反复促进疗法对脑卒中恢复期偏瘫患者手功能的影响

doi:10.3969/j.issn.1006-9771.2023.06.010

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (6): 697-702.doi: 10.3969/j.issn.1006-9771.2023.06.010

反复促进疗法对脑卒中恢复期偏瘫患者手功能的影响

顾彬¹^,², 张津沁², 夏元浩², 胡靖然³, 诸桥直纪⁴, 黄富表¹^,²()

1.首都医科大学康复医学院，北京市 100068
2.中国康复研究中心北京博爱医院，北京市 100068
3.山西省心血管病医院，山西太原市 030024
4.畿央大学，日本奈良县 635-0832

收稿日期:2023-03-31 修回日期:2023-05-29 出版日期:2023-06-25 发布日期:2023-07-14
通讯作者: 黄富表(1983-)，男，汉族，浙江绍兴市人，博士，副主任技师，主要研究方向：神经系统的作业治疗，近红外脑功能成像在康复领域中的应用。E-mail： huangfubiao123@126.com
作者简介:顾彬(1986-)，男，汉族，山东滨州市人，硕士，主管技师，主要研究方向：神经康复、手功能康复、作业治疗。
基金资助:
国家自然科学基金项目(U1913209)

Effect of repetitive facilitative exercise on hand function of stroke patients with hemiplegic during recovery period

GU Bin¹^,², ZHANG Jinqin², XIA Yuanhao², HU Jingran³, NAOKI Morohashi⁴, HUANG Fubiao¹^,²()

1. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
2. Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China
3. Shanxi Cardiovascular Hospital, Taiyuan, Shanxi 030024, China
4. Kio University, Nara 635-0832, Japan

Received:2023-03-31 Revised:2023-05-29 Published:2023-06-25 Online:2023-07-14
Contact: HUANG Fubiao, E-mail: huangfubiao123@126.com
Supported by:
National Natural Science Foundation of China(U1913209)

摘要/Abstract

摘要：

目的观察反复促进疗法(RFE)对脑卒中恢复期偏瘫患者手功能的影响。
方法 2022年1月至12月，北京博爱医院脑卒中恢复期偏瘫伴手功能障碍患者80例随机分为对照组(n = 40)和试验组(n = 40)。两组均进行常规康复治疗，对照组增加功能性作业治疗，试验组增加RFE，共4周。治疗前后采用Fugl-Meyer评定量表上肢部分(FMA-UE)、简易上肢功能检查(STEF)和改良Barthel指数(MBI)进行评价。
结果试验组脱落1例。治疗后，两组各项评分均显著提高(|t| > 12.698, P < 0.001)，且试验组均优于对照组(|t| > 2.302, P < 0.05)。
结论 RFE有助于促进脑卒中恢复期偏瘫患者手功能和日常生活活动能力恢复。

关键词: 脑卒中, 偏瘫, 反复促进疗法, 手功能

Abstract:

Objective To observe the effect of repetitive facilitative exercise (RFE) on the hand function of stroke patients with hemiplegia during recovery period.
Methods From January to December, 2022, 80 stroke patients with hemiplegia following hand dysfunction during recovery period in Beijing Bo'ai Hospital were randomly divided into control group (n = 40) and experimental group (n = 40). Both groups received routine rehabilitation, the control group added functional occupational therapy, and the experimental group added RFE, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Simple Test for Evaluating Hand Function (STEF) and modified Barthel Index (MBI) before and after treatment.
Results One case dropped down in the experimental group. After treatment, all the scores increased in both groups (|t| > 12.698, P < 0.001), and were better in the experimental group than in the control group (|t| > 2.302, P < 0.05).
Conclusion RFE could promote the recovery of hand function and activities of daily living in patients with hemiplegia during stroke recovery period.

Key words: stroke, hemiplegia, repetitive facilitative exercise, hand function

中图分类号:

R743.3

顾彬, 张津沁, 夏元浩, 胡靖然, 诸桥直纪, 黄富表. 反复促进疗法对脑卒中恢复期偏瘫患者手功能的影响[J]. 《中国康复理论与实践》, 2023, 29(6): 697-702.

