上肢康复机器人训练对亚急性脑卒中患者认知和上肢运动功能的效果

doi:10.3969/j.issn.1006-9771.2022.05.003

摘要/Abstract

摘要：

目的探讨上肢康复机器人训练对亚急性脑卒中患者认知功能、上肢运动功能和日常生活能力的影响。方法 2019年9月至2020年9月,温州医科大学附属第一医院康复科亚急性期脑卒中并发认知障碍的偏瘫患者65例随机分为对照组(n = 32,脱落2例)和试验组(n = 33,脱落3例)。两组均接受常规作业治疗,对照组接受常规认知训练,试验组接受上肢康复机器人训练,共4周。治疗前后采用蒙特利尔认知评估(MoCA)、简易精神状态检查(MMSE)、Fugl-Meyer评定量表上肢部分(FMA-UE)和改良Barthel指数(MBI)进行评定。结果治疗后,两组MoCA、MMSE、FMA-UE和MBI评分均显著改善(t > 22.11, Z > 4.79, P < 0.001),试验组MoCA总分及部分维度分,MMSE总分及部分维度分,FMA-UE总分及手臂分,MBI评分均优于对照组(t > 2.06, Z > 3.19, P < 0.05)。结论上肢康复机器人训练有助于改善亚急性脑卒中患者的认知功能、上肢运动功能和日常生活活动能力。

关键词: 脑卒中, 认知障碍, 上肢康复机器人训练, 作业治疗

Abstract:

Objective To investigate the effects of upper limb robot-assisted training on cognitive function, upper limb motor function and activity of daily living for subacute stroke patients. Methods From September, 2019 to September, 2020, 65 subacute stroke hemiplegic patients with cognitive impairment were randomly divided into control group (n = 32, two cases dropped) and experimental group (n = 33, three cases dropped). Both groups accepted conventional occupational therapy; and then, the control group accepted conventional cognitive training, while the experimental group accepted upper limb robot-assisted training, for four weeks. They were assessed with Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and modified Barthel Index (MBI) before and after treatment. Results The scores of MoCA, MMSE, FMA-UE and MBI improved after treatment in both groups (t > 22.11, Z > 4.79, P < 0.001), the MoCA total score and some item-scores, MMSE total score and some item-scores, FMA-UE total score and the score of arm, and score of MBI improved more in the experimental group than in the control group (t > 2.06, Z > 3.19, P < 0.05). Conclusion Upper limb robot-assisted training could facilitate to improve the cognitive function, upper limb motor function and activities of daily living in subacute stroke patients.

Key words: stroke, cognitive impairment, upper limb robot-assisted training, occupational therapy

中图分类号:

R743.3

苏丽丽,方小养,林玲,李海燕. 上肢康复机器人训练对亚急性脑卒中患者认知和上肢运动功能的效果[J]. 《中国康复理论与实践》, 2022, 28(5): 508-514.

SU Lili,FANG Xiaoyang,LIN Ling,LI Haiyan. Effects of upper limb robot-assisted training on cognition and upper limb motor function for subacute stroke patients[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(5): 508-514.

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参考文献 35

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组别	n	性别(男/女) /n	年龄/岁	受教育年限 /年	文化程度 (小学/初中) /n	病程/d	类型 (脑梗死/脑出血) /n	偏瘫侧(左/右) /n
对照组	30	15/15	65.53±5.46	6.90±2.35	11/19	26.73±4.08	15/15	16/14
试验组	30	14/16	64.97±4.88	6.73±2.26	13/17	27.13±3.88	16/14	16/14
χ²/t值		0.07	0.42	0.28	0.52	0.39	0.07	0.00
P值		0.80	0.67	0.78	0.60	0.70	0.80	1.00

项目	对照组(n = 30)		试验组(n = 30)		t₁值	P₁值	t₂值	P₂值	t₃值	P₃值	t₄值	P₄值
项目	治疗前	治疗后	治疗前	治疗后	t₁值	P₁值	t₂值	P₂值	t₃值	P₃值	t₄值	P₄值
视空间与执行功能	1.20±0.71	1.80±0.92	1.27±0.64	2.27±0.83	5.84	< 0.001	12.04	< 0.001	0.38	0.705	2.06	0.044
命名	2.10±0.66	2.10±0.66	2.03±0.67	2.43±0.50	1.80	0.083	3.27	0.003	0.40	0.689	2.20	0.032
注意	1.17±0.53	1.90±0.80	1.13±0.73	2.37±0.76	5.81	< 0.001	15.70	< 0.001	0.20	0.840	2.31	0.025
语言	1.83±0.59	2.30±0.53	1.87±0.57	1.90±0.66	5.04	< 0.001	1.44	0.161	0.00	1.000	2.58	0.013
抽象	0.43±0.50	0.47±0.51	0.43±0.50	0.80±0.61	1.00	0.326	4.10	< 0.001	0.00	1.000	2.30	0.025
延迟回忆	1.10±0.80	1.13±0.82	0.97±0.49	2.10±0.55	1.00	0.326	12.23	< 0.001	0.78	0.441	5.37	0.000
定向	2.07±0.64	3.30±0.92	1.97±0.85	3.37±0.61	9.95	< 0.001	9.96	< 0.001	0.52	0.609	0.33	0.742
总分	9.93±2.39	13.07±2.66	9.70±2.22	15.20±2.19	22.11	< 0.001	36.74	< 0.001	0.39	0.696	3.39	0.001

项目	对照组(n = 30)		试验组(n = 30)		t₁值	P₁值	t₂值	P₂值	t₃值	P₃值	t₄值	P₄值
项目	治疗前	治疗后	治疗前	治疗后	t₁值	P₁值	t₂值	P₂值	t₃值	P₃值	t₄值	P₄值
定向	5.17±0.70	6.43±0.90	5.20±0.85	6.63±0.89	10.85	< 0.001	15.58	< 0.001	0.17	0.869	0.87	0.390
记忆	2.40±0.50	2.67±0.48	2.53±0.51	2.93±0.25	3.25	0.003	4.40	< 0.001	1.03	0.309	2.69	0.009
注意和计算	2.10±0.61	3.17±0.70	1.90±0.55	4.03±0.72	12.04	< 0.001	20.45	< 0.001	1.34	0.186	4.54	< 0.001
回忆	1.33±0.55	2.07±0.52	1.10±0.61	2.53±0.51	7.71	< 0.001	15.58	< 0.001	1.56	0.123	3.52	0.001
语言	3.30±0.70	4.50±0.90	2.97±0.61	5.07±0.78	9.20	< 0.001	18.94	< 0.001	1.96	0.055	2.60	0.012
视空间结构	0.37±0.49	0.53±0.51	0.53±0.51	1.00±0.00	2.41	0.023	5.04	< 0.001	1.29	0.201	5.04	< 0.001
总分	14.60±1.75	19.50±2.03	14.23±1.61	22.20±1.69	37.70	< 0.001	49.03	< 0.001	0.84	0.403	5.60	< 0.001

组别	n	治疗前	治疗后	t值	P值
对照组	11	13.09±1.45	17.73±1.62	22.81	< 0.001
试验组	13	13.77±1.30	21.85±1.63	26.11	< 0.001
t值		1.21	6.20
P值		0.239	< 0.001

组别	n	治疗前	治疗后	t值	P值
对照组	19	15.47±1.26	20.53±1.47	31.24	< 0.001
试验组	17	14.59±1.77	22.47±1.74	46.65	< 0.001
t值		1.74	3.64
P值		0.091	0.001