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

关键词：脑卒中  上肢运动功能  改良限制-诱导运动疗法  感知提醒疗法

Keywords:stroke  upper limb motor function  modified constrained-induced movement therapy  sensory cueing treatment

摘要：

      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mCIMT）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。

Abstract:

      Abstract 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.