强制性运动疗法结合个体化作业疗法对脑卒中上下肢运动及认知障碍的康复效果
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摘要
目的探讨强化运动疗法结合个体化作业疗法对脑卒中偏瘫上下肢运动及认知障碍的康复方法和效果。方法选取2015年12月至2017年12月在北京康复医院诊疗的脑卒中偏瘫患者48例,按照随机数字表法分为观察组和对照组,每组24例。对照组在常规康复锻炼基础上给予强制性运动疗法,观察组在对照组训练基础上给予个体化作业疗法。分析两组患者治疗前、治疗3个月后运动Fugl-Meyer运动功能评分法(FMA)评分、Barthel指数、蒙特利尔认知评估量表(MoCA)评分、美国国立卫生研究院卒中量表(NIHSS)以及生活质量指标评分情况。结果治疗3个月后,两组患者上肢FMA评分、下肢FMA评分、运动FMA评分、Barthel指数、MoCA评分、生活质量指标(生理功能、躯体疼痛、总体健康、活力、社会功能、精神健康)评分均显著高于治疗前,NIHSS评分显著低于治疗前(P均<0. 01);观察组上肢FMA评分、下肢FMA评分、运动FMA评分、Barthel指数、MoCA评分、生活质量指标(生理功能、躯体疼痛、总体健康、活力、社会功能、精神健康)评分均显著高于对照组,NIHSS评分显著低于对照组(P <0. 05,P <0. 01)。结论脑卒中偏瘫患者早前进行强制性运动疗法辅助个体化作业疗法可以明显改善患者的上下肢运动功能、认知障碍、日常生活能力,提高患者的生活质量。
Objective To explore the rehabilitative methods and effects of intensive exercise therapy combined with individualized home-based therapy on upper and lower limb movements and cognitive impairment in stroke hemiplegia.Methods Forty-eight stroke patients with hemiplegia diagnosed and treated in Beijing Rehabilitation Hospital from December 2015 to December 2017 were randomly divided into observation group and control group( n = 24,each). Based on routine rehabilitation exercise,the compulsory exercise therapy was given in control group,while compulsory exercise therapy and individualized home-based therapy was performed in observation group. The motor Fugl-Meyer Assessment( FMA) score,Barthel index,Montreal Cognitive Assessment Scale( MoCA),National Institutes of Health Stroke Scale( NIHSS) and quality of life( QOL) were evaluated and analyzed before and 3 months after treatment. Results After 3 months of treatment,FMA scores of upper limb,lower limb,motor,Barthel index,MoCA score and QOL( including physical function,body pain,general health,vitality,social function,mental health) were significantly higher than those before treatment in both groups,and NIHSS score was significantly lower than that before treatment( all P < 0. 01); compared with control group,FMA scores of upper limb,lower limb,motor,Barthel index,MoCA score and QOL increased,and NIHSS score decreased in observation group( P < 0. 05,P < 0. 01). Conclusion Early intensive exercise therapy combined with individualized home-based therapy can significantly improve upper and lower limb motor function,cognitive impairment,daily living ability and quality of life of stroke patients with hemiplegia.
Objective To explore the rehabilitative methods and effects of intensive exercise therapy combined with individualized home-based therapy on upper and lower limb movements and cognitive impairment in stroke hemiplegia.Methods Forty-eight stroke patients with hemiplegia diagnosed and treated in Beijing Rehabilitation Hospital from December 2015 to December 2017 were randomly divided into observation group and control group( n = 24,each). Based on routine rehabilitation exercise,the compulsory exercise therapy was given in control group,while compulsory exercise therapy and individualized home-based therapy was performed in observation group. The motor Fugl-Meyer Assessment( FMA) score,Barthel index,Montreal Cognitive Assessment Scale( MoCA),National Institutes of Health Stroke Scale( NIHSS) and quality of life( QOL) were evaluated and analyzed before and 3 months after treatment. Results After 3 months of treatment,FMA scores of upper limb,lower limb,motor,Barthel index,MoCA score and QOL( including physical function,body pain,general health,vitality,social function,mental health) were significantly higher than those before treatment in both groups,and NIHSS score was significantly lower than that before treatment( all P < 0. 01); compared with control group,FMA scores of upper limb,lower limb,motor,Barthel index,MoCA score and QOL increased,and NIHSS score decreased in observation group( P < 0. 05,P < 0. 01). Conclusion Early intensive exercise therapy combined with individualized home-based therapy can significantly improve upper and lower limb motor function,cognitive impairment,daily living ability and quality of life of stroke patients with hemiplegia.
引文
[1]徐立伟,胡志,高光仪,等.强化运动想象疗法对脑卒中偏瘫患者步行的影响与机制研究[J].中国康复,2016,31(5):345-348.
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[12] Takahashi K,Domen K,Sakamoto T,et al. Efficacy of upper extremi-ty robotic therapy in subacute poststroke hemiplegia:an exploratoryrandomized trial[J]. Stroke,2016,47(5):1385-1388.
