强制性运动与作业疗法对颅脑损伤后上肢功能恢复的影响

Influence of forced movement and occupational therapy in the recovery of upper limb function following craniocerebral injury

目的:探讨强制性运动配合作业疗法对颅脑损伤患者上肢运动功能康复的影响。方法:将21例有颅脑损伤上肢功能障碍的入选患者,根据入院的先后顺序,采用随机数字表,将患者随机分为作业组(单纯采用作业疗法)10例、强制性运动组(在强制限制运动的同时加强患侧作业运动)11例,其中女6例、男15例,4例经过脑外科手术治疗,病程为2～6个月。分别于治疗前和治疗后进行Fugl-Meyer和Bathel指数评定。结果:两组治疗前Fugl-Mgyer运动障碍评定分与Bathel指数差异无显著性意主义(P>0.05),治疗后两组患者的上肢Fugl-Mgyer运动障碍评定总积分均有变化,作业组积分由治疗前的(21.51±9.24)分增加为(37.44±6.29)分(P<0.01);强制性运动组积分由治疗前的(25.79±6.22)分增加为(51.66±7.76)分,差异有显著性意义(F=35.04,P<0.001);日常生活能力评定作业组Bathel指数由治疗前的(36.16±7.74)分上升为(69.69±10.58)分(P<0.01),而强制性作业治疗组Bathel指数由治疗前的(38.04±9.16)分上升为(86.75±6.57)分(F=88.13,P<0.01)。结论:强制性运动下适当地选择作业疗法对颅脑损伤后上肢功能,尤其是上肢的精细运动的恢复有明显的效果,为肢体功能的康复训练开辟了一条的新型的道路。

AIM:To explore the effects of forced movement and occupational therapy in the rehabilitation of upper limb function in patients with craniocerebral injury.METHODS:According to the hospitalized order,21 craniocerebral injuiry patients with upper limb dysfunction were selected and randomized into occupational group of 10 cases,forced movement group of 11 cases(6 females and 15 males),including 4 cases receiving surgical intervention.The course of disease ranged from 2 to 6 months.Fugl-Meyer assessment was performed to evaluate movement dysfunction and Bathel index(BI) was measured respectively before and after treatment.RESULTS:There were no significant differences between the two groups before treatment in Fugl-Meyer assessment and BI(P >0.05).The scores of Fugl-Meyer assessment for upper limb dysfunction were increased from 21.51±9.24 to 37.44±6.29 in the occupational group(P< 0.01),and from 25.79±6.22 to 51.66±7.76 in the forced movement group(F=35.04,P< 0.001).BI for ability of daily living in the occupational group was increased from 36.16±7.74 to 69.69±10.58(P< 0.01),while from 38.04±9.16 to 86.75±6.57 in the forced movement group(F=88.13,P< 0.01).CONCLUSION:Selective occupational therapy during forced movement plays a remarkable role in the rehabilitation of fine motor function of upper limb in patients with craniocerebral injury,which breaks a new path for the rehabilitation of limb function.