基于作业分析任务导向性训练对脑卒中患者上肢功能的疗效

Effects of task-oriented training based on occupation-based analysis in upper limb function of stroke patients

目的研究基于作业分析的任务导向性训练对脑卒中偏瘫患者上肢的功能效果。方法2019年1月至2020年11月住院治疗60例脑卒中患者,按照随机数字表法分为对照组(n=30)和观察组(n=30)。对照组患者在接受正规的神经内科药物治疗、针灸治疗的基础上采用常规康治疗,其中包括传统的作业治疗。观察组患者在对照组治疗基础之上,到作业治疗部门接受传统作业治疗后完成以任务导向为基础的作业治疗。治疗前和治疗4周后采用加拿大作业表现量表(Canadian Occupational Performance Measure,COPM)、Fugl-Meyer运动功能评定量表上肢部分(Fugl-Meyer Motor Assessment-Upper Extremities,FMA-UE)和九孔插板测试对患者患侧上肢作业表现、运动功能、手指灵活度及协调性进行评估。结果治疗4周后,两组COPM满意度评分、COPM表现评分、FMA-UE、九孔插板测试均优于治疗前,观察组COPM表现评分差值、COPM满意度评分差值、FMA-UE评分差值、九孔插板测试差值均优于对照组(P<0.05)。结论基于作业分析的任务导向性训练可以改善脑卒中恢复期患者的上肢运动功能和手指灵活性,提高患者作业活动的表现和满意度。

Objective To study the effects of task-oriented training based on occupation-based analysis in upper limb functions of stroke patients with hemiplegia.Methods Sixty stroke patients admitted from January 2019 to November 2020 were randomly divided into control group(n=30)and observation group(n=30)by means of random number table.The patients in control group received regular neurology drug therapy and conventional rehabilitation therapy based on acupuncture and moxibustion therapy including traditional occupational therapy.The patients in observation group completed task-oriented occupational therapy after receiving traditional occupational therapy in the occupational therapy department on the basis of therapy in the control group.Canadian Occupational Performance Measure(COPM),Fugl-Meyer Motor Assessment Scale upper limb part(FMA-UE)and nine-hole socket test were used to assess the upper limb performance,motor function,finger flexibility and coordination of patients before and four weeks after treatment.Results COPM satisfaction scores,COPM expressivity scores,FMA-UE and nine-hole insert test results of patients in two groups were better after treatment than before treatment.The differences in the COPM expressivity scores,COPM satisfaction scores,FMA-UE scores and nine-hole insert test results of observation group were better than those of control group(P<0.05).Conclusion The task-oriented training based on occupational analysis can improve upper limb motor function and finger flexibility in convalescent stroke patients and improve the performance and satisfaction of patients′occupational activities.