双侧上肢训练在脑卒中患者康复中的应用

摘要

目的:初步观察双侧上肢训练对上肢功能中度到重度残损的恢复期脑卒中患者的疗效.方法:48例上肢功能中度到重度残损的恢复期脑卒中患者随机分为双侧训练组(n=24)、对照组(n=24),前者接受双侧(患侧、健侧)上肢同向、节律运动的重复练习,后者接受常规上肢训练,即以患侧上肢为主的单侧训练.两组患者上肢训练的时间均为1h/d,5d/周,持续4周,其余康复治疗如运动疗法和日常生活活动训练等两组均相同.两组患者分别于治疗前、治疗后予以FMA上肢部分(FMA-UE)、MAS上肢部分和MBI评定.结果:两组患者治疗后FMA-UE、FMA上肢的近端部分(FMA-PUE)和远端部分(FMA-DUE)、MAS-UE及MBI的评分均较治疗前提高,治疗前、后各量表的评分差异具有显著性(P＜0.05＝;与对照组相比,双侧训练组患者FMA-UE、FMA-PUE的评分提高幅度更大(P＜0.05).结论:对于上肢功能中度到重度残损的恢复期脑卒中患者,采用双侧上肢训练可以更好地改善其患侧上肢,尤其是上肢近端的运动功能.%Objective: To observe the effect of bilateral upper extremities training on upper extremities function of stroke patient in convalescent phase with moderate to severe upper extremity impairment.Method: Forty-eight subjects participated in the randomized, single-blind training study. Subjects in the bilateral training group (n=24) practiced bilateral upper extremities(affected and unaffected sides) symmetrical thythmic repetitive activities, and the control group (n=24) performed conventional upper extremities training, mainly affected upper extremity unilateral training. The program of upper extremities training for both groups were 1h per day, 5d per week for 4 weeks. Physical therapy and training of activities of daily living were the same in both groups.Fugl-Meyer assessment of upper extremity (FMA-UE), motor assessment scale of upper extremity (MAS-UE) and modified Barthel index (MBI) were used as outcome measures. Assessments were administered at pretraining and posttraining by a rater blinded to group assignment.Result: Compared with pretraining both groups had significant improvements post training on FMA-UE (P＜0.05),Fugl-Meyer assessment of proximal upper extremity (FMA-PUE) (P＜0.05). Fugl-Meyer assessment of distal upper extremity (FMA-DUE) (P ＜ 0.05), MAS-UE (P ＜ 0.05) and MBI (P ＜ 0.05). Compared with control group bilateral upper extremities training group had significantly greater improvement on FMA-UE (P ＜ 0.05) and FMA-PUE (P ＜0.05).Conclusion: Bilateral upper extremities training may be more effective on upper extremities function of stroke patients in convalescent phase with moderate to severe upper extremity impairment. Bilateral upper extremities training may be more advantageous for improving motor function of affected upper extremity, especially for proximal upper extremity.