作业技能再学习策略对脑卒中偏瘫上肢功能效果的随机对照试验

doi:10.3969/j.issn.1006-9771.2024.07.011

Abstract

Abstract:

Objective To explore the effect of occupational skills relearning programme on hemiplegic arm motor function and activities of daily living (ADL) in stroke patients.
Methods From February, 2022 to August, 2023, 74 stroke patients in Guangdong Work Injury Rehabilitation Hospital were enrolled and randomly divided into control group (n = 37) and experimental group (n = 37). The control group received conventional rehabilitation training, and the experimental group received additional occupational skills relearning programme, for three weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Functional Test for the Hemiplegic Upper Extremity-Hong Kong (FTHUE-HK), Motor Activity Log (MAL)-amount of use (AOU) and MAL-quality of movement (QOM), modified Barthel Index (MBI), and Stroke Impact Scale (SIS)-Hand and SIS-ADL before and after treatment.
Results The scores in all assessments improved significantly in both groups (|t| > 3.597, P < 0.05) after treatment, while the scores of FMA-UE, FTHUE-HK, MAL-AOU, MAL-QOM were higher in the experimental group than in the control group (|t| > 2.352, P < 0.05).
Conclusion Occupational skills relearning programme could promote the recovery of hemiplegic arm motor and activity, and facilitate the use of the hemiplegic arm in daily life in stroke patients.

Key words: stroke, occupational skills relearning, upper limb, motor function, activities of daily living, randomized controlled trial

CLC Number:

R743.3

HE Aiqun, LI Jingbo, HE Maoli, YE Simei, SONG Qiushuang, LIU Haiou, XIE Youshu. Effect of occupational skills relearning on hemiplegic arm function after stroke: a randomized controlled trial[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(7): 823-830.

