脑梗死急性期康复训练流程对患者运动功能和日常生活活动能力改善程度的影响

A preliminary study on the effect of rehabilitation training process on the motor function and activities of daily living

目的:初步探究脑梗死急性期标准化康复训练流程对患者运动功能及ADL能力改善程度的影响。方法:选取2014年6月—2014年12月在江苏省人民医院进行住院康复治疗的中重度运动功能损伤脑梗死急性期患者32例,随机分入实验组与对照组,各16例。对照组患者接受常规的神经内科药物治疗和3周常规康复训练;实验组患者接受常规神经内科药物治疗和3周的标准化运动训练流程干预,该流程从患者生命体征稳定无进行性加重时开始执行,持续3周,要求总训练强度至少达到每天1.5h,且其中治疗师的一对一训练与手法训练应≥60min,且从第一周就开始进行既定的5个主要方面,16到22项具体的训练介入。具体内容包括:肢体主被动活动、神经肌肉电刺激、床上运动、站立训练和日常生活活动(ADL)能力训练等。使用Fugl-Meyer运动功能评估量表(FMA)和改良Barthel指数(MBI)分别于康复介入前后对患者的肢体运动功能和日常活动能力进行评估。结果:试验组患者MBI差值(MBI_1-MBI_0)与MBI改善程度([MBI_1-MBI_0]/[100-MBI_0]×100%)均显著高于常规治疗组(P<0.05);两组患者的FMA相关指标评分及其差值无显著性差异(P>0.05)。结论:脑梗死急性期标准化康复训练流程能够在一定程度上改善脑梗死急性期患者的ADL能力恢复速度和恢复程度;虽然与常规治疗相比未能获得运动功能的显著差异,但该运动训练方案有助于脑梗死急性期患者的标准化康复干预。

Objective： To explore the effect of standard rehabilitation training process in motor function and activities of daily living of patients with acute cerebral infarction. Method： Thirty-two cerebral infarction inpatients in Jiangsu province hospital with moderate to severe motor disorders in acute phase were involved and randomly divided into study group and control group. Conventional neurological medication was provided for all patients in our research for 3 weeks. And when As vital signs were stable, the study group would receive 3 weeks standard rehabilitation treatment followed established docu- ments （passive movement, neuromuscular electronic stimulation, motor exercise in on bed, standing and activity ADL training, et al. Standard training requires a total intensity of at least 1.5h per day, and the therapist＇s one- on-one training and manipulation should be ≥60min, and should begin to carry out the five main aspects, 16-22 detailed training interventions from the first week. Meanwhile routine rehabilitation training was taken for control group. Motor function and ADL were evaluated respectively by Fugl-Meyer and MBI. Result： The average improvement of MBI （MBI^-MBI0） and the percentage of MBI improvement （[MBI1-MBI0]/ [100-MBI0]×100%） of study group were both significant higher than control （P〈0.01; P=0.04）. No significant difference was detected between the two groups in the average improvement of FMA （FMA1-FMA0） and the percentage of FMA improvement （[FMA1-FMA0]/[100-FMA0]× 100%） （P 〉 0.05）. Conclusion： The rehabilitation process of acute cerebral infarction could partly accelerate the recovery of ADL for acute cerebral infarction inpatients with moderate damage. Though no difference of FMA was detected, this rehabilitation process could help to establish standard training program for acute cerebral infarction patients.