[13]贾亮,刘俊英,王贵玲.改良强制性运动疗法对脑卒中偏瘫患者上肢功能及日常生活能力的影响[J].中华保健医学杂志,2018,20(1):51-53.
[14]张大富,曲建蕊,王云,等.改良强制性诱导运动疗法对脑卒中偏瘫患者康复的疗效[J].心血管康复医学杂志,2017,26(3):234-237.
[15] Lee JS,Kim CY,Kim HD. Short-term effects of whole-body vibrationcombined with task-related training on upper extremity function,spasticity,and grip strength in subjects with poststroke hemiplegia:apilot randomized controlled trial[J]. Am J Physl Med Rehabil,2016,95(8):608-617.
[16]官娉,陈妍,张韶辉.作业疗法结合运动想象对脑卒中偏瘫患者的上肢与手功能的影响[J].临床和实验医学杂志,2018,17(6):647-649.
[17]叶超毅,叶鹏,Askim T,等.脑卒中后个体化指导的有效性和安全性[J].中华高血压杂志,2018,26(1):9.
[18]姜艳平,邢乃姣,任萍.趣味性作业疗法对改善脑卒中后抑郁的临床观察[J].精神医学杂志,2017,30(3):221-222.
[19] Zerna C,Hegedus J,Hill MD. Evolving treatments for acute ischemicstroke[J]. Circ Res,2016,118(9):1425-1442.
[2]赵琳,郭兵妹,高元鹏,等.运动想象疗法在脑卒中偏瘫患者下肢运动功能障碍远程康复护理中应用的研究进展[J].护士进修杂志,2017,32(17):1565-1568.
[3] Zhang Y,Liu H,Wang L,et al. Relationship between functional con-nectivity and motor function assessment in stroke patients with hemi-plegia:a resting-state functional MRI study[J]. Neuroradiology,2016,58(5):503-511.
[4]张有超,李斌,范录平,等.早期介入运动想象疗法对急性脑卒中偏瘫患者下肢运动功能及日常生活活动能力的影响[J].临床神经病学杂志,2016,29(4):296-298.
[5]王新德.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[6] Nasreddine ZS,Phillips NA,Bédirian V,et al. The montreal cogni-tive assessment,Mo CA:a brief screening tool for mild cognitive im-pairment[J]. J Am Geriatr Soc,2005,53(4):695-699.
[7] Hsieh YW,Hsueh IP,Chou YT,et al. Development and validation ofa short form of the Fugl-Meyer motor scale in patients with stroke[J]. Stroke,2007,38(11):3052-3054.
[8] Sarker SJ,Rudd AG,Douiri A,et al. Comparison of 2 extended activ-ities of daily living scales with the Barthel Index and predictors oftheir outcomes:cohort study within the South London Stroke Register(SLSR)[J]. Stroke,2012,43(5):1362-1369.
[9] Jeyaseelan RD,Vargo MM,Chae J. National Institutes of HealthStroke Scale(NIHSS)as an early predictor of poststroke dysphagia[J]. PM R,2015,7(6):593-598.
[10] Ware JE Jr,Sherbourne CD. The MOS 36-item short-form health sur-vey(SF-36). I. Conceptual framework and item selection[J]. MedCare,1992,30(6):473-483.
[11]张情,潘世琴,王丽.改良强制性运动疗法在脑卒中后上肢功能恢复中应用的研究进展[J].中国康复理论与实践,2016,22(12):1395-1398.
[12] Takahashi K,Domen K,Sakamoto T,et al. Efficacy of upper extremi-ty robotic therapy in subacute poststroke hemiplegia:an exploratoryrandomized trial[J]. Stroke,2016,47(5):1385-1388.
[13]贾亮,刘俊英,王贵玲.改良强制性运动疗法对脑卒中偏瘫患者上肢功能及日常生活能力的影响[J].中华保健医学杂志,2018,20(1):51-53.
[14]张大富,曲建蕊,王云,等.改良强制性诱导运动疗法对脑卒中偏瘫患者康复的疗效[J].心血管康复医学杂志,2017,26(3):234-237.
[15] Lee JS,Kim CY,Kim HD. Short-term effects of whole-body vibrationcombined with task-related training on upper extremity function,spasticity,and grip strength in subjects with poststroke hemiplegia:apilot randomized controlled trial[J]. Am J Physl Med Rehabil,2016,95(8):608-617.
[16]官娉,陈妍,张韶辉.作业疗法结合运动想象对脑卒中偏瘫患者的上肢与手功能的影响[J].临床和实验医学杂志,2018,17(6):647-649.
[17]叶超毅,叶鹏,Askim T,等.脑卒中后个体化指导的有效性和安全性[J].中华高血压杂志,2018,26(1):9.
[18]姜艳平,邢乃姣,任萍.趣味性作业疗法对改善脑卒中后抑郁的临床观察[J].精神医学杂志,2017,30(3):221-222.
[19] Zerna C,Hegedus J,Hill MD. Evolving treatments for acute ischemicstroke[J]. Circ Res,2016,118(9):1425-1442.