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References 41

[1]	SIMPSON L A, HAYWARD K S, MCPEAKE M, et al. Challenges of estimating accurate prevalence of arm weakness early after stroke[J]. Neurorehabil Neural Repair, 2021, 35(10): 871-879.
[2]	LIN S H, YANG T R, CHUANG I C, et al. Upper extremity motor abilities and cognitive capability mediate the causal dependency between somatosensory capability and daily function in stroke individuals[J]. Sci Rep, 2022, 12(1): 690.
[3]	KANTAK S, JAX S, WITTENBERG G. Bimanual coordination: a missing piece of arm rehabilitation after stroke[J]. Restor Neurol Neurosci, 2017, 35(4): 347-364.
[4]	CARR J H, SHEPHERD R B. A motor learning model for stroke rehabilitation[J]. Physiotherapy, 1989, 75: 372-380.
[5]	王宁华, 黄真. 神经康复: 优化运动技能[M]. 2版. 北京: 北京大学医学出版社, 2015: 1-17.
[6]	陈捷, 吴福春, 莫国清, 等. 优化运动再学习训练对脑卒中患者手功能的影响[J]. 康复学报, 2016, 26(2): 42-45.
	CHEN J, WU F C, MO G Q, et al. Effect of optimun motor relearning programme on hand function of stroke patients[J]. Rehabil Med, 2016, 26(2): 42-45.
[7]	曲斯伟, 朱琳, 宋为群. 经颅直流电刺激联合运动再学习方案对卒中患者上肢运动功能的改善作用[J]. 中国脑血管病杂志, 2017, 14(1): 20-24.
	QU S W, ZHU L, SONG W Q. Improving effect of transcranial direct current stimulation combined with motor relearning program for the upper limb motor function in patients with stroke[J]. Chin J Cerebrovasc Dis, 2017, 14(1): 20-24.
[8]	ULLAH I, ARSH A, ZAHIR A, et al. Motor relearning program along with electrical stimulation for improving upper limb function in stroke patients: a quasi experimental study[J]. Pak J Med Sci, 2020, 36(7): 1613-1617. doi: 10.12669/pjms.36.7.2351 pmid: 33235584
[9]	CHEN R, ZHANG Y, WANG X, et al. Treatment effects of low-frequency repetitive magnetic stimulation combined with motor relearning procedure on spasticity and limb motor function in stroke patients[J]. Front Neurol, 2023, 14: 1213624.
[10]	SHAIKH S. Effect of motor relearning program on the upper limb function in stroke survivors: a systematic review[J]. VIMSJ Physical Ther, 2022, 4(1): 3-9.
[11]	SINGHA R. Motor relearning program versus proprioceptive neuromuscular facilitation technique for improving basic mobility in chronic stroke patients: a comparative study[J]. Int J Physiother Res, 2017, 5(1): 2490-2500.
[12]	JAN S, ARSH A, DARAIN H, et al. A randomized control trial comparing the effects of motor relearning programme and mirror therapy for improving upper limb motor functions in stroke patients[J]. J Pak Med Assoc, 2019, 69(9): 1242-1245. pmid: 31511706
[13]	HATEM S M, SAUSSEZ G, DELLA F M, et al. Rehabilitation of motor function after stroke: a multiple systematic review focused on techniques to stimulate upper extremity recovery[J]. Front Hum Neurosci, 2016, 10: 442. doi: 10.3389/fnhum.2016.00442 pmid: 27679565
[14]	MAIER M, BALLESTER B R, VERSCHURE P F M J. Principles of neurorehabilitation after stroke based on motor learning and brain plasticity mechanisms[J]. Front Syst Neurosci, 2019, 13: 74. doi: 10.3389/fnsys.2019.00074 pmid: 31920570
[15]	王荣丽, 王宁华. 运动再学习理论体系在神经康复领域的应用原则[J]. 华西医学, 2020, 35(5): 519-526.
	WANG R L, WANG N H. Principles of neurorehabilitation based on motor re-learning[J]. West China Med J, 2020, 35(5): 519-526.
[16]	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.
[17]	RECH K D, SALAZAR A P, MARCHESE R R, et al. Fugl-Meyer assessment scores are related with kinematic measures in people with chronic hemiparesis after stroke[J]. J Stroke Cerebrovasc Dis, 2020, 29(1): 104463.
[18]	FONG N K, NG B, CHAN D, et al. Development of the Hong Kong version of the Functional Test for the Hemiplegic Upper Extremity (FTHUE-HK)[J]. Hong Kong J Occupl Ther, 2004, 41(1): 21-29.
[19]	SANTISTEBAN L, TEREMETZ M, BLETON J P, et al. Upper limb outcome measures used in stroke rehabilitation studies:a systematic literature review[J]. PLoS One, 2016, 11(5): e0154792.
[20]	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.
[21]	兰月, 黄东锋, 徐光青, 等. 脑卒中患者生存质量量表中文版反应度研究[J]. 中国康复医学杂志, 2006, 21(12): 1090-1092.
	LAN Y, HUANG D F, XU G Q, et al. A research on sensitivity evaluation of Chinese version of quality of life in Stroke Impact Scale[J]. Chin J Rahabil Med, 2006, 21(12): 1090-1092.