GU Bin, ZHANG Jinqin, XIA Yuanhao, HU Jingran, NAOKI Morohashi, HUANG Fubiao. Effect of repetitive facilitative exercise on hand function of stroke patients with hemiplegic during recovery period[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(6): 697-702.

图/表 4

表1

表2

表3

表4

参考文献 28

[1]	CHEN J, OR C K, CHEN T. Effectiveness of using virtual reality-supported exercise therapy for upper extremity motor rehabilitation in patients with stroke: systematic review and meta-analysis of randomized controlled trials[J]. J Med Internet Res, 2022, 24(6): e24111. doi: 10.2196/24111
[2]	GALEOTO G, IORI F, DESANTIS R, et al. The outcome measures for loss of functionality in the activities of daily living of adults after stroke: a systematic review[J]. Top Stroke Rehabil, 2019, 26(3): 236-245. doi: 10.1080/10749357.2019.1574060 pmid: 30774018
[3]	XING Y, YANG S D, DONG F, et al. The beneficial role of early exercise training following stroke and possible mechanisms[J]. Life Sci, 2018, 198: 32-37. doi: S0024-3205(18)30068-7 pmid: 29452165
[4]	王剑桥, 刘惠林. Bobath理念在卒中后偏瘫患者步态康复中的研究进展[J]. 中国康复理论与实践, 2019, 25(6): 683-685. doi: 10.3969/j.issn.1006-9771.2019.00.004
	WANG J Q, LIU H L. Bobath Concept in the process of gait rehabilitation for post-stroke patients with hemiplegia (review)[J]. Chin J Rehabil Theory Pract, 2019, 25(6): 683-685.
[5]	川平和美. 脳卒中リハビリテーションの革新を目指す促通反復療法(川平法)-患者に無駄をさせない神経路の再建強化を目指して[J]. 全日本鍼灸学会雑誌, 2013, 63(4): 244-251.
	KAWAHIRA K. Repetitive facilitative exercise (Kawahira's Methods) aiming at the innovation of stroke rehabilitation training aim at reconstructing and strengthening neural pathways[J]. Jpn J Acup Moxib, 2013, 63 (4): 244-251.
[6]	小川彰, 園田茂, 児玉三彦,他. 脳卒中治療ガイドライン2015[M]. 東京: 協和企画, 2015: 292-294.
	OGAWA A, SONODA S, KODAMA M, et al. Japanese Guidelines for the Management of Stroke 2015[M]. Tokyo: KYOWA KIKAKU, 2015: 292-294.
[7]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志, 2019, 52(9): 710-715.
	Chinese Society of Neurology, Chinese Stroke Society. Diagnostic Criteria of Cerebrovascular Diseases in China (version 2019)[J]. Chin J Neurol, 2019, 52(9): 710-715.
[8]	AMANO S, UMEJI A, UCHITA A, et al. Clinimetric properties of the Fugl-Meyer Assessment with adapted guidelines for the assessment of arm function in hemiparetic patients after stroke[J]. Top Stroke Rehabil, 2018, 25(7): 500-508. doi: 10.1080/10749357.2018.1484987 pmid: 30028660
[9]	曹丽辉, 黄富表, 徐筱婧媛. 中国人简易上肢功能检查测试结果分析[J]. 中国康复理论与实践, 2021, 27(6): 730-736. doi: 10.3969/j.issn.1006-9771.2021.06.016
	CAO L H, HUANG F B, XU X J Y. Simple Test for Evaluating Hand Function for Chinese[J]. Chin J Rehabil Theory Pract, 2021, 27(6): 730-736.
[10]	王赛华, 施加加, 孙莹, 等. 简体版改良Barthel指数在脑卒中恢复期中的信度与效度研究[J]. 中国康复, 2020, 35(4): 179-182.
	WANG S H, SHI J J, SUN Y, et al. Reliability and validity of the simplified version modified Barthel Index in convalescence period of stroke[J]. Chin J Rehabil, 2020, 35(4): 179-182.
[11]	CONNELL L A, KLASSEN T K, JANSSEN J, et al. Delivering intensive rehabilitation in stroke: factors influencing implementation[J]. Phys Ther, 2018, 98(4): 243-250. doi: 10.1093/ptj/pzy018 pmid: 29415282
[12]	MURRELL J E, PISEGNA J L, JUCKETT L A. Implementation strategies and outcomes for occupational therapy in adult stroke rehabilitation: a scoping review[J]. Implement Sci, 2021, 16(1): 105. doi: 10.1186/s13012-021-01178-0 pmid: 34922568
[13]	ROLL S C, HARDISON M E. Effectiveness of occupational therapy interventions for adults with musculoskeletal conditions of the forearm, wrist, and hand: a systematic review[J]. Am J Occup Ther, 2017, 71(1): 7101180010p1-7101180010p12. doi: 10.5014/ajot.2017.023234
[14]	ETOH S, NOMA T, MIYATA R, et al. Effects of repetitive facilitative exercise on spasticity in the upper paretic limb after subacute stroke[J]. J Stroke Cerebrovasc Dis, 2018, 27(10): 2863-2868. doi: S1052-3057(18)30333-1 pmid: 30072181
