强制性使用运动疗法在最低上肢运动标准慢性脑卒中偏瘫患者中的疗效  

Efficacy of constraint-induced movement therapy on minimum motor criterion of upper-extremity for individuals with hemiparalysis after stroke

作　　者：瓮长水[1] 王军[1] 潘小燕[1] 于增志[1] 王刚[1] 高丽萍[2] 霍春暖[3] 

机构地区：[1]解放军总医院康复医学科,北京市100853 [2]解放军总医院中医科 [3]解放军总医院神经内科

出　　处：《中国康复医学杂志》2007年第9期772-775,共4页Chinese Journal of Rehabilitation Medicine

基　　金：全军医药卫生科研基金资助项目(200626Z000058)

摘　　要：目的:探讨强制性使用运动疗法(CIMT)在最低上肢运动标准慢性脑卒中偏瘫患者中的疗效。方法:10例符合CIMT最低上肢运动标准即腕关节伸展>10°,拇指外展>10°,其他四指中任何两个手指伸展>10°的慢性脑卒中偏瘫患者参与此研究。在基线期接受常规康复治疗。在CIMT治疗期间,要求患者健侧穿戴吊带和夹板来限制健侧肢体动作,每天清醒时固定时间不少于90%,连续12天,同时接受塑形训练,密集地训练患侧肢体活动,完成日常生活中的动作,连续两周共10个工作日。在基线期与CIMT治疗前后用Fugl-Meyer评价法(FMA)和上肢动作研究量表(ARAT)来评价患者的上肢运动功能,用动作活动日志(MAL)来评价患者的上肢的使用量(AOU)和动作质量(QOM)。结果:患者在基线期,在FMA、ARAT、AOU和QOM上显现出微小改善,效应值(ES)分别为:0.15、0.24、0.07和0.05。但患者在接受CIMT治疗后,在FMA、ARAT、AOU和QOM上显现极为显著的改善,ES分别为:2.1、3.75、5.19和4.29。结论:CIMT可以改善最低上肢运动标准慢性脑卒中偏瘫患者上肢运动功能,但CIMT在这些脑卒中患者中的长期功能效益尚需进一步明确。Objective： To determine the efficacy of constraint-induced movement therapy（CIMT） on minimum motor criterion of upper-extremity for individuals with hemiparalysis after stroke. Method： Ten patients experienced stroke more than 6 months were enrolled in this study. The minimum motor criterion for including into CIMT was 10° extension of the wrist, 10° abduction of the thumb and 10° extension of any two other digits in upper-extremity hemiparalysis. A 2-week baseline period with regular treatment, was followed by a 2-week CIMT period. The CIMT involvet restricting the movement of intact upper extremity by placing it in a sling for 90% of waking hours in 12 days and training affected extremity by shaping for 6 hours in 10 workdays during CIMT period. Outcome was measured by Fugl-Meyer Assessment （FMA）, Action Research Arm Test （ARAT） and Motor Activity Log （MAL）. Result： The patients in CIMT period exhibited greater motor changes on FMA, ARAT and MAL （ES, 2.1,3.75,5.19 and 4.29, respectively） than the patients in baseline period （ES, 0.15,0.24,0.07, and 0.05,respectively）. Conelnsion： CIMT may be an efficacious treatment to improve function of the affected arm on minimum motor criterion of upper-extremity for individuals with hemiparalysis after stroke. However, the confirmatory studies about long-term benefits of this treatment on poststroke motor impairments and related functional disabilities are needed to be warranted.

关 键 词：脑卒中 上肢 强制性使用运动疗法 偏瘫 

分 类 号：R743.3[医药卫生—神经病学与精神病学]