强制性使用运动疗法在亚急性期和慢性期脑卒中患者中的效力

Effectiveness of constraint-induced movement therapy in subacute and chronic stroke patients

目的:强制性使用运动疗法(CIMT)是近年来针对脑卒中后上肢功能障碍的一种新的康复训练技术。本研究目的是评价和比较CIMT在亚急性期和慢性期脑卒中患者中的康复效力。方法:30例脑卒中偏瘫患者参与此研究,其中亚急性期组患者14例(平均病程3.5个月),慢性期组患者16例(平均病程12.1个月)。在CIMT治疗期间要求两组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,密集的训练患侧肢体活动,完成日常生活中的动作,连续2周共10个工作日。在接受CIMT治疗前和治疗后用上肢功能测验(UEFT)来评价两组患者的上肢运动功能。结果:两组患者在CIMT治疗前UEFT的比较差异无显著性意义(Ρ>0.05),在治疗后两组患者UEFT的比较差异无显著性意义(Ρ>0.05),但是亚急性期组治疗后UEFT的改善值明显高于慢性期组患者治疗后UEFT的改善值,两组改善值的比较差异有显著性意义(Ρ<0.05)。亚急性期组患者和慢性期组患者在CIMT在治疗前、后UEFT的比较差异有显著性意义(Ρ<0.001),但CIMT在上肢运动功能改善效果上亚急性期组患者优于慢性期组患者(效应值ES:1.51:0.89)。结论:本文的研究结果表明CIMT在亚急性期和慢性期患者中均显现出较大的康复效力,尤其在亚急性期患者中显现出更大的康复效力。

Objective： Constraint-induced movement therapy（CIMT） is a promising approach to promoting recovery of functional arm movement after stroke. The goal of this study is to evaluate and compare the treatment effect differences between CIMT groups before 6 months （subacute） and after 1 year （chronic）stroke patients. Method： The 30 stroke patients who had upper-limb hemiparesis were included. The groups were allocated either to subacute group （n=14） or chronic group（n=16） for according to duration of stroke. The two group patients were given CIMT, involving restriction of movement of the intact upper extremity by placing it in a sling for 90% of waking hours for 12 days and training （by repetitive practice, shaping） of the more affected extremity for 6 hours on the 10 weekdays during that period. Outcome was measured with upper extremity function test （UEFT）. Result： No statistical significant difference was showed between the subacute and the chronic groups in motor improvement on the UEFT （P〉0.05） pre- and post- CIMT treatment. However, the subacute group in treatment gain on the UEFT had statistically significant higher than the chronic group （P〈0.05）.The effect size for the subacute group （1.51） was larger than for the chronic group（0.89） at the quality of movement（UEFT）. Conclusion： CIMT is an effective rehabilitation technique for subacute and chronic stroke natients, especially in subacute stroke patients.