康复机器手治疗对脑卒中不同时期患者手功能恢复的影响

Effect of rehabilitation robotic hand therapy on hand function recovery at different periods of stroke

目的探讨康复机器手治疗对脑卒中急性期和恢复期患者手功能恢复的影响。方法选取2018年1月至2020年1月于新疆医科大学第一附属医院康复医学科住院的80例脑卒中患者作为研究对象,按照随机数字表法分为对照组与实验组,每组40例。对照组给予常规康复治疗,实验组在对照组基础上给予康复机器手治疗,比较两组Brunnstorm评分、Fugl-Meyer上肢运动功能量表中手功能部分(FMA-UEH)评分、Barthel指数(BI)评分及不良事件发生情况。结果组内比较:治疗2周,两组急性期Brunnstrom评分、FMA-UE-H评分与恢复期比较差异均无统计学意义;治疗4周,两组急性期、恢复期Brunnstrom评分、FMA-UE-H评分均高于治疗2周,且实验组急性期Brunnstrom评分、FMA-UE-H评分均高于恢复期,差异有统计学意义(P<0.05),对照组急性期Brunnstrom评分、FMA-UE-H评分与恢复期比较差异均无统计学意义;组间比较:治疗2周,两组急性期Brunnstrom评分、FMA-UE-H评分比较差异无统计学意义;治疗4周,实验组急性期Brunnstrom评分、FMA-UE-H评分均高于对照组,差异有统计学意义(P<0.05);治疗2、4周,两组恢复期Brunnstrom评分、FMA-UE-H评分比较差异均无统计学意义。两组急性期、恢复期BI评分时点比较差异有统计学意义(P<0.05),两组急性期BI评分组间比较差异有统计学意义(P<0.05),两组急性期、恢复期BI评分交互比较差异无统计学意义,两组恢复期BI评分组间比较差异无统计学意义。组内治疗前后比较:实验组急性期、恢复期治疗后各时点BI评分均高于前一时间点,差异有统计学意义(P<0.05);治疗2、4周,对照组急性期、恢复期BI评分均高于治疗前(P<0.05);组内不同分期比较:治疗4周,实验组急性期BI评分高于恢复期,差异有统计学意义(P<0.05),对照组急性期BI评分与恢复期比较差异无统计学意义。组间比较:治疗4周,实验组急性期BI评分高于对照组,差异有统计学意义P<0.05);两组各时间点恢复期BI评分比较差异均无统计学意义。两组均无皮肤擦伤、肌肉酸痛(不能耐受)、手部肿胀进行性加重情况发生。结论康复机器手治疗与常规康复治疗均可不同程度地改善患者手功能及日常生活活动能力,但康复机器手治疗急性期脑卒中疗效更佳。

Objective To explore the effect of rehabilitation robotic hand therapy on hand function recovery in patients with acute and convalescence stage of stroke.Methods 80 patients with stroke admitted to the department of Rehabilitation Medicine of the First Affiliated Hospital of Xinjiang Medical University from January 2018 to January 2020 were selected as the research subjects,and they were divided into the control group and the experimental group according to random number table method,with 30 cases in each group.The control group was given conventional rehabilitation therapy,and the experimental group was given rehabilitation robotic hand therapy on the basis of the control group,the Brunnstorm score,hand mobility scales of the Fugl-Meyer assessment upper extremity(FMA-UE-H)score,and Barthel index(BI)score and the occurrence of adverse events between two groups were compared.Results Within-group comparison:after 2 weeks of treatment,there was no significant difference in Brunnstrom score and FMA-UE-H score in acute and convalescence stages between the two groups;after 4 weeks of treatment,the Brunnstrom score and FMA-UE-H score in acute and convalescence stages of the two groups were higher than those at 2 weeks of treatment,and the Brunnstrom score and FMA-UE-H score in acute stage were higher than those in the convalescence stage in the experimental group,and the differences were statistically significant(P<0.05),there was no significant difference in the Brunnstrom score and FMA-UE-H score between the acute stage and convalescent stage in the control group.Comparison between the groups:after 2 weeks of treatment,there was no significant difference in the Brunnstrom score and FMA-UE-H score in the acute stage between the two groups;after 4 weeks of treatment,the Brunnstrom score and FMA-UE-H score in the experimental group were higher than those in the control group in acute stage,the differences were statistically significant(P<0.05).after 2 and 4 weeks of treatment,there was no significant difference in the Brunnstrom score and FMA-UE-H score in convalescence stage between the two groups.There was significant difference in the time point of BI score in acute and convalescence stages between the two groups(P<0.05),there was statistically significant difference in terms of inter-group of BI score in acute stage between the two groups(P<0.05);there was no significant difference in the interactive of BI score in acute and convalescence stages between the two groups,and there was no significant difference in terms of intergroup of BI score in convalescence stage between the two groups.Comparison before and after treatment within the groups:BI score in acute and convalescence stages in the experimental group at each time point after treatment were higher than those at the previous time point,and the differences were statistically significant(P<0.05);after 2 and 4 weeks of treatment,BI scores in acute and convalescence stages in the control group were higher than those before treatment,the differences were statistically significant(P<0.05).Comparison of different stages within the group:after 4 weeks of treatment,BI score in acute stage was higher than that in convalescence stage in the experimental group,the difference was statistically significant(P<0.05),there was no significant difference in BI score between the acute stage and convalescence stage in the control group.Comparison between groups:after 4 weeks of treatment,BI score in the experimental group was higher than that in the control group in the acute stage,and the difference was statistically significant(P<0.05);there was no significant difference in BI scores between the two groups at each time point.There was no skin abrasion,soreness(intolerable)and progressive aggravation of hand swelling in the two groups.Conclusion Both rehabilitation robotic hand therapy and conventional rehabilitation therapy can improve stroke patients'hand function and activities of daily living,however,but the effect of rehabilitation robotic hand therapy in the treatment of acute cerebral apoplexy is better.