[15]	OHNISHI H, MIYASAKA H, SHINDO N, et al. Effectiveness of repetitive facilitative exercise combined with electrical stimulation therapy to improve very severe paretic upper limbs in with stroke patients: a randomized controlled trial[J]. Occup Ther Int, 2022, 2022: 4847363.
[16]	ETOH S, NOMA T, TAKIYOSHI Y, et al. Effects of repetitive facilitative exercise with neuromuscular electrical stimulation, vibratory stimulation and repetitive transcranial magnetic stimulation of the hemiplegic hand in chronic stroke patients[J]. Int J Neurosci, 2016, 126(11): 1007-1012. doi: 10.3109/00207454.2015.1094473
[17]	SHIMODOZONO M, NOMA T, NOMOTO Y, et al. Benefits of a repetitive facilitative exercise program for the upper paretic extremity after subacute stroke: a randomized controlled trial[J]. Neurorehabil Neural Repair, 2013, 27(4): 296-305. doi: 10.1177/1545968312465896 pmid: 23213077
[18]	王晓光, 陶徉聿, 薛新宏, 等. 反复促通疗法对脑卒中合并高血压偏瘫患者手功能的影响[J]. 华北理工大学学报(医学版), 2022, 24(4): 296-300.
	WANG X G, TAO Y L, XUE X H, et al. Effect of repeated facilitation therapy on hand function in stroke patients with hypertensive hemiplegia[J]. J North China Univ Sci Technol (Health Sci Ed), 2022, 24(4): 296-300.
[19]	SHIMODOZONO M, NOMA T, MATSUMOTO S, et al. Repetitive facilitative exercise under continuous electrical stimulation for severe arm impairment after sub-acute stroke: a randomized controlled pilot study[J]. Brain Inj, 2014, 28(2): 203-210. doi: 10.3109/02699052.2013.860472 pmid: 24304090
[20]	庞争争, 计弯弯, 张环, 等. 重复经颅磁刺激联合反复促通疗法对脑卒中患者上肢运动功能康复的疗效观察[J]. 中国康复, 2022, 37(8): 464-467.
	PANG Z Z, JI W W, ZHANG H, et al. Effect of repeated transcranial magnetic stimulation combined with repeated facilitation therapy on the rehabilitation of upper limb motor function in stroke patients[J]. Chin J Rehabil, 2022, 37(8): 464-467.
[21]	ETOH S, KAWAMURA K, OMONAGA K, et al. Effects of concomitant neuromuscular electrical stimulation during repetitive transcranial magnetic stimulation before repetitive facilitation exercise on the hemiparetic hand[J]. NeuroRehabilitation, 2019, 45(3): 323-329. doi: 10.3233/NRE-192800 pmid: 31796693
[22]	陈忠强, 杨帆, 朱鑫鑫, 等. 反复促通技术联合针灸对脑梗死患者功能恢复及生存质量的影响分析[J]. 中国康复, 2022, 37(5): 276-278.
	CHEN Z Q, YANG F, ZHU X X, et al. Effect of repetitive facilitative exercise combined with acupuncture on functional recovery and quality of life in patients with cerebral infarction[J]. Chin J Rehabil, 2022, 37(8): 276-278.
[23]	KAWAHIRA K, SHIMODOZONO M, ETOH S, et al. Effects of intensive repetition of a new facilitation technique on motor functional recovery of the hemiplegic upper limb and hand[J]. Brain Inj, 2010, 24(10): 1202-1213. doi: 10.3109/02699052.2010.506855 pmid: 20715890
[24]	姜文, 郭川, 徐胜, 等. 反复促通疗法联合肌电反馈式助力电刺激对卒中偏瘫患者下肢运动功能障碍的效果研究[J]. 中国脑血管病杂志, 2022, 19(8): 548-553, 571.
	JIANG W, GUO C, XU S, et al. Effect of repetitive facilitative exercise combined with power-assisted electrical stimulation on the stroke patients with lower extremity motor dysfunction[J]. Chin J Cerebrovasc Dis, 2022, 19(8): 548-553, 571.
[25]	钮晟佳, 杨卫新, 张大伟, 等. 上肢机器人联合川平疗法对脑卒中患者上肢运动功能及日常生活活动能力的影响[J]. 中国康复医学杂志, 2021, 36(8): 1003-1005.
	NIU S J, YANG W X, ZHANG D W, et al. Effect of upper limb robot combined with repeated facilitation therapy on the rehabilitation of upper limb motor function and activities of daily living in stroke patients[J]. Chin J Rehabil Med, 2021, 36(8): 1003-1005.
[26]	RENNER C I, SCHUBERT M, HUMMELSHEIM H. Selective effect of repetitive hand movements on intracortical excitability[J]. Muscle Nerve, 2005, 31(3): 314-320. pmid: 15635691
[27]	RENNER C I, SCHUBERT M, JAHN M, et al. Intracortical excitability after repetitive hand movements is differentially affected in cortical versus subcortical strokes[J]. J Clin Neurophysiol, 2009, 26(5): 348-357. doi: 10.1097/WNP.0b013e3181baaa86 pmid: 20168132
[28]	HARRIS J E. Repetitive facilitative exercise improves upper limb function in patients with subacute stroke[J]. J Physiother, 2013, 59(3): 208. doi: 10.1016/S1836-9553(13)70186-3 pmid: 23896337

