佩戴腕托对脑卒中后偏瘫手功能康复的影响

doi:10.3969/j.issn.1006-9771.2020.03.008

Abstract

Abstract:

Objective To observe the effect of a wrist brace on activities of spastic hemiplegic hand after stroke, based on Botulinum toxin type A (BTX-A) injection and electrical stimulation. Methods From January, 2016 to December, 2018, 52 stroke patients with spastic hemiplegia on upper extremities accepted BTX-A injection, and electrical stimulation two days later, while group A (n = 26) wore a wrist brace during stimulation and group B (n = 26) did not. They were assessed with modified Ashworth Scale (MAS), Box and Block test (BBt) and Action Research Arm Test (ARAT) before treatment (T0), and two (T1), four (T2) and twelve 12 (T3) weeks after treatment. Results The scores of MAS, BBt and ARAT improved after treatment in both groups (F_time > 118.32, P < 0.001), and improved more in group A than in group B in the scores of BBt and ARAT at each time point ( F_group > 31.26, P < 0.001; F_interact = 10.65,P < 0.001). Conclusion Based on the BTX-A injection and electrical stimulation, wearing a wrist brace would further improve the activities of hand for stroke patients.

Key words: stroke, hemiplegia, Botulinum toxin type A, electric stimulation, wrist brace, hand

CLC Number:

R743.3

MA Shan-xin,XU Jian-wen,MA Nan,SU Yi,LIN Wei-shan,TAO Guang-lin. Effects of Wrist Brace on Activities of Hemiplegic Hand after Stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(3): 306-309.