[22]	VARGHESE R, KUTCH J J, SCHWEIGHOFER N, et al. The probability of choosing both hands depends on an interaction between motor capacity and limb-specific control in chronic stroke[J]. Exp Brain Res, 2020, 238(11): 2569-2579.
[23]	GNANAPRAKASAM A, KARTHIKBABU S, RAVISHANKAR N, et al. Effect of task-based bilateral arm training on upper limb recovery after stroke: a systematic review and meta-analysis[J]. J Stroke Cerebrovasc Dis, 2023, 32(7): 107131.
[24]	RUSSO C, VERONELLI L, CASATI C, et al. Explicit motor sequence learning after stroke: a neuropsychological study[J]. Exp Brain Res, 2021, 239(7): 2303-2316. doi: 10.1007/s00221-021-06141-5 pmid: 34091696
[25]	JOY M T, CARMICHAEL S T. Encouraging an excitable brain state: mechanisms of brain repair in stroke[J]. Nat Rev Neurosci, 2021, 22(1): 38-53. doi: 10.1038/s41583-020-00396-7 pmid: 33184469
[26]	JOHNSON L, BURRIDGE J, EWINGS S, et al. Principles into practice: an observational study of physiotherapists use of motor learning principles in stroke rehabilitation[J]. Physiotherapy, 2023, 118: 20-30.
[27]	KIM S H, PARK J H. The effect of occupation-based bilateral upper extremity training in a medical setting for stroke patients:a single-blinded,pilot randomized controlled trial[J]. J Stroke Cerebrovasc Dis, 2019, 28(12): 104335.
[28]	WALL G, ISBEL S, GUSTAFSSON L, et al. Occupation-based interventions to improve occupational performance and participation in the hospital setting: a systematic review[J]. Disabil Rehabil, 2023, 31(7): 1-22.
[29]	SUN X L, O'SHEA D J, GOLUB M D, et al. Cortical preparatory activity indexes learned motor memories[J]. Nature, 2022, 602(7896): 274-279.
[30]	STOYKOV M E, CORCOS D, MADHAVAN S. Movement-based priming: clinical applications and neural mechanisms[J]. J Mot Behav, 2017, 49(1): 88-97. doi: 10.1080/00222895.2016.1250716 pmid: 28277966
[31]	HERSZAGE J, SHARON H, CENSOR N, et al. Reactivation-induced motor skill learning[J]. Proc Natl Acad Sci U S A, 2021, 118(23): e2102242118.
[32]	CHEN S, QIU Y, BASSILE C C, et al. Effectiveness and success factors of bilateral arm training after stroke: a systematic review and meta-analysis[J]. Front Aging Neurosci, 2022, 14: 875794.
[33]	DAHMS C, BRODOEHL S, WITTE O W, et al. The importance of different learning stages for motor sequence learning after stroke[J]. Hum Brain Mapp, 2020, 41(1): 270-286. doi: 10.1002/hbm.24793 pmid: 31520506
[34]	田婧, 何志杰, 杨青, 等. 基于功能性近红外光谱技术的卒中后上肢单侧任务与双侧任务的脑功能成像对比观察[J]. 中国卒中杂志, 2022, 17(4): 360-364.
	TIAN J, HE Z J, YANG Q, et al. Comparative observation of functional near-infrared brain imaging in stroke patients with unilateral upper limb training and bilateral upper limb training[J]. Chin J Stroke, 2022, 17(4): 360-364.
[35]	郑雅丹, 胡昔权, 李奎, 等. 双侧上肢训练影响脑梗死患者脑功能重组的fMRI研究[J]. 中华物理医学与康复杂志, 2017, 39(5): 336-341.
	ZHENG Y D, HU X Q, LI K, et al. Bilateral arm training and cortical reorganization in cerebral infarction: a functional MRI study[J]. Chin J Phys Med Rehabil, 2017, 39(5): 336-341.
[36]	WU J Y, CHENG H, ZHANG J Q, et al. The modulatory effects of bilateral arm training (BAT) on the brain in stroke patients: a systematic review[J]. Neurol Sci, 2021, 42(2): 501-511. doi: 10.1007/s10072-020-04854-z pmid: 33180209
[37]	POTTS C A, KANTAK S S. Post-stroke deficits in the anticipatory control and bimanual coordination during naturalistic cooperative bimanual action[J]. J Neuroeng Rehabil, 2023, 20(1): 153. doi: 10.1186/s12984-023-01257-x pmid: 37950249
[38]	MAWASE F, UEHARA S, BASTIAN A J, et al. Motor learning enhances use-dependent plasticity[J]. J Neurosci, 2017, 37(10): 2673-2685. doi: 10.1523/JNEUROSCI.3303-16.2017 pmid: 28143961
[39]	CAREY L, WALSH A, ADIKARI A, et al. Finding the intersection of neuroplasticity,stroke recovery, and learning:scope and contributions to stroke rehabilitation[J]. Neural Plast, 2019, 2019:5232374.
[40]	PI Y L, WU X H, WANG F J, et al. Motor skill learning induces brain network plasticity: a diffusion-tensor imaging study[J]. PLoS One, 2019, 14(2): e0210015.
[41]	LEE Y, KIM M Y, PARK J H, et al. Comparison of the effects of bilateral and unilateral training after stroke: a meta-analysis[J]. NerroRehabilitation, 2017, 40(3): 301-313.

