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目的探讨强制性运动疗法(CIMT)对亚急性偏瘫患者上肢运动功能障碍的治疗效果,并对比该疗法与传统康复治疗间的疗效差异。方法将36例偏瘫患者随机分成治疗组及对照组。治疗组患者每天强化训练患侧上肢5 h,每周训练5 d,连续训练3周,同时采用休息位手夹板和吊带限制健侧手的使用,每天8 h。对照组采用传统物理治疗和作业治疗等方法,每天训练患肢5 h,每周训练5 d,治疗期间不限制健侧手的使用。采用运动活动记录表(MAL)、Wolf运动功能实验(WMFT)和Barthel指数作为疗效评测工具,分别于治疗前、治疗后即刻、治疗后1个月和3个月时进行疗效评估。结果治疗组患者治疗前、后存在明显的组内效应(P<0．01),其疗效持续至随访期;在提高患侧上肢灵活性及上肢使用方面,治疗组与对照组间差异具有统计学意义(P<0．05);治疗组患者在治疗2周时和3周时其疗效差异无统计学意义(P>0．05);2组患者在Barthel指数及WMFT时间得分方面,组间差异均无统计学意义(P>0．05)。结论CIMT能显著提高亚急性偏瘫患者的上肢运动功能,加强患侧上肢在日常生活中的使用频率,其疗效明显优于传统康复治疗。
Objective To investigate the therapeutic effect of forced exercise therapy (CIMT) on motor dysfunction in upper limbs in patients with subacute hemiplegia and to compare the curative effects between this therapy and traditional rehabilitation. Methods Thirty-six patients with hemiplegia were randomly divided into treatment group and control group. Patients in the treatment group were given intensive training on the affected side for 5 hours a day for 5 days a week and continuous training for 3 weeks. Resting hands and sling were used to restrain the use of contralateral hands for 8 hours a day. Control group using traditional physical therapy and homework and other methods, training limbs 5 h per day, training 5 d per week, during treatment does not limit the contralateral hand use. The MAL, WMFT and Barthel index were used as the evaluation tools of curative effect. The curative effect was evaluated before treatment, immediately after treatment, at 1 month and 3 months after treatment. Results There was a significant intra-group effect (P <0.01) before and after treatment in the treatment group, and the effect continued to the follow-up period. The difference between the treatment group and the control group was statistically significant in improving the upper limb flexibility and upper limb use (P <0.05). There was no significant difference in curative effect between two groups at the 2nd week and the 3rd week after treatment (P> 0.05). There was no significant difference between the two groups in Barthel index and WMFT score There was no significant difference between the two groups (P> 0.05). Conclusions CIMT can significantly improve the upper extremity motor function in patients with subacute hemiplegia and enhance the frequency of use of upper limbs in daily life. The curative effect is obviously better than that of traditional rehabilitation.