任务导向性序列训练治疗脑卒中偏瘫患者步行能力障碍

The treatment effect of task-oriented circuit therapy for the walking ability disorder in stroke patients with hemiplegia

目的探索验证任务导向性序列训练(task-oriented circuit therapy,TOCT)对脑卒中患者步行能力康复训练的有效性。方法选择2019年9月-2020年12月四川大学华西医院神经内科及康复医学中心收治的60例脑卒中患者。通过信封法,随机将患者分配至试验组和对照组,每组各30例。两组患者均接受常规康复治疗项目,对照组在训练过程中采用一对一的指导模式,而试验组在训练过程中采用TOCT模式。干预周期总共4周,并在干预结束后3个月进行随访。分别在干预前、训练4周结束时(干预后)及随访时对患者步行能力采用脑卒中运动评定量表(Motor Assessment Scale,MAS)和功能性步行能力评分(Functional Ambulation Category Scale,FAC)进行评估。干预前和随访时采用SF-36健康调查简表对患者生活质量进行评估。结果干预前,两组患者在性别、年龄、病程、卒中部位、步行能力评分及SF-36评分比较,差异均无统计学意义(P>0.05)。干预后及随访时,两组患者在步行能力相关评分均表现出一定的提升,试验组优于对照组(MAS:Z=-3.220,P=0.001;Z=-4.703,P<0.001。FAC:Z=-2.447,P=0.014;Z=-3.249,P=0.001)。两组患者SF-36评分于3个月随访时较干预前均存在一定的提升,试验组优于对照组(Z=-6.674,P<0.001)。干预与随访期间,患者均未出现与康复训练相关的并发症或不良反应。结论 TOCT对脑卒中患者步行训练的效果显著,在提升患者步行能力、提高生活质量方面较常规康复训练模式更具优势。

Objective To explore and verify the effectiveness of task-oriented circuit therapy(TOCT)in rehabilitation training for stroke patients’walking ability.Methods Sixty patients with stroke were selected from the Department of Neurology and Department of Rehabilitation Medicine of West China Hospital of Sichuan University from September 2019 to December 2020.By envelope method,the patients were randomly divided into the trial group and the control group,with 30 cases in each group.Both groups received routine rehabilitation treatment.The patients in the control group received conventional one-to-one rehabilitation therapy,and the patients in the trial group received TOCT training.The training lasted for 4 weeks.The patients were followed up 3 months after the training.Motor Assessment Scale(MAS)and Functional Ambulation Category Scale(FAC)were used to evaluate the walking ability of the patients before training,at the end of 4 weeks of training(after training)and at the follow-up.SF-36 health survey short form was used to evaluate the quality of life of patients before training and during follow-up.Results Before training,there was no significant difference in gender,age,course of disease,stroke location,walking ability score or SF-36 score between the two groups(P>0.05).After training and at follow-up,the walking ability related scores of the two groups were improved.The trial group was better than the control group(MAS:Z=-3.220,P=0.001;Z=-4.703,P<0.001.FAC:Z=-2.447,P=0.014;Z=-3.249,P=0.001).SF-36 scores of the two groups were improved after 3 months of follow-up.The trial group was better than the control group(Z=-6.674,P<0.001).During the study period,there were no complications or adverse reactions related to rehabilitation training.Conclusions TOCT has a significant effect on rehabilitation training of lower limb function of stroke patients.It has more advantages than conventional rehabilitation training in improving the walking ability and the quality of life of patients.