三种康复治疗对脑卒中偏瘫患者上肢运动功能的改善情况  

Evaluation of therapies of modified constraint-induced movement therapy, constraint-induced movement therapy and Bobath in the improvement of motor function in upper extremities in patients with apoplexy hemiparalysis

作　　者：王文清[1] 张欣[1] 李艳双[1] 姚艳华[1] 柴叶红[1] 王宏卫[1] 

机构地区：[1]河北省承德医学院附属医院康复科,067000

出　　处：《中华神经科杂志》2010年第8期546-550,共5页Chinese Journal of Neurology

摘　　要：目的比较改良强制性使用运动疗法（modified constraint—induced movement therapy，mCIMT）、强制性使用运动疗法（constraint—induced movement therapy，CIMT）和神经发育疗法（Bobath技术）3种治疗方法对脑卒中偏瘫患者上肢运动功能的康复疗效。方法选取符合入选标准的脑卒中偏瘫患者57例，随机分为3组，常规组治疗以Bobath技术为主，2h／d，每周训练5d，连续6周；强制组和改良组采用健侧穿戴吊带和夹板限制肢体动作，CIMT组6h／d，每周训练5d，连续2周；mCIMT组在治疗环境中进行，1h／d，每周3次，其他时间在日常生活中训练，不少于2h／d，连续10周。在治疗前和治疗后的第2周、第6周、第10周后，3组患者同时采用简易Fugl—Meyer运动功能评价量表（Fugl—Meyer Motor Assessment，FMA）测定上肢的运动模式、简易上肢功能检查量表（Simple Test for Evaluating Hand Function，STEF）测定上肢的运动速度、Baahel指数（Baahel Index，BI）测定日常生活能力。结果治疗前3组患者3项评分均无统计学意义；FMA治疗前的评分为45．2±5．1（F=1．107，P=0．382），BI评分为63．1±10．3（F=0．930，P=0．401），STEF评分为63．4±8．6（F=1．843，P=0．168）。2周后，CIMT组疗效达到高峰，FMA评分为53．9±5．0（F=11．666，P=0．000），BI评分为77．4±9．6（F=4．139，P=0．021），STEF评分为78．9±4．7（F=13．893，P=0．000），优于mCIMT组和Bobath组；6周后，Bobath组疗效达到高峰，FMA评分为50．4±3．7（F=123．770，P=0．000），STEF评分为78．7±6．2（F=8．372，P=0．000），BI评分为78．7±7．9（F=4．373，P=0．017），优于mCIMT组；到10周时，mCIMT组和CIMT组FMA评分为60．1±3．4和59．7±4．1（F=64．287，P：0．000），STEF评分为89．8±4．7和88．7±5．0（F=63．641，P=0．000），优于Bobath组。10周时，mCIMT组的BI评分为91．7±3．7（F=46．774，P=0．000），Objective To compare effect of three therapies （modified constraint-induced movement therapy （mCIMT） , constraint-induced movement therapy （CIMT） and Bobath therapies）on the recovery of motor function in upper-extremities of patients with apoplexy hemiparalysis. Methods Fifty-seven patients with apoplexy hemiparalysis were randomly divided into CIMT treatment group （n = 19 ） , mCIMT group （n = 19） and Bobath group （n = 19）. Patients in Bobath group exercised 2 h/d, 5 d/week for 6 weeks. CIMT group and mCIMT group had restriction of movement at the unimpaired upper extremity by placing it in a sling a whole day for training using impaired extremity. Patients in CIMT treatment group exercised 6 h/d, 5 days a week for 2 weeks in a row ; mCIMT treatment group exercised for 1 h/d, 3 days a week, and also exercised in daily life at least 2 hours every day, for ten consecutive weeks. The patients in all three groups were assessed for upper-extremities motor function using FMA of Fugl-Meyer, for recovery of upper- extremities motor speed using STEF and for recovery of daily ability at respective time-points of pre-treatment and the second week, sixth week and tenth week of post-treatment. Results In 3 assessments in the 3 groups there was no obvious change before treatment, while the FMA score was 45.2 ± 5.1 （ F = 1. 107 ,P = 0. 382）, BI score was 63. 1 ±10. 3 （ F = 0. 930, P = 0. 401 ） , STEF score was 63.4 ±8.6 （ F = 1. 843, P = 0. 168）. At the second week, sixth week and tenth week of the treatment, the difference of assessment in the three groups was significant. The improvement in CIMT group was better after 2 weeks treatment compared with Bobath and mCIMT group, while the Bobath group showed better results than mCIMT group did after 6 weeks treatment. After 10 weeks treatment, the FMA, STEF in mCIMT and CIMT groups were improved better than Bobath group, while the BI score in mCIMT group was better than that in Bobath and CIMT group. Conclusions The mCIMT and CIMT therapy are

关 键 词：卒中 偏瘫 运动疗法 日常生活活动 治疗结果 

分 类 号：R743.3[医药卫生—神经病学与精神病学]