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

Abstract

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

CLC Number:

R743.3

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.

Figures/Tables 9

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References 35

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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

Effect of wrist-hand orthosis combined with modified constraint-induced movement therapy on upper limb and hand function in patients with stroke

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组别	n	测试	$\bar{x} \pm s$	t值	P值
对照组	16	前测	2.91±1.07	-2.595	0.020
		后测	3.17±0.88
试验组	16	前测	2.90±1.30	-3.170	0.006
		后测	3.46±0.99
训练前均值差			0.01±1.56	0.044	0.965
训练后均值差			0.28±1.08	-0.860	0.397

组别	n	测试	$\bar{x} \pm s$	t值	P值
对照组	16	前测	4.75±2.67	3.184	0.006
		后测	3.50±2.09
试验组	16	前测	4.18±2.66	3.151	0.007
		后测	2.75±2.26
训练前均值差			0.56±3.66	0.596	0.555
训练后均值差			0.75±3.51	0.972	0.339

组别	n	测试	$\bar{x} \pm s$	t值	P值
对照组	16	前测	8.68±3.77	1.978	0.067
		后测	6.81±3.50
试验组	16	前测	9.06±6.08	2.819	0.013
		后测	5.81±3.86
训练前均值差			0.37±6.67	-0.210	0.835
训练后均值差			1.00±6.04	0.766	0.450

组别	n	测试	$\bar{x} \pm s$	t值	P值
对照组	16	前测	0.54±0.24	-2.241	0.041
		后测	0.70±0.41
试验组	16	前测	0.47±0.28	-2.179	0.046
		后测	0.64±0.33
训练前均值差			0.06±0.35	0.698	0.491
训练后均值差			0.05±0.52	0.426	0.673

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