任务导向训练与音乐治疗在脑卒中上肢运动功能康复中的应用

Application of Task-oriented Training Combined with Music Therapy in Upper Limb Function Rehabilitation of Stroke Patients

目的:观察任务导向训练结合音乐治疗对脑卒中后患者上肢运动功能和日常生活活动能力的影响。方法:随机选取84名在上海申养康复医院住院接受治疗的脑卒中发病后6个月~1年,患侧上肢Brunnstrom 3期的患者,实际入组76例,随机分为4组。其中A组(20例)为常规作业治疗15min+任务导向训练15min;B组(19例)训练为常规作业治疗15min+音乐治疗15min;C组(18例)训练为常规作业治疗15min+任务导向训练15min,在任务导向训练的同时进行音乐治疗15min;D组(19例)训练为常规作业治疗30min,各组均连续训练4周。在治疗前后分别进行Fugl-Meyer评分量表(FMA)、Wolf功能试验量表(WFMT)和改良Barthel指数(MBI)评定。结果:治疗4周后,4组FMA、WFMT及MBI评分较治疗前均有显著升高(P<0.05),且C组评分高于A、B及D组(P<0.05),A组和B组评分高于D组(P<0.05),A组和B组评分比较差异无统计学意义。结论:在常规作业治疗基础上,对脑卒中患者进行音乐治疗联合任务导向训练,能显著改善其患侧上肢的运动功能和日常生活能力,临床效果优于任务导向训练和音乐治疗单独治疗。

Objective:To observe the effect of task-oriented training combined with music therapy in upper limb motor function and activities of daily living in post-stroke patients,and to provide a more economical and easy-to-promote treatment method for stroke patients with upper limb motor dysfunction.Methods:A total of 84 patients with Brunnstrom stage 3 of the upper limb on the affected side receiving treatment from 6 months to 1 year after stroke onset who were hospitalized in Shanghai Shenyang Rehabilitation Hospital were randomly divided into 4 groups,and 76 cases were actually enrolled.All patients were trained according to the grouping situation.Group A(n=20)was trained with conventional occupational therapy for 15 min and task-oriented training for 15 min.Group B(n=19)was trained with conventional occupational therapy for 15 min and music therapy for 15 min.Group C(n=18)was trained with conventional occupational therapy for 15 min and task-oriented training for 15 min at the same time as music therapy for 15 min.Group D(n=19)was given conventional occupational therapy for 30 min.The patients in each group received continuous training for 4 weeks.Fugl-meyer scale,WFMT functional test scale and modified Barthel index scale were used before and after treatment.Results:After treatment,scores of Fugl-Meyer scale,WFMT functional test scale and modified Barthel index scale were higher than those before the trial(P<0.05).The score in group C was higher than that in group A,group B and group D(P<0.05).The score in group A and group B was higher than that in group D(P<0.05).but thare was no statistical cignificance bctueen group A an group B.Conclusion:On the basis of routine occupational therapy,music therapy combined with task-oriented training for stroke patients can significantly improve the motor function and daily living ability of the upper limbs on the affected side,and the clinical effect is better than task-oriented training and music therapy alone.