3种疗法对脑卒中后偏瘫患者上肢运动速度的临床比较

Clinical comparison of three therapies on recovery of upper-limbs′ motor speed of patients with stroke

目的比较改良强制性使用运动疗法（modified constraint-induced movement therapy, mCIMT）、强制性使用运动疗法（constraint-induced movement therapy, CIMT）和常规神经发育技术（neurodevelopment treatment,NDT）对脑卒中偏瘫患者上肢运动功能的康复疗效。方法选取符合入选标准的脑卒中偏瘫患者45例，随机分为改良组（15例）、强制组（15例）和常规组（15例）。在治疗前和治疗后的第2周、第3周、第5周和第8周的随访后，分别进行简易上肢功能检查法（simple test for evaluating hand function，STEF）的功能评定。结果在治疗前3组患者上肢的STEF评分差异无统计学意义（P〉0．05）。随着治疗时间的延长，3组的STEF评分均有上升趋势，组间、不同时点以及组间和不同时点的交互作用差异均有统计学意义（P〈0．05），但是3组的上升趋势有所不同，CIMT组上升很快，治疗后2周在3组中评分最高，由治疗前的（42．3±9．6）分提高到（72．3±5．7）分，随访时提高到到（75．2±8．4）分；mCMT组治疗后3～5周近乎直线上升，由治疗前的（42．1±9．7）分提高到（73．6±4．7）分，随访时仍继续提高到到（79．8±5．1）分，并在治疗后8周维持在3组的最高水平；Bobath组作用缓慢，由治疗前的（41．2±9．8）分提高到（56．6±4．7）分，在治疗3周后呈逐渐下降趋势降低到（50．3±5．3）分，为3组中评分最低。结论对于脑卒中患者上肢运动功能的恢复，强制性使用运动疗法和改良强制性使用运动疗法比常规神经发育技术治疗更为有效。对于偏瘫患者上肢运动速度的提高和效果的持续时间，改良强制性使用运动疗法显示出更大的优势。

Objective Comparing effect of modified constraint-induced movement therapy（mCIMT）,constraintinduced movement therapy （CIMT） and neurodevelopment treatment （NDT） on motor function of upper-limbs of herniparalysis patients. Methods Forty-patients were chosen and randomly divided into modified group, constraint group and routine group,each group was 15 patients. The functional effect was respectively evaluated with STEF before and after the second,the third,the fifth,the eighth weeks＇ treatment of follow-up. Results Before treatment, patient＇s upper limb＇s STEF grading level in three groups had no obvious change （ P 〉0.05）. The STEF score of three groups had a tendency to rise with the extension of time, between groups, different points in time and interaction difference between groups,different point in time had statistical significance,between group（ F = 125. 371, P =0. 008） ; different point in time（ F = 285. 213, P = 0. 004） ; between group·different point in time（ F=179. 058, P = 0. 006）. But upward trend of the three groups was different,CIMT group rose rapidly,the score was the highest in the three groups in the second week after treatment, the level was upgraded from （42. 3±9.6） scores of pre-treatment to （72.3±5.7） scores,when revisited it was upgraded to （75.2-4- 8.4） scores; MCMT group almost straight up after 3-5 weeks, the level was upgraded from （42.1±9.7） scores of pre-treatment to （73.6±4.7） scores, when revisited it was upgraded to （79.8±5.1） scores, the score maintained the highest level of the three groups after eight weeks＇ treatment;action of Bobath group was slow, the level was upgraded from （41.2±9.8） scores of pre-treatment to （56.6±4.7） scores, gradually reduced （50.3±5.3） scores,the score was the lowerest of the three groups. Conclusion CIMT and mCIMT are more effective than routine NDT on motor function of upper-extremity of stroke patients. MCIMT shows greater advantage on patients with hemiplegia for improving their upper movement speed and the duration of the effect.