作业疗法早期介入对脑卒中患者日常生活活动能力的作用

Effect of early occupational therapy on the activities of daily life in stroke patients

目的:观察作业疗法配合运动疗法早期干预对脑卒中患者日常生活活动能力的作用,并与单纯应用运动疗法相比较。方法:选择2003-03/2005-06河南省中医中风病工程技术研究中心住院脑卒中患者160例[开始康复治疗距发病时间为(6.6±5.0)d],随机分为两组:①运动疗法组(n=40),予以良肢位摆放、被动活动关节、桥式运动、神经肌肉促通术、坐位平衡、站位平衡及步态训练等治疗。40～50min/d,平均疗程7周。②运动+作业疗法组(n=120):在运动疗法组基础上,早期开始予以日常生活活动再学习训练,恢复期重点予以选择性作业课题治疗,患侧上肢的精细活动强化训练,自助具、辅助具的使用训练及健肢的代替、代偿训练等,40～50min/d。在康复治疗开始的24h进行首次评定,应用Fugl-Meyer肢体运动功能评分评价运动功能,Barthel指数评估日常生活活动能力,以后每2周评价1次。结果:按意向处理分析,160例进入结果分析。①Fugl-Meyer得分:运动+作业疗法组在治疗后2,4,6,8周时得分均高于运动疗法组(P<0.01)。②Barthel指数:运动+作业疗法组在治疗后2,4,6,8周时得分均高于运动疗法组(P<0.01)。③两组处于同一运动功能状态下(Fugl-Meyer得分相同时),运动+作业疗法组的日常生活活动能力评分高于运动疗法组,在Fugl-Meyer积分在45～60分时差异最为显著(P<0.01)。结论:早期应用作业疗法配合运动疗法干预,可有效提高脑卒中患者的日常生活活动能力和运动能力,其康复疗效优于单用运动疗法组。

AIM： To observe the effects of the early intervention of occupational therapy plus exercise therapy on the activities of daily life （ADL） in stroke patients, and compare the effects with those of exercise therapy only. METHODS： Totally 120 inpatients, who were hospitalized in the Henan Project Technological Research Center of Stroke of Traditional Chinese Medicine between March 2003 and June 2005, participated in the study, the duration from the attack to the beginning of rehabilitation therapy was （6.6±5.0） days. The patients were randomly divided into exercise therapy group （n=40） and exercise＋occupational therapy group （n=120）. All the patients were given the exercise therapy of keeping good posture and position of limbs, passive activity of joint, bridge movement, neuromuscular facilitation, balance of sitting positive, balance of standing-position and gait training. 40-50 minutes per day for an average course of 7 weeks. Besides, the patients in the exercise＋occupational therapy group also participated in the ADL relearning training, selective topic therapy was mainly given at convalescent period, other trainings were the reinforced training of refined activity of ipsilateral upper limb, training by means of self-help tool and assisted tool, replacement and compensation training of the unaffected limb, 40-50 minutes per day. The first evaluation was performed at 24 hours after the beginning of rehabilitation therapy, the motor function was assessed with Fugl-Meyer score for motor function of limbs, and ADL was evaluated with Barthel index, and then the patients were evaluated once every two weeks. RESULTS： According to intention-to-treat analysis, all the 160 cases entered the analysis of results.①Fugl-Meyer scores： The scores at 2, 4, 6 and 8 weeks after therapy were higher in the exercise＋occupational therapy group than in the exercise therapy group （P 〈 0.01）. ②Barthel index： The Barthel indexes at 2, 4, 6 and 8 weeks after therapy were higher in the exercise＋occupational therapy group than in the exercise therapy group （P 〈 0.01）. ③Under the same motor function （the same Fugl-Meyer score）, the ADL score in the exercise＋occupational therapy group was higher than that in the exercise therapy group, and it was the most significantly different when the Fugl-Meyer score was 45-60 points （P〈 0.01）. CONCLUSION： Early intervention of occupational therapy plus exercise therapy can effectively improve the ADL and motor ability of stroke patients, and the rehabilitative effects are better than those of the exercise therapy only.