组别	n	性别(男/女)/n	年龄/岁	病程/月	卒中类型(出血/梗死)/n	病灶侧别(左/右)/n
对照组	40	26/14	46.83±7.58	2.50±0.85	9/31	23/17
试验组	39	23/16	48.28±7.28	2.38±0.88	11/28	25/14
χ²/t值		0.304	0.207	0.005	0.340	0.361
P值		0.581	0.651	0.946	0.560	0.548

组别	n	治疗前	治疗后	t值	P值
对照组	40	28.68±5.15	46.33±7.47	-12.776	< 0.001
试验组	39	27.72±4.89	50.13±7.20	-14.732	< 0.001
t值		0.847	-2.302
P值		0.400	0.024

组别	n	治疗前	治疗后	t值	P值
对照组	40	33.10±4.88	49.95±9.81	-12.698	< 0.001
试验组	39	32.87±5.20	59.93±10.83	-19.812	< 0.001
t值		0.201	-4.299
P值		0.841	< 0.001

组别	n	治疗前	治疗后	t值	P值
对照组	40	50.25±7.42	65.63±6.52	-14.237	< 0.001
试验组	39	50.38±6.73	71.92±6.24	-17.260	< 0.001
t值		-0.084	-4.383
P值		0.933	< 0.001

反复促进疗法对脑卒中恢复期偏瘫患者手功能的影响

Effect of repetitive facilitative exercise on hand function of stroke patients with hemiplegic during recovery period

