作业疗法改善脑外伤后肢体功能和日常生活能力的疗效

Influence of occupational therapy in improving the scores of Fugl-Meyer assessment and Modified Barthel Index in patients with traumatic brain injury

目的观察作业疗法(occupational therapy,OT)改善脑外伤患者肢体运动功能及对日常生活能力评分的影响。方法选择住院治疗的脑外伤合并肢体功能障碍患者55例,随机分为观察组(28例)和对照组(27例)。病情平稳后,两组对象均接受基础康复治疗,观察组另加功能性OT,根据患者个体情况分别选择OT方案,1～2次/d,20～30 min/次,20～30次为一疗程,共进行2个疗程。两组对象治疗前后分别接受了"日常生活活动能力评定(modified barthel Index,MBI)"和"运动能力评估(fugl-meyer assessment,FMA)"。结果两组患者治疗前MBI分项评分和总分分布无明显区别,治疗后两组多数MBI分项评分及总分均明显优于治疗前,同时观察组的部分分项评分和MBI总分也均明显高于对照组(P<0.01,P<0.05)。治疗前两组患者运动功能评分和FMA总分无明显区别,治疗后两组各项运动功能评分和FMA总分均明显优于治疗前,同时观察组的上肢运动功能评分和FMA总分也明显高于对照组同期结果(P<0.01,P<0.05)。结论功能性OT可以明确改善脑外伤患者上肢运动功能及日常生活能力评分。

Objective To study the influence of occupational therapy in improving the scores of Fugl - Meyer Assessment （FMA） and Modified Barthel Index （MBI） in patients with traumatic brain injury. Methods Fifty - five patients with traumatic brain injury accompanied by limb dysfunction, who were treated in hospital recently, were successively recruited and randomly divided into observation group （n = 28, OT group） and control group （n = 27）. Since the conditions became stable, the patients in both groups were given the basic rehabilitative therapy. Besides, those in the observation group were treated with functional OT, and the OT schemes were selected separately according to the conditions of individual patients ; 1 - 2 times a day, 20 - 30 min for each time, and 20 - 30 times as a course for a total of 2 courses. All the subjects in both groups were evaluated with MBI and FMA before and after therapy. Results Before therapy, the distributions of item scores and the total score of MBI were close between the two groups （P all 〉 0.05 ）. Most item scores and the total score of MBI after therapy were all obviously better than those before therapy in both groups, and partial item scores and the total score of MBI after therapy in the OT group were also better than those in the control group （P all 〈 0.01 ~ 0.05 ）. Before therapy, the distributions of item scores and the total score of FMA were close between the two groups （P all 〉 0.05）. All the item scores and the total score of FMA after therapy were all obviously better than those before therapy in both groups, and item scores for upper limbs and the total score of FMA in the OT group were also better than those in the control group in the same period （P all 〈 0. 01- 0.05）. Conclusion Functional OT can obviously improve the FMA scores for the upper limbs and MBI in patients with traumatic brain injury.