新型感知提醒疗法与改良限制诱导运动疗法对偏瘫上肢功能疗效的对照研究
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摘要
目的:对照研究改良限制-诱导运动疗法(modified constraint-induced movement therapy, mCIMT)与感知提醒疗法(sensory cueing treatment, SCT)对慢性期脑卒中患者上肢运动功能的疗效差异。方法:招募60名符合入选标准的脑卒中患者,随机分成mCIMT组(20例)、SCT组(20例)与对照组(20例)。三组均接受常规康复训练,mCIMT组与SCT组在此基础上分别接受连续3周的单侧和双侧上肢强化训练。所有患者均接受治疗前和治疗后的上肢功能评估,包括Fugl-Meyer上肢功能评定(FMA-UE)、上肢动作研究测试(ARAT)、运动活动日志(MAL)、改良Barthel指数(MBI)。结果:治疗前三组患者各项评定指标差异无显著性意义(P>0.05)。与治疗前相比,治疗后mCIMT组与SCT组FMA-UE、ARAT、MAL与MBI得分均明显增加,其差异均有显著性意义(P<0.05)。治疗后,mCIMT组MAL使用数量与活动质量评分均优于SCT组,其疗效差异具有显著性意义(P<0.05)。治疗后,SCT组ARAT与MBI得分优于mCIMT组,其疗效差异具有显著性意义(P<0.05)。结论:重复性单侧肢体强化训练(如m CIMT)与双侧上肢强化训练(如SCT)均能够有效提高脑卒中后偏瘫上肢的运动功能、日常使用频率与运动质量,以及功能性活动表现和日常生活自理能力。
Objective: To compare the effects of modified constraint-induced movement therapy(mCIMT) and sensory cueing treatment(SCT) on upper limb motor function in patients with chronic stroke.Method: Sixty inpatients with chronic stroke were recruited and randomly assigned into mCIMT group(n=20),SCT group(n=20), and control group(n=20). Patients in mCIMT and SCT group received repetitive unilateral and bilateral arm training respectively for a continuous 15 working days within 3-weeks. Patients in control group only received conventional rehabilitation therapy. All of patients were evaluated by the Fugl-Meyer Assessment-Upper Extremity(FMA-UE), Action Research Arm Test(ARAT), Motor Activity Log(MAL), and Modified Barthel Index(MBI) in pretreatment and immediate posttreatment.Result: There is no significant difference in all outcomes before treatment among three groups. There are significant improvement at all outcomes immediately after mCIMT and SCT treatment(P<0.05), whereas no change was found in control group(P>0.05). Compared with the control group, the changes at all outcomes were significant in mCIMT and SCT groups(P<0.05). After treament, the mCIMT group exhibited more increase on the scale of MAL(AOU) and MAL(QOM)(P<0.05), whereas SCT group showed more improvement on ARAT and MBI(P<0.05).Conclusion: Both repetitive unilateral(mCIMT) and bilateral(SCT) arm training programmes were effective to improve upper limb motor functions, the amount and quality of hand use in daily life, and improve the motor performance in functional activities and independence in activity of daily life.
Objective: To compare the effects of modified constraint-induced movement therapy(mCIMT) and sensory cueing treatment(SCT) on upper limb motor function in patients with chronic stroke.Method: Sixty inpatients with chronic stroke were recruited and randomly assigned into mCIMT group(n=20),SCT group(n=20), and control group(n=20). Patients in mCIMT and SCT group received repetitive unilateral and bilateral arm training respectively for a continuous 15 working days within 3-weeks. Patients in control group only received conventional rehabilitation therapy. All of patients were evaluated by the Fugl-Meyer Assessment-Upper Extremity(FMA-UE), Action Research Arm Test(ARAT), Motor Activity Log(MAL), and Modified Barthel Index(MBI) in pretreatment and immediate posttreatment.Result: There is no significant difference in all outcomes before treatment among three groups. There are significant improvement at all outcomes immediately after mCIMT and SCT treatment(P<0.05), whereas no change was found in control group(P>0.05). Compared with the control group, the changes at all outcomes were significant in mCIMT and SCT groups(P<0.05). After treament, the mCIMT group exhibited more increase on the scale of MAL(AOU) and MAL(QOM)(P<0.05), whereas SCT group showed more improvement on ARAT and MBI(P<0.05).Conclusion: Both repetitive unilateral(mCIMT) and bilateral(SCT) arm training programmes were effective to improve upper limb motor functions, the amount and quality of hand use in daily life, and improve the motor performance in functional activities and independence in activity of daily life.
引文
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[16]瓮长水,王军,王刚,等.上肢动作研究量表在脑卒中患者中的信度[J].中国康复理论与实践,2007,13(9):868-869.
[17]瓮长水,王军,潘小燕,等.上肢动作研究量表在脑卒中患者中的效度[J].中国康复理论与实践,2008,14(1):53-54.
[18]Doussoulin-Sanhueza A,Rivas-Sanhueza R.Validation and use motor activity log and action research arm scales as tools to assess the function of the paretic upper limb after a stroke in clinic and research[J].Revista Mexicana De Neurociencia,2014,15(3):138-146.
[19]唐朝正,陈昌成,丁政,等.基于镜像神经元理论的动作观察在脑卒中后肩手综合征疼痛康复中的应用[J].中国康复医学杂志,2016,31(2):145-149.
[20]黄红红,王凌星,张泉香,等.强制性运动疗法对脑卒中亚急性早期偏瘫患者上肢功能恢复的影响[J].中华物理医学与康复杂志,2014,36(11):838-841.