Figures/Tables 5

References 27

[1]	Simpson D M, Hallett M, Ashman E J, et al. Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: report of the Guideline Development Subcommittee of the American Academy of Neurology[J]. Neurology, 2016, 86(19):1818-1826. doi: 10.1212/WNL.0000000000002560 pmid: 27164716
[2]	Fheodoroff K, Ashford S, Jacinto J, et al. Factors influencing goal attainment in patients with post-stroke upper limb spasticity following treatment with Botulinum toxin A in real-life clinical practice: sub-analyses from the Upper Limb International Spasticity (ULIS)-II Study[J]. Toxins (Basel), 2015, 7(4):1192-1205. doi: 10.3390/toxins7041192
[3]	Gracies J M, Brashear A, Jech R, et al. Safety and efficacy of abobotulinumtoxinA for hemiparesis in adults with upper limb spasticity after stroke or traumatic brain injury: a double-blind randomised controlled trial[J]. Lancet Neurol, 2015, 14(10):992-1001. doi: 10.1016/S1474-4422(15)00216-1
[4]	Foley N, Pereira S, Salter K, et al. Treatment with Botulinum toxin improves upper-extremity function post stroke: a systematic review and meta-analysis[J]. Arch Phys Med Rehabil, 2013, 94(5):977-989. doi: 10.1016/j.apmr.2012.12.006
[5]	Dong Y, Wu T, Hu X, et al. Efficacy and safety of Botulinum toxin type A for upper limb spasticity after stroke or traumatic brain injury: a systematic review with meta-analysis and trial sequential analysis[J]. Eur J Phys Rehabil Med, 2017, 53(2):256-267.
[6]	Wang W, Jiang B, Sun H, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480 687 adults[J]. Circulation, 2017, 135(8):759-771. doi: 10.1161/CIRCULATIONAHA.116.025250
[7]	贾杰. 脑卒中后手功能康复现状[J]. 老年医学与保健, 2015(3):129-131.
[8]	Fischer H C, Stubblefield K, Kline T, et al. Hand rehabilitation following stroke: a pilot study of assisted finger extension training in a virtual environment[J]. Top Stroke Rehabil, 2007, 14(1):1-12. pmid: 17311785
[9]	Lee J M, Gracies J M, Park S B, et al. Botulinum toxin injections and electrical stimulation for spastic paresis improve active hand function following stroke[J]. Toxins (Basel), 2018, 10(11):426. doi: 10.3390/toxins10110426
[10]	Toshiyuki F, Michiyuki K, Kaoru H, et al. Hybrid assistive neuromuscular dynamic stimulation therapy: a new strategy for improving upper extremity function in patients with hemiparesis following stroke[J]. Neural Plast, 2017, 2017:2350137.
[11]	Eraifej J, Clark W, France B, et al. Effectiveness of upper limb functional electrical stimulation after stroke for the improvement of activities of daily living and motor function: a systematic review and meta-analysis[J]. Syst Rev, 2017, 6(1):40. doi: 10.1186/s13643-017-0435-5
[12]	中华神经科学会, 中华神经外科学会. 各类脑血管疾病诊断要点[J]. 中华神经科杂志, 1996, 29(6):379-380.
[13]	励建安, 朱晓军, 敖丽娟, 等. 肉毒毒素治疗成人肢体痉挛状态中国指南(2015)[J]. 中国康复医学杂志, 2015, 30(1):81-110.
[14]	张永祥, 张文洁, 王强, 等. 胫骨前肌注射A型肉毒毒素对脑卒中痉挛性足下垂和足内翻患者步行功能的影响[J]. 中华物理医学与康复杂志, 2018, 40(12):899-902.
[15]	Desrosiers J, Bravo G, Hébert R, et al. Validation of the Box and Block Test as a measure of dexterity of elderly people: reliability, validity, and norms studies[J]. Arch Phys Med Rehabil, 1994, 75(7):751-755. doi: 10.1016/0003-9993(94)90130-9
[16]	Lee J H V D, Beckerman H, Lankhorst G J, et al. The responsiveness of the Action Research Arm Test and the Fugl-Meyer Assessment scale in chronic stroke patients[J]. J Rehabil Med, 2001, 33(3):110-113. doi: 10.1080/165019701750165916
[17]	Mayo N E, Wood-Dauphinee S, Côté R, et al. Activity, participation, and quality of life 6 months poststroke[J]. Arch Phys Med Rehabil, 2002, 83(8):1035-1042. doi: 10.1053/apmr.2002.33984
[18]	Franck J A, Smeets R J E M, Seelen H A M. Evaluation of a functional hand orthosis combined with electrical stimulation adjunct to arm-hand rehabilitation in subacute stroke patients with a severely to moderately affected hand function[J]. Disabil Rehabil, 2019, 41(10):1160-1168. doi: 10.1080/09638288.2017.1423400 pmid: 29316821
[19]	唐朝正, 李春燕, 张晓莉, 等. 低频经皮穴位电刺激对软瘫期脑卒中患者手和上肢功能的影响[J]. 中国康复理论与实践, 2015, 21(3):252-255.
[20]	丁丽君, 荣积峰, 王卫宁, 等. 经皮穴位电刺激对脑卒中后手功能的康复效果[J]. 中国康复理论与实践, 2017, 23(1):10-13.
[21]	田凌, 谢家兴, 张静, 等. 社区综合康复管理对脑卒中后遗症患者生活质量的影响[J]. 中国康复理论与实践, 2016, 22(12):1467-1470.
[22]	Levin M F, Hui-Chan C W. Relief of hemiparetic spasticity by TENS is associated with improvement in reflex and voluntary motor function[J]. Electroencephalogr Clin Neurophysiol, 1992, 85(2):131-142. pmid: 1373366
[23]	Eraifej J, Clark W, France B, et al. Effectiveness of upper limb functional electrical stimulation after stroke for the improvement of activities of daily living and motor function: a systematic review and meta-analysis[J]. Syst Rev, 2017, 6(1):40. doi: 10.1186/s13643-017-0435-5
[24]	Howlett O A, Lannin N A, Ada L, et al. Functional electrical stimulation improves activity after stroke: a systematic review with meta-analysis[J]. Arch Phys Med Rehabil, 2015, 96(5):934-943. doi: 10.1016/j.apmr.2015.01.013
[25]	陈瑶, 王鹤玮, 项育枝, 等. 低频经皮穴位电刺激对脑卒中后遗症期手和上肢功能障碍的疗效[J]. 中国康复理论与实践, 2018, 24(12):13-17.
[26]	Picelli A, Baricich A, Cisari C, et al. The Italian real-life post-stroke spasticity survey: unmet needs in the management of spasticity with Botulinum toxin type A[J]. Funct Neurol, 2017, 32(2):89-96. pmid: 28676142
[27]	Simpson D M, Patel A T, Alfaro A, et al. OnabotulinumtoxinA injection for poststroke upper-limb spasticity:Guidance for early injectors from a Delphi panel process[J]. PM R, 2017, 9(2):136-148. doi: 10.1016/j.pmrj.2016.06.016

组别	n	性别(n)		年龄(岁)	卒中类型(n)		病程(d)	偏瘫侧(n)
组别	n	男	女	年龄(岁)	脑梗死	脑出血	病程(d)	左侧	右侧
A组	26	17	9	53.2±6.52	15	11	91.2±26.81	16	10
B组	26	14	12	54.7±7.45	18	8	98.2±24.19	13	13
χ²/t值		0.719		1.796	0.746		2.364	0.746
P值		0.397		0.471	0.388		0.142	0.388

组别	指浅屈肌	指深屈肌	拇长屈肌
A组	28.42±15.0	35.71±18.7	22.5±20.5
B组	30.12±14.5	36.52±20.2	21.4±25.2

组别	n	T0	T1	T2	T3
A组	26	3.31±0.48	2.96±0.43	2.56±0.51	2.21±0.41
B组	26	3.17±0.52	2.91±0.46	2.52±0.53	2.18±0.45

组别	n	T0	T1	T2	T3
A组	26	3.06±3.32	4.01±4.82	4.98±5.12	5.72±6.46
B组	26	3.02±3.47	3.76±3.99	4.32±4.51	5.08±5.63

组别	n	T0	T1	T2	T3
A组	26	11.16±8.52	13.39±8.38	15.19±9.43	18.72±9.47
B组	26	11.23±8.51	12.24±8.16	14.32±8.54	16.65±9.38

Effects of Wrist Brace on Activities of Hemiplegic Hand after Stroke

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