动态腕手矫形器结合改良强制性运动疗法对脑卒中偏瘫患者上肢和手功能障碍的效果

doi:10.3969/j.issn.1006-9771.2024.05.016

摘要/Abstract

摘要：

目的观察动态腕手矫形器结合改良强制性运动疗法(mCIMT)对脑卒中偏瘫患者上肢及手功能的影响。

方法 2022年2月至2023年12月，复旦大学附属华山医院脑卒中恢复期患者32例，随机分为对照组(n = 16)和试验组(n = 16)。两组均接受常规康复训练，采用改良强制性运动疗法，每天健侧上肢佩戴约束手套4 h；试验组同时患侧上肢佩戴动态腕手矫形器4 h；每周5 d，连续3周。分别于治疗前后采用Wolf运动功能量表(WMFT)、手臂动作调查测试(ARAT)和握力评估上肢运动功能，动作活动记录量表(MAL)评估动作使用量(AOU)和动作完成质量(QOM)，汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)评估情绪变化，采用表面肌电图观察训练前后患/健侧腕背伸肌均方根值(RMS)比。

结果治疗后，两组WMFT、ARAT、MAL-QOM、HAMA评分和患/健侧腕背伸肌RMS比均改善(|t| > 2.179, P < 0.05)，试验组WMFT和握力的进步值优于对照组(|t| > 2.343, P < 0.05)；试验组握力、MAL-AOU和HAMD评分均改善(|t| > 2.819, P < 0.05)。

结论动态腕手矫形器结合mCIMT可以促进偏瘫患者上肢和手功能的恢复。

关键词: 脑卒中, 改良强制性运动疗法, 腕手矫形器, 上肢, 手, 运动功能, 康复

Abstract:

Objective To observe the effect of wrist-hand orthosis combined with modified constraint-induced movement therapy (mCIMT) on upper limb and hand function in patients with stroke.

Methods From February, 2022 to December, 2023, 32 patients after stroke in Huashan Hospital, Fudan University were randomly assigned to control group (n = 16) and experimental group (n = 16). Both groups underwent routine rehabilitation, and wore constraint glove almost four hours a day. The experimenal group wore dynamic wrist-hand orthosis four hours everyday, additionally; five days every week, for three weeks. They were evaluated with Wolf Motor Function Test (WMFT), Action Reach Arm Test (ARAT), the strength of gripping, Amount of Use (AOU) and Quality of Movement (QOM) of Motor Activity Log (MAL), Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) before and after treatment, while root mean square ratio of affected/healthy extensor muscle of wrist was measured with surface electromyography

Results After treatment, the scores of WMFT, ARAT, MAL-QOM, HAMA and the root mean square ratio of affected/healthy extensor muscle of wrist improved in both groups (|t| > 2.179, P < 0.05), and the improvement of WMFT score and the strength of gripping was greater in the experimental group than in the control group (|t| > 2.343, P < 0.05); the strength of gripping, the scores of MAL-AOU and HAMD improved in the experimental group (|t| > 2.819, P < 0.05).

Conclusion mCIMT assisted with dynamic wrist-hand orthosis could improve upper limb and hand function in stroke patients.

Key words: stroke, modified constraint-induced movement therapy, wrist-hand orthosis, upper limb, hand, motor function, rehabilitation

中图分类号:

R743.3

黄崧华, 凌骏麒, 高天昊, 黄仪佳, 白玉龙. 动态腕手矫形器结合改良强制性运动疗法对脑卒中偏瘫患者上肢和手功能障碍的效果[J]. 《中国康复理论与实践》, 2024, 30(5): 606-612.

HUANG Songhua, LING Junqi, GAO Tianhao, HUANG Yijia, BAI Yulong. Effect of wrist-hand orthosis combined with modified constraint-induced movement therapy on upper limb and hand function in patients with stroke[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(5): 606-612.

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组别	n	卒中类型(梗死/出血)	偏瘫侧(左/右)
对照组	16	11/5	7/9
试验组	16	14/2	7/9
χ²/t值		1.646	0.001
P值		0.200	0.999

组别	n	测试	$\bar{x} \pm s$	t值	P值
对照组	16	前测	56.56±10.50	-4.122	0.001
		后测	59.00±9.28
试验组	16	前测	50.00±19.23	-3.308	0.001
		后测	58.87±12.54
训练前均值差			6.56±18.98	-1.198	0.243
训练后均值差			0.12±11.42	-0.032	0.975

组别	n	测试	$\bar{x} \pm s$	t值	P值
对照组	16	前测	46.00±9.91	-4.388	< 0.001
		后测	49.12±8.35
试验组	16	前测	42.06±16.73	-2.779	0.014
		后测	50.62±7.80
训练前均值差			3.93±20.21	0.810	0.425
训练后均值差			1.50±9.85	-0.525	0.604

组别	n	测试	$\bar{x} \pm s$	t值	P值
对照组	16	前测	8.22±7.80	-1.363	0.193
		后测	9.10±7.60
试验组	16	前测	9.54±8.88	-4.872	< 0.001
		后测	13.39±10.49
训练前均值差			1.32±11.51	-0.448	0.658
训练后均值差			4.28±11.77	-1.324	0.196

组别	n	测试	$\bar{x} \pm s$	t值	P值
对照组	16	前测	2.66±1.08	-1.992	0.065
		后测	2.94±1.02
试验组	16	前测	2.50±1.28	-4.394	< 0.001
		后测	3.07±1.08
训练前均值差			0.16±1.73	0.385	0.703
训练后均值差			0.13±1.42	-0.353	0.726