上肢运动游戏对轻度认知障碍脑卒中患者功能恢复的效果

doi:10.3969/j.issn.1006-9771.2023.01.015

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (1): 98-103.doi: 10.3969/j.issn.1006-9771.2023.01.015

上肢运动游戏对轻度认知障碍脑卒中患者功能恢复的效果

李秀丽¹^,², 李珊¹^,², 冯梦晨¹^,², 黄富表¹^,²()

1.中国康复研究中心北京博爱医院作业疗法科，北京市 100068
2.首都医科大学康复医学院，北京市 100068

收稿日期:2021-12-22 修回日期:2022-04-15 出版日期:2023-01-25 发布日期:2023-02-17
通讯作者: 黄富表(1983-)，男，汉族，浙江绍兴市人，博士，副主任治疗师，主要研究方向：作业治疗策略的循证研究，E-mail： huangfubiao123@126.com。
作者简介:李秀丽(1984-)，女，汉族，北京市人，硕士研究生，主管治疗师，主要研究方向：作业疗法。
基金资助:
中国康复研究中心课题(2021ZX-Q4)

Effects of upper limb exergames on functional recovery in stroke patients with mild cognitive impairment

LI Xiuli¹^,², LI Shan¹^,², FENG Mengchen¹^,², HUANG Fubiao¹^,²()

1. Department of Occupational Therapy, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China
2. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China

Received:2021-12-22 Revised:2022-04-15 Published:2023-01-25 Online:2023-02-17
Contact: HUANG Fubiao, E-mail: huangfubiao123@126.com
Supported by:
China Rehabilitation Research Center Project(2021ZX-Q4)

摘要/Abstract

摘要：

目的观察上肢运动游戏对轻度认知障碍脑卒中患者认知功能、上肢运动功能和日常生活活动能力的影响。

方法选取2020年8月至2021年11月在北京博爱医院住院的脑卒中后轻度认知障碍患者50例，随机分为对照组和试验组各25例，两组均接受常规作业疗法训练，对照组增加功能性作业治疗，试验组增加上肢运动游戏训练，共4周。治疗前后分别采用蒙特利尔认知评估量表(MoCA)、Fugl-Meyer评定量表上肢部分(FMA-UE)和改良Barthel指数(MBI)评估治疗效果。

结果治疗后，两组MoCA总分、FMA-UE评分和MBI评分均较治疗前明显改善(|t| > 3.354, |Z| > 4.379, P < 0.01)。对照组MoCA 5个认知维度(除命名和抽象思维外)较治疗前提高(|Z| > 2.000, P < 0.05)；试验组MoCA 6个认知维度(除命名外)较治疗前明显提高(|Z| > 2.646, P < 0.01)。试验组治疗后MoCA总分及5个维度评分(除命名和抽象思维外)以及FMA-UE评分较对照组改善(|Z| > 1.982, t = 3.565, P < 0.05)。

结论上肢运动游戏可促进轻度认知障碍脑卒中患者认知功能、上肢运动功能和日常生活活动能力的恢复。

关键词: 脑卒中, 上肢运动游戏, 认知功能, 上肢运动功能, 日常生活活动能力

Abstract:

Objective To explore the effects of upper limb exergames on cognitive function, upper limb motor function and activities of daily living in stroke patients with mild cognitive impairment.

Methods From August, 2020 to November, 2021, 50 troke patients with mild cognitive impairment in Beijing Bo'ai Hospital were randomly allocated to control group (n = 25) and experimental group (n = 25). Both groups received traditional occupational therapy. Additional functional occupational therapy was provided to the control group, and upper limb exergames were provided to the experimental group, for four weeks. They were assessed with Montreal Cognitive Assessment (MoCA), Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and modified Barthel Index (MBI) before and after the treatment.

Results After treatment, the scores of MoCA, FMA-UE and MBI improved in both groups (|t| > 3.354, |Z| > 4.379, P < 0.01), and the scores increased in five MoCA cognitive domains in the control group (except map naming and abstract thinking) (|Z| > 2.000, P < 0.05) and in six MoCA cognitive domains in the experimental group (except map naming) (|Z| > 2.646, P < 0.01). After treatment, the scores of MoCA, MoCA five cognitive domains (except map naming and abstract thinking) and FMA-UE were better in the experiment group than in the control group(|Z| > 1.982, t = 3.565, P < 0.05).

