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目的:强制性使用运动疗法(CIMT)是近年来针对脑卒中后上肢功能障碍的一种新的康复训练技术。本研究目的是评价和比较CIMT在亚急性期和慢性期脑卒中患者中的康复效力。方法:30例脑卒中偏瘫患者参与此研究,其中亚急性期组患者14例(平均病程3.5个月),慢性期组患者16例(平均病程12.1个月)。在CIMT治疗期间要求两组患者健侧穿戴吊带和夹板来限制健侧肢体动作,每天清醒时固定时间不少于90%,连续12天。同时接受塑形训练,密集的训练患侧肢体活动,完成日常生活中的动作,连续2周共10个工作日。在接受CIMT治疗前和治疗后用上肢功能测验(UEFT)来评价两组患者的上肢运动功能。结果:两组患者在CIMT治疗前UEFT的比较差异无显著性意义(Ρ>0.05),在治疗后两组患者UEFT的比较差异无显著性意义(Ρ>0.05),但是亚急性期组治疗后UEFT的改善值明显高于慢性期组患者治疗后UEFT的改善值,两组改善值的比较差异有显著性意义(Ρ<0.05)。亚急性期组患者和慢性期组患者在CIMT在治疗前、后UEFT的比较差异有显著性意义(Ρ<0.001),但CIMT在上肢运动功能改善效果上亚急性期组患者优于慢性期组患者(效应值ES:1.51:0.89)。结论:本文的研究结果表明CIMT在亚急性期和慢性期患者中均显现出较大的康复效力,尤其在亚急性期患者中显现出更大的康复效力。
OBJECTIVE: Mandatory exercise therapy (CIMT) is a new rehabilitation training technique for upper extremity dysfunction after stroke in recent years. The purpose of this study was to evaluate and compare the effectiveness of CIMT in the recovery of patients with stroke in subacute and chronic phases. Methods: Thirty stroke patients with hemiplegia were involved in this study. Among them, 14 were in the subacute group (mean duration was 3.5 months) and 16 were in the chronic group (mean duration was 12.1 months). During the CIMT treatment, both groups of patients were required to wear braces and cleats on the contralateral side to restrain contralateral limb movements and hold a fixed time of not less than 90% every day for 12 consecutive days. At the same time accept the plastic training, intensive training of ipsilateral physical activity, to complete the daily life of the action, a total of 10 working days for 2 weeks. Upper extremity motor function was assessed in both groups before and after CIMT treatment using Upper Extremity Function Test (UEFT). Results: There was no significant difference in UEFT between the two groups before and after CIMT (P> 0.05). There was no significant difference in UEFT between the two groups after treatment (P> 0.05) The improvement of UEFT was significantly higher than the improvement of UEFT after treatment in patients with chronic phase, the difference between the two groups was significant (P <0.05). The difference of UEFT between subacute group and chronic group before and after CIMT was significant (P <0.001), but CIMT was superior to chronic group in the effect of improving upper limb motor function in subacute group Patients (effect value ES: 1.51: 0.89). CONCLUSIONS: The results of this study demonstrate that CIMT shows greater efficacy in the recovery of patients in both subacute and chronic phases, especially in subacute stage patients.