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中华老年病研究电子杂志 ›› 2015, Vol. 02 ›› Issue (02) : 12 -16. doi: 10.3877/cma.j.issn.2095-8757.2015.02.005

所属专题: 文献

临床研究

强制性运动疗法对提高脑卒中患者日常生活能力的疗效观察
章晓英1, 左惠榕1, 孙晓东2, 钱开林3,()   
  1. 1. 314400 浙江省嘉兴市海宁市康华医院康复医学科
    2. 314400 浙江省嘉兴市海宁市人民医院康复科
    3. 210000 南京,江苏省人民医院康复科
  • 收稿日期:2015-04-22 出版日期:2015-05-28
  • 通信作者: 钱开林

Effect of constraint-induced movement therapy on improving the activities of daily living among stroke patients

Xiaoying Zhang1, Huirong Zuo1, Xiaodong Sun2, Kailin Qian3,()   

  1. 1. Rehabilitation Department, Haining Kanghua Hospital of Zhejiang Province, Jiaxing 314400, China
    2. Rehabilitation Department, Haining People's Hospital of Zhejiang Province, Jiaxing 314400, China
    3. Rehabilitation Department, Jiangsu Province people's Hospital, Nanjing 210000, China
  • Received:2015-04-22 Published:2015-05-28
  • Corresponding author: Kailin Qian
  • About author:
    Corresponding author: Qian Kailin, Email:
引用本文:

章晓英, 左惠榕, 孙晓东, 钱开林. 强制性运动疗法对提高脑卒中患者日常生活能力的疗效观察[J]. 中华老年病研究电子杂志, 2015, 02(02): 12-16.

Xiaoying Zhang, Huirong Zuo, Xiaodong Sun, Kailin Qian. Effect of constraint-induced movement therapy on improving the activities of daily living among stroke patients[J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2015, 02(02): 12-16.

目的

观察强制性运动疗法(constraint-induced movement therapy,CIMT)对提高脑卒中患者日常生活能力的疗效。

方法

选取浙江省海宁市康华医院2012年5月至2014年5月收治的30例脑卒中患者,其中采用常规康复训练治疗15例(对照组),采用常规康复训练+CIMT治疗15例(实验组),所有治疗方案均根据患者自身情况及自愿情况制定,均签署知情同意书。对照组采用神经肌肉促进技术、关节活动度训练、步态训练、医疗体操等常规康复治疗,实验组在常规康复治疗基础上增加CIMT(主要包括限制健侧肢体使用及强化患侧肢体活动两方面,强化训练包括进食训练、洗漱训练、穿脱上衣训练、穿脱裤子训练、如厕训练、床椅转移训练、上下便器训练)。两组患者均治疗4周,治疗后均采用Fugl-Meyer assessment(FAM)方法评定运动功能,采用功能独立性评定量表(functional independence measurement,FIM)评估患者日常生活活动能力。组内FIM评分的比较采用配对t检验,组间FMA及FIM评分的比较采用独立t检验;计数资料的比较采用χ2检验。

结果

两组患者治疗前FMA评分的差异无统计学意义(实验组为31±21,对照组为37±26;t=1.76,P>0.05);治疗2周后两组患者FMA评分的差异仍无统计学意义(实验组为48±22,对照组为43±26;t=2.01,P>0.05);治疗3、4周后实验组FMA评分均显著高于对照组(实验组FMA评分分别为64±22、75±20,对照组分别为47±30、55±28),差异均有统计学意义(t=8.32、14.26,均P<0.01)。治疗前,两组患者各项目FIM评分的差异均无统计学意义(实验组治疗前进食、洗漱、穿上衣、穿裤子、如厕、床椅转移、上下便器的FIM评分分别为3.4±0.5、3.3±0.5、3.3±0.5、3.4±0.6、3.2±0.4、3.9±0.5、3.6±0.6,对照组治疗前分别为3.7±0.5、3.5±0.5、3.6±0.5、3.7±0.5、3.5±0.5、3.9±0.5、3.7±0.6;t=1.89、1.12、1.47、1.29、1.95、0.37、0.60,均P>0.05)。治疗后,两组患者各项目FIM评分均较治疗前明显提高(实验组治疗后FIM评分分别为5.5±0.6、5.2±0.7、5.3±0.6、5.3±0.6、5.1±1.0、6.1±0.6、5.8±0.7;对照组治疗后分别为4.9±0.6、4.7±0.7、4.8±0.6、4.7±0.6、4.5±0.5、5.5±0.5、4.8±0.7),差异均有统计学意义(t=17.49、10.64、14.49、11.30、9.37、11.12、9.89,6.86、9.03、11.23、9.03、10.25、12.22、9.03;均P<0.05);与对照组比较,实验组各项目FIM评分均明显提高,差异均有统计学意义(t=2.57、2.09、2.48、2.46、2.08、2.95、4.05,均P<0.05)。

