| 何爱群,黎景波,聂天翠,应其兴,刘娜,王瑜.团体改良限制-诱导运动疗法对脑卒中后上肢功能障碍的疗效研究[J].中国康复,2018,33(6):443-447 |
| 团体改良限制-诱导运动疗法对脑卒中后上肢功能障碍的疗效研究 |
| Effects of group modified Constraint-induced Movement Therapy on hemiplegic upper limb functions |
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| DOI： |
| 中文关键词: 脑卒中 上肢运动功能 团体限制诱导运动疗法（gmCIMT） 作业治疗 |
| 英文关键词: Stroke Upper limb motor function Group modified Constraint-Induced Movement Therapy Occupational therapy |
| 基金项目:广东省医学科研基金（A2015177） |
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| 中文摘要: |
| 目的：探讨4周的团体改良限制 诱导运动疗法（gmCIMT）对脑卒中后上肢功能障碍的疗效。方法：选取29例符合入选标准的脑卒中患者，随机分为gmCIMT组（14例）及常规治疗组（15例），2组均以团体治疗的形式在作业治疗科进行；gmCIMT组每天使用限制手板限制健侧5h，患肢训练3h（gmCIMT治疗1h和病房管理ADL活动2h）；常规治疗组在不限制健侧的前提下患肢每天进行3h的训练（团体作业治疗1h和自我管理活动2h）。在治疗前、治疗4周后分别使用Fugl-Meyer评定上肢部分（FMA-UE）、上肢动作研究量表（ARAT），偏瘫上肢功能测试香港版（FTHUE-HK）评估偏瘫上肢的运动功能；使用运动活动日志（motor activity log, MAL）评定患手使用频率（AOU）和动作完成质量（QOM）；用改良Barthel指数（MBI）评估患者的日常生活能力。结果：治疗4周后，2组患者在FMA-UE、ARAT、FTHUE-HK、MAL-AOU、MAL-QOM、MBI评分均较治疗前明显提高（P＜0.05），而gmCIMT组患者除MBI评分与常规治疗组无统计学差异外，其他各项得分均优于常规治疗组（P＜0.05）。结论：gmCIMT和常规团体作业治疗都能够显著提高脑卒中后的偏瘫上肢运动功能，gmCIMT可以更加有效改善偏瘫上肢的运动控制及日常使用频率与质量。 |
| 英文摘要: |
| Objective: To investigate the effect of a 4-week group modified Constraint-Induced Movement Therapy (gmCIMT) on hemiplegic upper limb functions after stroke. Methods: Twenty-nine inpatients with chronic stroke were recruited and randomly assigned into gmCIMT group (n=14) and control group (n=15). In gmCIMT group, the non-affected hand was restricted for 5 h every day and the affected hand underwent a 3 h program (1 h gmCIMT and 2 h ward-based ADL) per day for 4 weeks, 6 days per week. In control group, the non-affected hand was un-restricted, and the affected hand received a 3 h program (1 h group occupational therapy and 2 h self-management activities) per day for 4 weeks, 6 days per week. All patients were evaluated by the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), Functional Test of Hemiplegic Upper Extremity-Hong Kong (FTHUE-HK), MAL-AOU (Amount of Use) and MAL-QOM (Quality of Movement), and Modified Barthel Index (MBI) pretreatment and immediate posttreatment. Results: After treatment for 4 weeks, there were significant differences in the changes of all outcomes in both gmCIMT group and control group (P<0.05). Except the score of MBI, patients in gmCIMT group showed much more increase on all the other outcome measures than those in the control group (P<0.05). Conclusion: Both gmCIMT and conventional group occupational therapy program were effective to improve upper limb motor functions in patients with chronic stroke. The gmCIMT demonstrated more benefit on motor control and increase the amount and quality of hand use in daily life. |
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