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  

A clinical study of modified constraint-induced movement therapy for upper extremity motor recovery in stroke patients

作　　者：王文清[1] 段一娜[2] 徐利[3] 王宏卫[1] 谢睿智[1] 冯晶晶[1] 方鑫洋[1] 黄武[1] 刘亚梅[1] 

机构地区：[1]河北承德医学院附属医院康复医学科,承德067000 [2]承德医学院预防医学教研室 [3]北京中国人民解放军六二三0一部队门诊部

出　　处：《中华物理医学与康复杂志》2008年第5期320-323,共4页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：河北省承德市科学技术局立项课题（200721051）

摘　　要：目的观察改良强制性使用运动疗法（mCIMT）对脑卒中偏瘫患者上肢运动功能的康复疗效。方法选取27例符合人选标准的脑卒中偏瘫患者，随机分为改良强制性使用运动疗法组（改良组，14例）和常规治疗组（常规组，13例）。常规组治疗以Bobath技术为主，进行上肢运动功能训练，每日2h，每周训练5d，连续10周。改良组采用改良强制性使用运动疗法，限制健侧肢体动作，在治疗期间要求患者穿戴吊带和夹板，每天清醒时固定时间不少于90％，训练在治疗环境中进行，每日1h，每周3次，其它时间在日常生活活动中进行训练，时间不少于每日2h，连续10周。治疗前、后分别采用简易上肢机能检查量表（STEF）和Wolf运动功能量表（WMFT）评价患者的上肢运动功能。结果2组患者治疗前，STEF中的10项活动评分和WMFT评分差异均无统计学意义（P〉0．05）。经过治疗后，组内评分比较，差异均有统计学意义（P〈0．05）；组间比较，STEF中的10项活动评分除拿大球、拿大方块和拿中方块3项差异无统计学意义（P〉0．05）外，其余7项差异均有统计学意义（P〈0．05）；WMFT评分比较，差异有统计学意义（P〈0．05）。结论改良强制性使用运动疗法是改善脑卒中偏瘫患者上肢运动功能的有效治疗方法，与常规Bobath技术相比，可显著提高患者偏瘫侧上肢的灵活性和运动速度。Objective To observe the clinical effect of a modified version of constraint-induced movement therapy （MCIMT） on motor recovery in the upper extremities of stroke patients. Methods Twenty-seven stroke patients were randomly divided into a treatment group （ n = 14） and a routine group （ n = 13 ）. The Bobath approach and functional arm exercise were administered to the patients in the routine group （2 h/d, 5 times a week） for ten weeks. The MCIMT administered to the treatment group involved restriction of the functional arm by a sling during 90% of waking time and during training （ by shaping） of the affected extremity （ 1 hour per day, three times a week） in addition to activities of daily living exercise for at least 2 hours every day. The main outcome measures were the ten items of the simplified test for evaluating hand function （STEF） and Wolf＇s Motor Function Test （ WMFT）. Results No significant difference was observed between the 2 groups with regard to WMFT and STEF scores before treatment. After treatment, both groups had improved their WMFT and STEF scores significantly, but there was a significant difference between the treatment and the control groups with regard to WMFT scores and 7 items of the STEF test. Conclusion Modified constraint-induced movement therapy is effeetive not only for promoting motor recovery of the upper extremity, but also for improving the flexibility and velocity of movement in stroke patients.

关 键 词：改良强制性使用运动疗法 脑卒中 上肢 运动功能 

分 类 号：R743.3[医药卫生—神经病学与精神病学]