强制性运动疗法对脑损伤后上肢灵活性和日常生活能力的影响

Effect of Constraint-Induced Movement Therapy on Improving the Flexibilty of Upper Extremities and the Ability of Daily Living of Patients With Hemiplegia

目的探讨强制性运动疗法(C IMT)对偏瘫患者上肢灵活性和日常生活能力的康复效果。方法36例偏瘫患者随机分成C IMT组和传统治疗组。C IMT组每天强化训练患侧上肢5 h,5 d/周,连续3周,同时使用休息位手夹板和吊带限制健手的使用,每天8 h。对照组采用传统PT和OT等康复方法,每天训练患肢5 h,5 d/周,不限制健手的使用。使用上肢动作研究(ARA)试验和Barthel指数分别在治疗前、治疗后即刻、治疗后1个月和3个月进行疗效评价;同时使用ARA试验比较C IMT组强化治疗2周和3周对上肢灵活性的疗效差异。结果C IMT组与对照组间ARA试验结果有显著性差异(P<0.05);C IMT组2周和3周强化训练的疗效无显著性差异;Barthel指数两组间无显著性差异,但C IMT组可见治疗前后B I明显改善(P<0.01)。结论C IMT能明显提高偏瘫患者上肢灵活性,提高日常生活能力,其疗效优于传统康复治疗方法。

Objective To investigate the effect of constraint-induced movement therapy （CIMT） on improving the flexibilty of upper extremities and the ability of daily living （ADL） of patients with hemiplegia. Methods 36 patients with bemiparesis were randomized to two groups ： CIMT and traditional rehabilitation （TR）. In CIMT group, 18 patients received intensive shaping training of 5 h/d, lasting 3 weeks, with the constraint of unaffected arms. In TR group, patients received traditional rehabilitation in the same times, without the constraint of unaffected arms. They were evaluated with Action Research Arm （ARA） Test and Barthel Index （BI） before intervention, immediate after intervention, 4 and 12 weeks after intervention respectively. Patients in CIMT group were also evaluated with ARA tests 2 and 3 weeks after training. Results Significant difference was found between CIMT and TR group on the improvement of ARA test （ P 〈 0.05 ）. There was no significant difference between 2 and 3 weeks after training in CIMT group. Significant difference in BI was also found in CIMT group （P 〈 0. 01 ）, but has not been found between CIMT and TR group. Conclusion CIMT significantly improved the flexibilty of upper extremities and ADL of patients with hemiplegia, which is superior to the traditional rehabilitation.