[21]Wolf SL,Winstein CJ,Miller JP,et al.Effect of constraintinduced movement therapy on upper extremity function 3to 9 months after stroke:the EXCITE randomized clinical trial[J].JAMA,2006,96(17):2095-2104.
[22]Page SJ,Levine P,Leonard A,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.
[23]Wu CY,Chen CL,Tsai WC,et al.A randomized controlled trial of modified constraint-induced movement therapy for elderly stroke survivors:changes in motor impairment,daily functioning,and quality of life[J].Arch Phys Med Rehab,2007,88(3):273-278.
[24]Hayner K,Gibson G,Giles GM.Research scholars initiative-comparison of constraint-induced movement therapy and bilateral treatment of equal intensity in people with chronic upper-extremity dysfunction after cerebrovascular accident[J].Amer J Occup Ther,2010,64(4):528-539.
[2]Go AS,Mozaffarian D,Roger VL,et al.Heart disease and stroke statistics-2014 update:a report from the American Heart Association[J].Circulation,2014,129(3):e28.
[3]Buma F,Kwakkel G,Ramsey N.Understanding upper limb recovery after stroke[J].Restor Neurol Neuros,2013,31(6):707-722.
[4]Wolf SL,Winstein CJ,Miller JP,et al.Effect of constraintinduced movement therapy on upper extremity function 3 to9 months after stroke:The EXCITE randomized clinical trial[J].JAMA,2006,296(17):2095-2104.
[5]Feigin VL,Lawes CM,Bennett DA,Anderson CS.Stroke epidemiology:a review of population-based studies of incidence,prevalence,and case fatality in the late 20th century[J].Lancet Neurol,2003,2(1):43-53.
[6]Mayo NE,Wood Dauphinee S,Core R,et al.Activity,participation,and quality of life 6 months poststroke[J].Arch Phys Med Rehab,2002,83(8):1035-1042.
[7]Page SJ,Sisto S,Levine P,et al.Efficacy of modified Constraint-induced movement therapy in chronic stroke:a singleblinded randomized controlled trial[J].Arch Phys Med Rehab,2004,85(1):14-18.
[8]刘旭东,勾丽洁,王文清,等.两种不同类型强制性使用运动疗法对脑卒中偏瘫患者上肢运动速度和日常生活活动能力的影响[J].中国康复医学杂志,2011,26(2):174-175.
[9]何宗颖,何予工.改良强制性运动疗法对脑卒中患者上肢功能及日常生活能力的影响[J].中华物理医学与康复杂志,2014,36(10):790-792.
[10]Fong KN,Lo PC,Yu YS,et al.Effects of sensory cueing on voluntary arm use for patients with chronic stroke:Apreliminary study[J].Arch Phys Med Rehab,2011,92(1):15-23.
[11]Dong VA,Fong KNK,Chen Y,et al.‘Remind-to-move’treatment versus constraint-induced movement therapy for children with hemiplegic cerebral palsy:a randomized controlled trial[J].Dev Med Child Neurol,2017,59(2):160-167.
[12]Safaz I,Yilmaz B,Ya?ar E,et al.Brunnstrom recovery stage and motricity index for the evaluation of upper extremity in stroke:analysis for correlation and responsiveness[J].Int J Rehabil Res,2009,32(3):228-231.
[13]Fong K,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 J Occup Ther,2004,14(1):21-29.
[14]Fugl-Meyer A R,J??sk?L,Leyman I L,et al.The post stroke hemiplegic patient.I.A method for evaluation of physical performance[J].Scand J Rehab Med,1975,7(1):13-31.
[15]Li KY,Lin KC,Wang TN,et al.Ability of three motor measures to predict functional outcomes reported by stroke patients after rehabilitation[J].NeuroRehab,2012,30(4):267-275.
[16]瓮长水,王军,王刚,等.上肢动作研究量表在脑卒中患者中的信度[J].中国康复理论与实践,2007,13(9):868-869.
[17]瓮长水,王军,潘小燕,等.上肢动作研究量表在脑卒中患者中的效度[J].中国康复理论与实践,2008,14(1):53-54.
[18]Doussoulin-Sanhueza A,Rivas-Sanhueza R.Validation and use motor activity log and action research arm scales as tools to assess the function of the paretic upper limb after a stroke in clinic and research[J].Revista Mexicana De Neurociencia,2014,15(3):138-146.
[19]唐朝正,陈昌成,丁政,等.基于镜像神经元理论的动作观察在脑卒中后肩手综合征疼痛康复中的应用[J].中国康复医学杂志,2016,31(2):145-149.
[20]黄红红,王凌星,张泉香,等.强制性运动疗法对脑卒中亚急性早期偏瘫患者上肢功能恢复的影响[J].中华物理医学与康复杂志,2014,36(11):838-841.
[21]Wolf SL,Winstein CJ,Miller JP,et al.Effect of constraintinduced movement therapy on upper extremity function 3to 9 months after stroke:the EXCITE randomized clinical trial[J].JAMA,2006,96(17):2095-2104.
[22]Page SJ,Levine P,Leonard A,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.
[23]Wu CY,Chen CL,Tsai WC,et al.A randomized controlled trial of modified constraint-induced movement therapy for elderly stroke survivors:changes in motor impairment,daily functioning,and quality of life[J].Arch Phys Med Rehab,2007,88(3):273-278.
[24]Hayner K,Gibson G,Giles GM.Research scholars initiative-comparison of constraint-induced movement therapy and bilateral treatment of equal intensity in people with chronic upper-extremity dysfunction after cerebrovascular accident[J].Amer J Occup Ther,2010,64(4):528-539.