结论

CIMT疗法能够明显提高脑卒中患者的日常生活能力,从而改善其生活质量。

Objective

To observe the effect of constraint-induced movement therapy (CIMT) on improving the activities of daily living (ADL) among stroke patients.

Methods

Thirty stroke patients who were hospitalized in Haining Kanghua Hospital during May 2012 to May 2014 were selected. Fifteen patients took only routine rehabilitation therapy (control group), while the other 15 patients took routine rehabilitation therapy plus CIMT (experimental group). All treatment plans were made according to patients’ conditions and willingness, for which informed consent forms were signed. The control group received routine therapy including proprioceptive neuromuscular facilitation, joint moving training, gaittraining, and therapeutic cexercises, whereas the experimental group received CIMT in addition to routine therapy (which manily including limit of usage of healthy side and strengthening of activities of affected sides, the intensive training including eating training, washing training, putting on and off upper garment training, putting on and off trousers training, using the toilet training, transferring bed and chair training and up and down toilet stool training). Both groups received treatments for 4 weeks, after which Fugl-Meyer Assessment(FMA) was implemented to assess their motor function and functional independence measurement(FIM) was used to assess patients’ ADL. For measurement data, paired t test was used for in-group comparison and independent t test was used for between-group comparison. For enumeration data, χ2test was used for comparison.

Results

The difference of the FMA scores of the two groups of patients had no statistical meaning before treatments (t=1.76,P>0.05). The difference of their FMA scores still had no statistical meaning after two weeks of treatments (t=2.01,P>0.05). After 3 and 4 weeks of treatments the FMA scores of the experimental group were significantly higher than the control group (64±22, 75±20 and 47±30, 55±28) and the difference had statistical meaning (t=8.32, 14.26, bothP<0.01). Before treatment, the difference of the FIM scores of the two groups had no statistical meaning(FIM scores of eating training, washing training, putting on and off upper garment training, putting on and off trousers training, using the toilet training, transferring bed and chair training and up and down toilet stool training of experimental group before the treatment were 3.4±0.5, 3.3±0.5, 3.3±0.5, 3.4±0.6, 3.2±0.4, 3.9±0.5, 3.6±0.6 respectively, the control group before the treatment were 3.7±0.5, 3.5±0.5, 3.6±0.5, 3.7±0.5, 3.5±0.5, 3.9±0.5, 3.7±0.6.t=1.89, 1.12, 1.47, 1.29, 1.95, 0.37, 0.60, allP>0.05). After treatment, both groups had increased scores for every item of the FIM (FIM scores of experimental group after the treatment were 5.5±0.6, 5.2±0.7, 5.3±0.6, 5.3±0.6, 5.1±1.0, 6.1±0.6, 5.8±0.7 respectively, FIM scores of control group after the treatment were 4.9±0.6, 4.7±0.7, 4.8±0.6, 4.7±0.6, 4.5±0.5, 5.5±0.5, 4.8±0.7 respectively), and the difference had statistical meaning (t=17.49, 10.64, 14.49, 11.30, 9.37, 11.12, 9.89, and 6.86, 9.03, 11.23, 9.03, 10.25, 12.22, 9.03, allP<0.05). Compared to the control group, the experimental group all had significantly higher FIM scores, and the difference had statistical meaning (t=2.57, 2.09, 2.48, 2.46, and 2.08, 2.95, 4.05, all P<0.05).

Conclusion

CIMT can significantly improve ADL for stroke patients and further improve their life quality.

表1 采用强制性运动疗法与常规康复治疗患者一般资料的比较
表2 采用强制性运动疗法与常规康复治疗患者治疗前后FMA评分的比较(±s,分)
表3 采用强制性运动疗法和常规康复治疗患者组内治疗前后FIM评分的比较(±s,分)
表4 采用强制性运动疗法和常规康复治疗患者组间治疗前后FIM评分的比较(±s,分)
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