组别	n	性别(男/女)/n	年龄/岁	病程/d	卒中类型(出血/梗死)/n	偏瘫侧(左/右)/n	利手(左/右)/n
对照组	37	27/10	54.19±13.37	77.11±41.79	14/23	18/19	0/37
试验组	37	32/5	48.14±14.69	75.86±49.68	16/21	18/19	1/36
χ²/t值		2.090	-1.854	-0.116	0.224	0.000
P值		0.148	0.068	0.908	0.636	1.000	0.314^a

组别	n	测试	$\bar{x}±s$	t值	P值
对照组	37	前测	28.81±10.68	8.290	< 0.001
		后测	37.00±13.52
试验组	37	前测	30.39±12.23	9.693	< 0.001
		后测	44.49±13.86
治疗前两组均值差			1.57±14.98	0.590	0.557
治疗后两组均值差			7.49±19.38	2.352	0.021

组别	n	测试	$\bar{x}±s$	t值	P值
对照组	37	前测	3.68±0.67	3.597	0.001
		后测	4.08±1.09
试验组	37	前测	3.65±0.68	6.524	< 0.001
		后测	4.78±1.23
治疗前两组均值差			0.03±0.76	-0.173	0.863
治疗后两组均值差			0.70±1.71	2.604	0.011

组别	n	测试	$\bar{x}±s$	t值	P值
对照组	37	前测	1.23±0.76	6.093	< 0.001
		后测	1.74±1.04
试验组	37	前测	1.10±0.85	10.137	< 0.001
		后测	2.30±0.80
治疗前两组均值差			0.13±0.80	-0.703	0.484
治疗后两组均值差			0.56±0.90	2.602	0.011

组别	n	测试	$\bar{x}±s$	t值	P值
对照组	37	前测	1.27±0.79	9.374	< 0.001
		后测	1.76±0.84
试验组	37	前测	1.32±0.90	8.511	< 0.001
		后测	2.34±0.72
治疗前两组均值差			0.05±0.65	0.274	0.785
治疗后两组均值差			0.58±0.44	3.170	0.002

Effect of occupational skills relearning on hemiplegic arm function after stroke: a randomized controlled trial

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组别	n	测试	$\bar{x}±s$	t值	P值
对照组	37	前测	63.05±22.17	5.407	< 0.001
		后测	74.08±18.94
试验组	37	前测	62.16±24.74	6.846	< 0.001
		后测	78.00±21.61
治疗前两组均值差			0.89±31.82	-0.163	0.871
治疗后两组均值差			3.92±26.10	0.829	0.410

组别	n	测试	$\bar{x}±s$	t值	P值
对照组	37	前测	16.35±16.14	8.317	< 0.001
		后测	35.41±22.02
试验组	37	前测	18.50±19.13	13.176	< 0.001
		后测	39.22±23.19
治疗前两组均值差			2.15±22.78	0.522	0.603
治疗后两组均值差			3.82±29.53	0.727	0.470

组别	n	测试	$\bar{x}±s$	t值	P值
对照组	37	前测	40.28±19.09	5.293	< 0.001
		后测	49.44±20.27
试验组	37	前测	44.07±17.36	5.080	< 0.001
		后测	54.81±17.71
治疗前两组均值差			3.79±23.50	0.894	0.374
治疗后两组均值差			5.37±24.63	1.215	0.228

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