-analysis[J].Arch Phys Med Rehabil.2011,92(6):972-982.