脑卒中单侧忽略的康复治疗:随机对照临床研究

Rehabilitation treatments for patients with stroke and unilateral neglect: A randomized controlled trial

目的:探讨脑卒中单侧忽略的康复治疗方法。方法:60例首次脑卒中后有左侧偏瘫及单侧忽略的患者。随机分为3组,2个干预组,1个对照组。第1组使用主动向患侧转动身躯的方法(TR),第2组使用TR及特殊眼镜遮盖双眼右半侧视野(EP),对照组则只使用传统日常生活动作及手功能训练。评价分3个阶段进行偏身忽略、功能及认知测试。结果:4周治疗后,TR组与对照组间在FIM行动评分方面有明显差异,尤其在移位、转移、行动、上下楼梯和FIM肢体总分方面。结论:对有单侧忽略的初期脑卒中患者应在早期积极采用向患侧转身的康复治疗方法。

Objective： To investigate the effectiveness of voluntary trunk rotation and hail-field eye-patching to treating patients with unilateral neglect in stroke. Method：A single-blinded randomized controlled trial in an inpatient rehabilitation hospital in Hung Kong. Sixty stroke in-patients with unilateral right lesion having neglect were randomly assigned to 3 groups： voluntary trunk rotation （TR）, voluntary trunk rotation in combination with half-field eye-patching （TR＋EP）, conventional training （Control）. Six subjects dropped out during interventions. Nineteen patients in TR received daily experimental training for 1 hour, five times a week for 30 days. Twenty patients received the same kind of treatment together with half-field eye-patching （TR＋EP）. Fifteen patients in control received conventional training with same contact time. Patients were assessed before the intervention, at week 4, and foUow-up at week 8 by using a battery of neglect measures, the FIM instrument, and the MMSE. Result： Significant differences between TR and Control were found in the gain of FIM scores on transfer, locomotion, and total score from initial assessment to week 4. Neither TR nor TR＋EP showed functional improvement and reduction of neglect at follow-up. Conclusion：Voluntary trunk rotation alone improved the motor aspects of patients＇ functional performance. This was not associated with a reduction of unilateral neglect.