复合式腕手矫形器辅助疗法对脑卒中后腕手功能障碍的效果

Efficacy of CompoundWrist-hand Orthosis-assisted Therapy onWrist-hand Dysfunction after Stroke

目的观察复合式腕手矫形器辅助下训练对脑卒中恢复期腕手功能障碍患者的效果。方法2018年6月至2019年12月,本院脑卒中患者34例随机分为对照组(n=17)和试验组(n=17)。两组均接受基础治疗和常规手工作业治疗,试验组在每天手工作业治疗时及休息时佩戴复合式腕手矫形器。常规手工作业治疗每次30 min,每天2次,共14 d;非训练时间佩戴矫形器每天累计5 h,共14 d。治疗前后分别采用Brunnstrom分期(上肢和手)、Fugl-Meyer评定量表(FMA)(腕手)评定上肢和手的运动功能,采用改良Ashworth量表(MAS)评定腕关节肌张力,采用改良Barthel指数(MBI)评定日常生活活动能力。结果对照组脱落2例。治疗前,两组Brunnstrom分期、FMA评分、MAS分级、MBI评分均无显著性差异(P>0.05)。治疗后,两组FMA和MBI评分较治疗前均明显提高(|Z|>3.420,P<0.01),且试验组FMA和MBI评分改善程度明显优于对照组(Z=-2.895,t=4.331,P<0.01);两组Brunnstrom分期、MAS分级在治疗前后均无改变(P>0.05)。结论佩戴复合式腕手矫形器进行康复训练可进一步促进脑卒中恢复期患者腕手运动功能和日常生活活动能力的改善。

Objective To observe the efficacy of compound wrist-hand orthosis-assisted training on wrist-hand dysfunction in patients with convalescent stroke.Methods From June,2018 to December,2019,34 stroke patients in our hospital were randomly divided into control group(n=17)and experimental group(n=17).Both groups received basic treatment and routine occupational therapy,while the experimental group wore a compound wrist-hand orthosis during and after the daily occupational therapy.The occupational therapy was carried out 30 minutes a time,twice a day for 14 days,and the nontraining time orthosis wearing was carried out cumulative five hours a day for 14 days.Before and after treatment,the Brunnstrom stage(upper limb and hand)and Fugl-Meyer Assessment(FMA)(wrist and hand)were used to assess the motor function of the upper limbs and hands,while the modified Ashworth Scale(MAS)and modified Barthel Index(MBI)were separately used to assess the wrist tension and activities of daily living.Results Two cases dropped out in the control group.There was no significant difference in Brunnstrom stage,FMA score,MAS score,and MBI score between two groups before treatment(P>0.05).After treatment,the scores of FMA and MBI significantly improved in both groups(|Z|>3.420,P<0.01),and the improvement was higher in the experimental group than in the control group(Z=-2.895,t=4.331,P<0.01);while,no significant difference was found in Brunnstrom stages and MAS score in both groups(P>0.05).Conclusion The compound wrist-hand orthosis-assisted therapy could improve the wrist-hand motor function and activities of daily living in patients with convalescent stroke.