Conclusion Upper limb exergames can facilitate the recovery of cognitive function, upper limb motor function and activities of daily living in stroke patients with mild cognitive impairment.

Key words: stroke, upper limb exergames, cognitive function, upper limb motor function, activities of daily living

中图分类号:

R743.3

李秀丽, 李珊, 冯梦晨, 黄富表. 上肢运动游戏对轻度认知障碍脑卒中患者功能恢复的效果[J]. 《中国康复理论与实践》, 2023, 29(1): 98-103.

LI Xiuli, LI Shan, FENG Mengchen, HUANG Fubiao. Effects of upper limb exergames on functional recovery in stroke patients with mild cognitive impairment[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(1): 98-103.

图/表 4

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项目	对照组 (n = 25)	试验组 (n = 25)	t/Z/χ²值	P值
性别(男/女)/n	20/5	17/8	0.936	0.333
年龄/岁	51.8±12.0	52.0±11.1	0.061	0.914
病程/d	40(35.5, 48)	40(21, 62)	-0.563	0.573
受教育年限/年	15(12, 16)	15(12, 17.5)	-0.437	0.662
MoCA总分	18.04±2.46	17.8±2.8	-1.743	0.081
卒中类型(梗死/出血)/n	10/15	12/13	0.325	0.569
脑损伤侧(右/左)/n	11/14	11/14	0.000	1.000

项目	对照组(n = 25)		试验组(n = 25)		t/Z值^a	P值^a	t/Z值^b	P值^b	t/Z值^c	P值^c	t/Z值^d	P值^d
项目	治疗前	治疗后	治疗前	治疗后	t/Z值^a	P值^a	t/Z值^b	P值^b	t/Z值^c	P值^c	t/Z值^d	P值^d
视空间执行能力	4.0(3.0，4.0)	4.0(3.0，4.0)	3.0(3.0，4.0)	4.0(3.0，5.0)	-2.449	0.014	-3.162	0.002	-0.459	0.646	-2.134	0.033
命名	3.0(3.0，3.0)	3.0(3.0，3.0)	3.0(3.0，3.0)	3.0(3.0，3.0)	-1.000	0.317	-1.414	0.157	-0.467	0.641	-1.429	0.153
注意力	3.0(3.0，4.0)	4.0(3.0，4.0)	3.0(3.0，4.0)	3.0(3.0，4.0)	-2.646	0.008	-2.646	0.008	-0.386	0.700	-2.086	0.037
语言流畅	2.0(1.0，2.0)	2.0(1.0，2.0)	1.0(1.0，2.0)	2.0(1.0，2.0)	-2.000	0.046	-2.646	0.008	-0.264	0.792	-1.982	0.048
抽象思维	1.0(1.0，1.0)	1.0(1.0，1.0)	1.0(1.0，1.0)	1.0(1.0，2.0)	-1.414	0.157	-2.646	0.008	-0.241	0.810	-1.402	0.161
延迟记忆	1.0(0.0，2.0)	2.0(1.0，2.0)	1.0(0.0，2.0)	2.0(1.0，3.0)	-3.606	< 0.001	-4.184	< 0.001	-0.264	0.792	-2.306	0.021
定向力	5.0(4.5，5.0)	5.0(5.0，5.0)	5.0(4.0，5.0)	5.0(5.0，6.00)	-2.236	0.025	-3.606	< 0.001	-0.705	0.481	-2.060	0.039
总分	18.04±2.458	18.76±2.83	17.80±2.80	20.52±3.27	-3.354	0.001	-12.364	< 0.001	-0.322	0.749	3.565	0.001

组别	n	治疗前	治疗后	Z值	P值
对照组	25	12.0(9.5，22.0)	20.0(12.5，30.5)	-4.383	< 0.001
试验组	25	18.0(12.5，35.5)	27.0(21.0，50.0)	-4.379	< 0.001
Z值		-1.477	-2.294
P值		0.140	0.022

组别	n	治疗前	治疗后	t值	P值
对照组	25	43.21±8.71	49.96±10.89	-10.246	< 0.001
试验组	25	42.54±6.24	53.17±7.48	-8.544	< 0.001
t值		-0.305	1.190
P值		0.762	0.241

上肢运动游戏对轻度认知障碍脑卒中患者功能恢复的效果

Effects of upper limb exergames on functional recovery in stroke patients with mild cognitive impairment

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