脑卒中后上肢运动功能表现与习得性废用的相关性研究

Relationship between upper extremity motor performances and learned non-use in stroke patients

目的:探索脑卒中亚急性期患者的上肢运动功能表现与习得性废用之间的相关性。方法:本研究从两家医院共招募了28例脑卒中亚急性期患者,所有患者在出院后1个月由同一名作业治疗师对其进行功能评定。上肢运动功能评价采用Fugl-Meyer评定量表(FMA)、上肢动作研究量表(ARAT)、盒子和木块测试(BBT)、偏瘫上肢功能测试香港版(FTHUE-HK)评估,习得性废用评价采用家居活动记录表(MAL),日常生活能力评价采用功能性独立量表(FIM)进行评估。相关性分析采用Spearman等级相关性分析。结果:MAL的使用量评分(MALAOU)与MAL的活动质量评分(MAL-QOM)及FMA显示强相关性(r=0.751至r=0.860);MAL-AOU与其它上肢运动功能表现呈现中等相关(r=0.551至r=0.744);MAL-QOM与ARAT之间显示出一般相关(r=0.38),与其它上肢功能表现则中等相关(r=0.599至r=0.724);FIM与所有量表均未显示出显著相关性。结论:上肢功能水平越好的脑卒中亚急性期患者越愿意在日常生活中使用患侧上肢;判断自我上肢能力水平时,患者则显示出更多依赖于上肢粗大功能表现,而非手部精细功能表现。

Objective： To investigate the relationship between upper extremity motor performances and learned non-use in subacute stroke patients. Method： Twenty-eight subacute stroke patients in this study were recruited from two hospitals, and evaluated by an occupational therapist at first month after discharge from hospitals. The assessments employed for upper extremity motor performances included Fugl-Meyer Assessment （FMA）, Action Research Arm Test （ARAT）, Box and Block Test （BBT）, Functional Test for the Hemiplegic Upper Extremity-Hong Kong Version （FTHUE-HK）, learned non-use was assessed by Motor Activity Log （MAL）, and Functional Independence Measure （FIM）. Spearman＇s rank correlation coefficient was used for the correlation analysis. Results. Excellent correlation between two subscales, Amount of Use （AOU） and Quality of Movement （QOM） was found （r=0. 751）. MAL-AOU was excellently correlated with FMA （r=0. 860）, and moderately with other upper extremity assessments （r values from 0. 551 to 0. 744）. Fair correlation was investigated between MAL-QOM and ARAT （r=0. 38）, but moderate correlation with other assessments （r values from 0. 599 to 0. 724）. FIM got insignificant correlation with any one of the used assessments. Conclusion： These subacute stroke patients with better upper extremity function were more likely to use their affected upper extremity in their daily life. While rating their own upper extremity capacity, they prefer to refer their gross motor but not fine motor performance.