多维度视频定量评估系统在脑卒中患者手功能康复评估中的应用

Application of multi-dimensional video quantitative evaluation system in hand function rehabilitation evaluation of stroke patients

目的 探讨多维度视频定量评估系统(简称多维系统)在脑卒中患者手功能评估中的应用。方法 对37例脑卒中并单手功能障碍的患者,采用多维系统、量角器测量手主动关节活动度(AROM)、Fugl-Meyer上肢运动功能评估量表(Fugl-Meyer motor assessment scale-upper extremities,U-FMA)、Brunnstrom分级进行评估。分析多维度系统和量角器测量AROM所得结果的一致性、耗时及对治疗效果反应性的差异性,分析4种评估方法所得结果的相关性。结果 一致性比较:指间夹角1(ICC=0.748)、指间夹角3(ICC=0.739)在治疗后的数据显示一致性一般,其余结果一致性好(ICC=0.754~0.990)。治疗效果反应性:多维系统和量角器测量AROM治疗前、后的增加量差异无统计学意义(P>0.05),前臂旋后、腕背伸治疗前、后比较差异均有统计学意义(P<0.05),尺偏、前臂旋前治疗前后差异均有统计学意义(P<0.05)。耗时:多维系统在2次评估过程中完成5个动作平均时间分别是(8.6±2.7)min、(6.9±3.1)min,与量角器测量耗时差异无统计学意义(P>0.05);全部完成10个动作的平均时间分别为(19.9±6.9) min、(15.4±8.0)min。相关性分析:多维系统与量角器测量、U-FMA、Brunnstrom 2次评估之间均呈高度相关(γ=0.922~0.973,P<0.01;γ=0.910~0.954,P<0.01)。针对多维系统其他动作在不同时间的结果比较,拇指外展、拇指环转的结果差异无统计学意义(P>0.05),其余差异均有统计学意义(P<0.05)。结论 多维系统和量角器测量的AROM治疗前、后的增加量是相同的,多维系统耗时不长,且能反映微小的功能变化,但稳定性及个别动作的评估不完善,需要改进。

Objective To explore the application of multi-dimensional video quantitative evaluation system(hereinafter refferred to as the Multi-dimensional system) in hand function evaluation of stroke patients.Methods Thirty-seven patients with stroke and one hand dysfunction were evaluated by multi-dimensional system,progler measurement of active range of motion(AROM),Fugl-Meyer upper limb motor function(FMA),and Brunnstrom.The consistency of AROM measurements by multi-dimensional system and protractor,the time consuming of the two assessment methods and the difference in response to treatment were analyzed,and the correlation of results obtained by the four evaluation methods was analyzed.Results Consistency comparison:Interfinger Angle 1(ICC=0.748) and interfinger Angle 3(ICC=0.739) showed general consistency after treatment,Other results were consistent(ICC=0.754~0.990).Reactivity of therapeutic effect:there was no significant difference in the increase of AROM measured by multi-dimensional system and prometer before and after treatment(P>0.05),there were significant differences in forearm supination and wrist dorsiflexion before and after treatment(P<0.05),and there were significant differences in ulnar deviation and forearm pronation before and after treatment(P<0.05).Time consuming:In the two evaluation processes,the average time of the multidimensional system to complete five actions was(8.6±2.7)minutes and(6.9±3.1) minutes respectively,which showed no difference with the measurement time of the prometer(P>0.05).The average time for all 10 actions was(19.9±6.9)minutes and(15.4±8.0) minutes,respectively.Correlation analysis:The results of the two evaluations showed that there was a high correlation between multi-dimensional system,prometer measurement,U-FMA and Brunnstrom(γ=0.922~0.973,P<0.01;γ=0.910~0.954,P<0.01).Comparing the results of other actions in the multi-dimensional system at different times,there was no statistical significance in the results of thumb abduction and thumb loop rotation(P>0.05),while the other differences were statistically significant(P<0.05).Conclusion The increase of AROM before and after treatment measured by the multi-dimensional system and protractor is the same.the system does not take long,and it can reflect small functional changes,but the stability of the system and the evaluation of individual movements are not perfect and need to be improved.