强制性使用运动疗法在不同程度上肢功能障碍脑卒中患者中的效力

目的 探讨强制性使用运动疗法（CIMT）在不同程度上肢运动障碍的脑卒中患者中的康复效力。方法 27例脑卒中偏瘫患者（平均病程8．3个月）参与此研究。在CIMT治疗期间，要求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12d。同时接受塑形训练，密集地训练患侧肢体活动，完成日常生活中的动作，连续两周共10个工作日。在接受CIMT治疗前和治疗后用上肢功能测验（UEFT）评价患者的上肢运动功能。根据CIMT治疗前UEFT评定结果进行上肢运动功能障碍程度分类。结果 在CIMT治疗后，上肢运动功能障碍重度组和中度组患者的UEF得分较治疗前均显著提高（P〈0．001），而且CIMT在重度组患者中比在中度组患者显现出更大的康复效力（ES分别为2．2和1．8）。在UEFT的改善值方面，重度组和中度组患者间无显著性差异（P〉0．05）。结论 CIMT可以有效地改善不同障碍程度脑卒中患者的上肢运动功能，特别是在上肢运动功能障碍严重的脑卒中患者中显现出更大的康复效力。

Effects of Constraint-induced Movement Therapy on Different Severities of the Motor Deficit of Upper Extremity after Stroke

ObjectiveTo determine the efficacy of constraint-induced movement therapy(CIMT) on different severity of the motor deficit of upper extremity after stroke.Methods27 stroke patients who had upper-limb hemiparesis and learned nonuse were allocated either to the moderate group(n=12) or the severe group(n=15) according to severity of initial motor deficit of upper extremity by Upper Extremity Function Test(UEFT).The two group patients were given CIMT,involving restriction of movement of the intact upper extremity by placing it in a sling for 90% of waking hours for 12 days and training(by repetitive practice,shaping) of the more affected extremity for 6 hours on the 10 weekdays during that period.Outcome were measured with UEFT.ResultsThere was no significant difference in treatment gain on the UEFT between the moderate patients and the severe patients(P>0.05).However,the Effect Size for the severe patients(ES=2.2) was larger than for the moderate patients(ES=1.8) at the quality of movement(UEFT).ConclusionCIMT is an effective rehabilitation technique for different severity of the motor deficit of upper extremity after stroke,especially in severe stroke patients.