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 4

参考文献 28

相关文章 15

Metrics

本文评价

推荐阅读 0

[1]	林娜, 高菡璐, 卢惠苹, 陈燕清, 郑军凡, 陈述荣. 虚拟现实技术对脑卒中上肢功能影响的弥散张量成像研究[J]. 《中国康复理论与实践》, 2024, 30(1): 61-67.
[2]	王昊懿, 史亚伟, 鲁俊, 许光旭. 主观垂直感知障碍对脑卒中患者功能影响的回顾性研究[J]. 《中国康复理论与实践》, 2024, 30(1): 68-73.
[3]	陈珺雯, 陈谦, 陈程, 李淑月, 刘玲玲, 吴存书, 龚翔, 鲁俊, 许光旭. 改良八段锦身体活动对脑卒中患者心肺功能、运动功能和日常生活活动能力的效果[J]. 《中国康复理论与实践》, 2024, 30(1): 74-80.
[4]	胡永林, 马颖, 窦超, 陆安民, 江小鸽, 宋新建, 肖玉华. 肩部控制训练联合神经松动术对脑卒中偏瘫患者肩痛及上肢功能的效果[J]. 《中国康复理论与实践》, 2024, 30(1): 81-86.
[5]	王贺, 韩靓, 阚梦凡, 于少泓. 电刺激治疗脑卒中后肩手综合征有效性的系统评价与Meta分析[J]. 《中国康复理论与实践》, 2023, 29(9): 1048-1056.
[6]	胡晓诗, 张琦, 岳青, 梁艳华, 李晓松, 冯啊美, 张燕庆. 矫形弹力绷带对痉挛性偏瘫脑性瘫痪患儿步态对称性和步行能力的效果[J]. 《中国康复理论与实践》, 2023, 29(9): 1083-1089.
[7]	孙藤方, 任梦婷, 杨琳, 王耀霆, 王红雨, 闫兴洲. 高压氧治疗联合重复外周磁刺激干预脑卒中患者踝运动功能和平衡能力的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 875-881.
[8]	王亚楠, 刘西花. 脑卒中偏瘫患者主观和客观平衡功能测量的相关性及预测效能[J]. 《中国康复理论与实践》, 2023, 29(8): 890-895.
[9]	王海云, 王寅, 周信杰, 何爱群. 基于“中枢-外周-中枢”理论的经颅直流电刺激结合针刺干预脑卒中患者中枢及上肢功能的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 919-925.
[10]	陈怡婷, 王倩, 崔慎红, 李映彩, 张思鈺, 魏衍旭, 任慧, 冷军, 陈斌. 双侧序贯重复经颅磁刺激干预脑卒中患者上肢运动功能的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 926-932.
[11]	李振亚, 孙洁, 郭鹏飞, 王光明. 脑卒中患者口期和咽期吞咽功能改变与误吸的相关性：基于电视透视吞咽检查[J]. 《中国康复理论与实践》, 2023, 29(8): 933-939.
[12]	华玲, 张一楠, 郑玉, 孙俏仪, 房辉, 宋达. 手控节律音乐治疗对脑卒中后单侧空间忽略的效果[J]. 《中国康复理论与实践》, 2023, 29(7): 833-838.
[13]	蒋孝翠, 刘臻, 苏清伦, 赵秦, 夏晓昧, 陆飞. 间歇性Theta节律经颅磁刺激对脑卒中后非流利性失语的影响[J]. 《中国康复理论与实践》, 2023, 29(7): 839-843.
[14]	许苗苗, 李楠, 应颖, 杨凯翔, 杨婧瑞, 李杰, 邱彦群. 重复外周磁刺激对左右颈7神经交叉移位术后脑卒中患者上肢运动功能的效果[J]. 《中国康复理论与实践》, 2023, 29(6): 686-690.
[15]	郑莉, 鲍治诚, 张琪, 任绪艳, 苏敏. 经皮耳迷走神经电刺激结合康复机器人训练对脑卒中患者上肢功能的效果[J]. 《中国康复理论与实践》, 2023, 29(6): 691-696.