康复机器手辅助下任务导向训练对脑卒中手功能的效果

Effects of Robot-assisted Task-oriented Training on Hand Function after Stroke

目的探究康复机器手辅助任务导向训练对脑卒中患者手部抓握功能的康复效果。方法 2015年6月至2016年9月住院脑卒中患者35例,随机分为对照组(n=17)和试验组(n=18)。两组接受相同的常规康复训练,试验组采用康复机器手辅助患手进行实物抓握训练,对照组在治疗师的辅助下进行实物抓握训练,共2周。训练前后测量手指关节主动活动度(AROM),采用Fugl-Meyer评定量表(FMA)手指功能部分和改良Barthel指数(MBI)与手功能相关的活动进行评估。结果对照组脱落3例,试验组脱落2例。治疗后,试验组患手五指伸展AROM和及屈曲AROM和,拇示中三指伸展AROM和及总AROM,各手指总AROM均较治疗前增加(t>2.937,P<0.05);对照组五指伸展AROM和及屈曲AROM和,拇示中三指伸展AROM和、屈曲AROM和及总AROM和,拇指、示指、小指AROM较治疗前改善(t>2.528,P<0.05);试验组拇示中三指伸展AROM和及总AROM和,拇指、示指总AROM大于对照组(t>2.535,P<0.05)。治疗后,试验组共同屈曲、共同伸展、拇示对捏、柱状抓握、球状抓握和FMA总分较治疗前改善(Z>2.000,P<0.05);对照组共同伸展、拇示对捏和总分较治疗前改善(Z>2.000,P<0.05);两组间各项分及总分均无显著性差异(P>0.05)。治疗后,试验组进食、穿衣、如厕、洗澡、修饰及总分较治疗前增高(Z>2.041,P<0.05);对照组治疗后总分较治疗前增高(Z=-2.527,P<0.05);两组各项分和总分均无显著性差异(P>0.05)。结论基于任务导向的康复机器手辅助训练可有效促进脑卒中早期患者患手手指主动关节活动度和抓握功能恢复。

Objective To study the effects of the rehabilitation robot-assisted task-oriented training on the hand function in patients after stroke. Methods From June, 2015 to September, 2016, 35 inpatients suffering from stroke were randomly allocated to control group（n=17）and trial group（n=18）. Based on the routine rehabilitation, the trial group accepted robot-assisted task-oriented training, while the control group accepted therapist-assisted task-oriented training, for two weeks. They were measured the active range of motion（AROM） of fingers,assessed with fingers motor of Fugl-Meyer Assessment（FMA） and modified Barthel Index（MBI） invovled with hands before and after training. Results The inpatients dropped three in the control group, two in the trial group. AROM of extension and flexion of all the fingers, the AROM of extension and total of three fingers of thumb, index and middle, and the total AROM of each finger improved in the trial group after training（t〉2.937, P〈0.05）, while the AROM of extension and flexion of all the fingers, AROM of extension, flexion and total of the fingers of thumb, index and middle, total AROM of the fingers of thumb, index and little improved in the control group after training（t〉2.528,P〈0.05）; the AROM of extension and total of the fingers of thumb, index and middle, and the total AROM of fingers of thumb and index improved more in the trial group than in the control group（t〉2.535, P〈0.05）. The scores of mass flexion, mass extension, opposition, cylinder grip, spherical grip and total score of FMA improved in the trial group after training（Z〉2.000, P〈0.05）, while the scores of mass extension,opposition and the total score of FMA improved in the control group after training（Z〉2.000, P〈0.05）. There was no significant difference between the two groups on the items and total scores after training（P〉0.05）. The scores of feeding, dressing, toilet transfers, bathing, grooming of MBI and the total score of them improved in the trial group after training（Z〉2.041, P〈0.05）, while the total score of MBI improved in the control group after training（Z=-2.527, P〈0.05）. There was no significant difference between the two groups in the items and total scores after training（P〉0.05）. Conclusion The rehabilitation robot-assisted task-oriented training can improve AROM of hemiplegic fingers and grip function.