任务导向性训练对上肢周围神经损伤患者肌电图及手功能的影响

Effect of task oriented training on electromyography and hand function for patients with the hand functional disorders after peripheral nerve injury

目的本文拟观察任务导向性训练对上肢周围神经损伤患者手功能障碍的影响,为其提供一种新的康复治疗手段。方法采用随机数字表法将60例上肢周围神经损伤导致手功能障碍患者随机分为治疗组(30例)和对照组(30例),两组患者均给予药物治疗及常规康复治疗,治疗组辅以任务导向性训练。于干预前及干预3个月时,通过手功能评定量表评估手功能,通过肌电图(EMG)检测周围神经的恢复情况。结果治疗3个月时,治疗组手功能实用率高于对照组,差异有统计学意义(P<0.05)。治疗3个月时,治疗组正中神经、尺神经、桡神经运动神经传导速度(MCV)均高于治疗前,且桡神经MCV高于对照组,差异均有统计学意义(均P<0.05),对照组正中神经、尺神经、桡神经MCV均高于治疗前,差异均有统计学意义(均P<0.05);治疗组正中神经、尺神经、桡神经EMG潜伏期(LAT)较治疗前均明显缩短,差异均有统计学意义(均P<0.05),对照组正中神经、桡神经LAT均较治疗前明显缩短,差异均有统计学意义(均P<0.05);治疗组正中神经、尺神经、桡神经EMG波幅(AMP)均高于治疗前,且正中神经、尺神经AMP均高于对照组,差异均有统计学意义(均P<0.05),对照组正中神经、桡神经AMP均高于治疗前,差异均有统计学意义(均P<0.05)。结论任务导向性训练能明显提高上肢周围神经损伤后手功能障碍患者的神经肌肉兴奋度,改善手功能,为一种安全、实用、有效的训练方案。

Objective To investigate the effect of task oriented training on the hand functional disorders after peripheral nerve injury,in order to offer a new kind of rehabilitation treatment.Methods Sixty cases of the hand functional recovery after peripheral nerve injury were divided into the treatment group(30 cases)and the control group(30 cases)on the basis of the random number table method.Two groups of cases received drug therapy and routine rehabilitation therapy,the treatment group with task orientation training.The hand function assessment scale was measured before and after 3 months treatment in order to evaluate the hand function,the electromyography were examed to evaluate peripheral nerve recovery.Results After3 months intervention,the total effective rate in the treatment group was obviously higher than the control group(P<0.05).After 3 months intervention,the median nerve MCV,ulnar nerve MCV,radial nerve MCV in the treatment group were obviously higher than that of before treatment,as well as the radial nerve MCV singnificantly higher than control group(P<0.05),the median nerve MCV,ulnar nerve MCV,radial nerve MCV in the control group were significantly higher than that of before treatment(P<0.05).The median nerve LAT,ulnar nerve LAT,radial nerve LAT in the treatment group were obviously shorter than that of before treatment,the median nerve LAT,radial nerve LAT in the control group were significantly shorter than that of before treatment(P<0.05).The median nerve AMP,ulnar nerve AMP,radial nerve AMP in the treatment group were obviously higher than that of before treatment,meanwhile,the median nerve AMP and ulnar nerve AMP were singnificantly higher than control group(P<0.05),the median nerve AMP and radial nerve AMP in the control group were significantly higher than that of before treatment(P<0.05).Conclusions The task orientation training can significantly improve neuromuscular excitability of patients with the hand functional disorders after peripheral nerve injury,as well as improve the hand function.The task of design orientation training is a safe,practical and effective training program which combines a variety of sensory stimulation and daily life activities.