任务导向性训练在社区卒中偏瘫患者康复中的效果研究

Efficacy of task-oriented training for rehabilitation of stroke patients with hemiplegia in community

目的探讨任务导向性训练在社区卒中偏瘫患者中的疗效。方法选择上海市黄浦区半淞园街道社区卫生服务中心2017年1月至2019年12月收治的80例卒中患者,38例在康复过程中采用常规Bobath技术和运动再学习方法的患者纳入对照组,42例在此基础上联合任务导向性训练的患者纳入观察组,所有患者均康复治疗12周。分别在治疗前和治疗12周后采用Brunnstrum分期评价患者肢体功能,采用Bobath法平衡功能评定表评价患者坐站平衡功能,采用改良Barthel指数(MBI)评价患者日常生活活动能力。结果两组患者治疗后上肢、手、下肢Brunnstrum分期,Bobath法坐位、立位平衡功能分级以及MBI评分均明显提高(观察组:Uc=5.037、4.567、5.228、2.538、6.508,t=36.215,均P<0.05;对照组:Uc=2.483、2.311、2.335、2.200、4.102,t=29.260,均P<0.05),且观察组患者治疗后各项指标均优于对照组,差异有统计学意义(Uc=2.592、2.243、2.897、2.018、2.825,t=8.375,均P<0.05)。结论Bobath技术和运动再学习方法结合任务导向性训练对卒中患者肢体运动功能的恢复和日常生活能力的提高具有积极的促进作用。

Objective To evaluate the efficacy of task-oriented training for rehabilitation of stroke patients with hemiplegia in the community.Methods Eighty stroke patients with hemiplegia receiving rehabilitation in Shanghai Babsongyuan Subdistrict Community Health Service Center from January 2017 to December 2019 were enrolled in the study.According to the rehabilitation methods,the patients were divided into the observation group(42 cases)and the control group(38 cases).Both groups were given routine Bobath technique and motor relearning method for 3 months;on this basis the observation group was given additional task-oriented training.The Brunnstrum stage was used to evaluate the limb function,Bobath balance scale was used to evaluate the sitting and standing balance function,and modified Barthel Index(MBI)was used to evaluate the activities of daily living.Results The Brunnstrum stage of upper limbs,hands and lower limbs,Bobath sitting and standing balance function classification and MBI score of the two groups were significantly improved after treatment(the observation group:Uc=5.037,4.567,5.228,2.538,6.508,t=36.215,P<0.05;the control group:Uc=2.483,2.311,2.335,2.200,4.102,t=29.260,P<0.05).While the Brunnstrum stage of upper limb,hand and lower limb,Bobath sitting and standing balance function grade of observation group were significantly better than those of control group,MBI score was significantly higher than that of control group(Uc=2.592,2.243,2.897,2.018,2.825,t=8.375,P<0.05).Conclusion Bobath technique and motor relearning method combined with task-oriented training can significantly enhance the recovery of limb motor function and the improvement of activities of daily living of stroke patients.