下肢改良强制性运动疗法对脑卒中偏瘫患者步行和日常生活活动能力的影响

Effects of modified constraint-induced movement therapy of the lower extremities on walking ability and activities of daily living in stroke patients with hemiplegia

目的:通过对脑卒中偏瘫患者进行下肢改良强制性运动疗法干预,探究其对脑卒中后偏瘫患者步行能力和日常生活活动能力的影响。方法:收集2018年6月—2019年8月复旦大学附属华山医院康复医学科住院脑卒中患者,符合纳入标准的共40例,随机分为试验组和对照组,试验组为改良强制性运动疗法组,对照组为常规治疗组,各20例。对照组进行每天总计1h 45min的常规治疗,之外需在护工或家属陪同下完成力所能及的活动或步行2h;试验组在常规治疗外再接受2h的改良强制性运动疗法训练,包括起坐训练、步行训练、上下楼梯训练、平衡训练、单腿负重训练,两组治疗频率均为每周5天,共8周。在第0、4、8周对两组患者进行6min步行距离、计时-起立行走测试和改良Barthel指数评定,并比对组间组内的差异性。结果:经过8周干预,两组的6分钟步行距离、计时-起立行走测试得分和改良Barthel指数评分前后均有显著性差异(P<0.05),但是试验组得分明显优于对照组;组间得分在第0周时无显著性差异,经过8周干预有显著性差异(P<0.05)。结论:下肢改良强制性运动疗法对于提升脑卒中偏瘫患者的步行能力和日常生活活动能力有一定促进作用。

Objective:To investigate the effect of modified constraint-induced movement therapy of the lower extremities on walking ability and activities of daily living in stroke patients with hemiplegia.Method:A total of 40 stroke patients in rehabilitation medicine department of Huashan hospital affiliated to Fudan University from June 2018 to August 2019 were collected,and they met the inclusion criteria.They were randomly divided into an experimental group and a control group.The control group received a total of 1 hour and 45 minutes of routine treatment every day.In addition,they were required to complete activities within their capacity or walk for 2 hours accompanied by nurses or family members.The experimental group received 2 hours of modified constraint-induced movement therapy of the lower extremities in addition to the conventional treatment,including sitting up,walking,walking up and down stairs,balance training,and oneleg weight training.The treatment frequency of the two groups was 5 days a week for a total of 8 weeks.At week 0,week 4,and week 8,patients in the two groups were tested for six minute walk distance,Time Up and Go Test,and the modified Barthel index evaluation,and the inter-group differences were compared.Result:After 8 weeks of intervention,there were statistically significant differences in the scores of six minute walk distance,Time Up and Go Test,and the modified Barthel index score before and after the intervention for two groups,P<0.05,but the scores of the experimental group were significantly better than those of the control group.There was no significant difference in scores between groups at week 0,but there was a significant difference after 8 weeks of intervention,P<0.05.Conclusion:Modified constraint-induced movement therapy of the lower extremities can promote the walkingability and activities of daily living of stroke patients with hemiplegia.