综合康复治疗对脑卒中恢复期偏瘫患者的影响

目的探讨综合康复治疗对脑卒中恢复期偏瘫患者生活能力的影响。方法对83例首发脑卒中,在恢复期(发病3个月以上)接受综合性康复治疗的偏瘫患者进行康复前后患肢运动功能及日常生活活动功能(ADL)比较。结果经综合康复治疗后,患者患肢Brunnstrom分级和ADL分值与治疗前比较均有非常显著性差异(P<0.01)。结论综合性康复治疗可以显著改善恢复期脑卒中偏瘫患者患肢功能,提高其生活质量。     

空气波压力治疗对缺血性脑卒中偏瘫患者康复效果的观察

目的观察空气波压力治疗对急性缺血性脑卒中患者康复的效果。方法将139例急性缺血性脑卒中偏瘫患者按入院顺序分为观察组70例和对照组69例。对照组予常规康复护理,观察组在常规康复护理基础上加用空气波压力治疗仪辅助治疗。采用简式Fugl-Meyer评分法、巴氏指数评分法测评患者康复护理前后患肢运动功能及日常生活活动能力。结果康复护理后观察组患肢运动功能及日常生活活动能力较干预前显著提高,且优于对照组。结论脑卒中偏瘫患者早期进行空气波压力辅助治疗能提高康复效果。     

强制性诱导运动治疗在脑卒中患者康复中的应用

强制性诱导运动治疗(constraint-induced movement therapy,CIMT)是一种比较新的运动疗法,该方法通过限制偏瘫患者的健肢活动的同时对患侧进行集中反复作业训练,诱使患肢的使用能力提高。自应用于治疗慢性脑卒中患者上肢运动功能障碍以来,强制性运动疗法得到较大发展,其原则在神经康复多个领域得到应用并获得了成功,受到越来越广泛的关注。     

强制性运动改善偏瘫患者步行能力的疗效观察

脑卒中是导致偏瘫的主要原因,卒中后上肢功能恢复最佳时间是发病后3个月,超过这个时期,上肢恢复将很困难[1],强制性运动疗法(constraint-induced movement therapy,CIMT)的出现,为卒中后上肢运动的恢复提供了一种新的有效康复方法。Wolf进行了前瞻性、大样本,多中心的随机临床实验[2],研究表明,强制性运动可明显促进患侧上肢的恢复,提高患肢的运动功能,提高患者的日常生活活动能力[3]。     

强制性运动疗法对脑损伤后上肢灵活性和日常生活能力的影响

目的探讨强制性运动疗法（CIMT）对偏瘫患者上肢灵活性和日常生活能力的康复效果。方法36例偏瘫患者随机分成CIMT组和传统治疗组。CIMT组每天强化训练患侧上肢5h，5d／周，连续3周，同时使用休息位手夹板和吊带限制健手的使用，每天8h。对照组采用传统PT和OT等康复方法，每天训练患肢5h，5d／周，不限制健手的使用。使用上肢动作研究（ARk,）试验和Barthel指数分别在治疗前、治疗后即刻、治疗后1个月和3个月进行疗效评价；同时使用ARA试验比较CIMT组强化治疗2周和3周对上肢灵活性的疗效差异。结果CIMT组与对照组间ARA试验结果有显著性差异（P〈0．05）；CIMT组2周和3周强化训练的疗效无显著性差异；Barthel指数两组间无显著性差异，但CIMT组可见治疗前后BI明显改善（P〈0．01）。结论CIMT能明显提高偏瘫患者上肢灵活性，提高日常生活能力，其疗效优于传统康复治疗方法。     

良肢位摆放对脑卒中偏瘫患者早期康复护理效果的影响

目的分析良肢位摆放对脑卒中偏瘫患者早期康复护理效果的影响。方法 2014年1月~2015年6月选取早期应用良肢位摆放护理的45例脑卒中偏瘫患者为研究组,选择同一时间内仅在护理的后期使用良肢位摆放的45例脑卒中偏瘫患者为对照组,比较2组患者在护理前后的日常生活能力和患肢运动能力。结果 2组患者护理前后的日常生活能力和患肢运动能力评分明显增高(P0.05),而且研究组患者提高程度明显优于对照组(P0.05)。结论良肢位摆放可明显提高脑卒中偏瘫患者早期康复护理效果,有利于促进患肢功能的恢复。     

强制性使用运动疗法在偏瘫患儿中的应用

目的探讨应用强制性使用运动疗法（Constraint—Iinduced-movent Therpy,CIMT）对偏瘫患儿康复治疗的可行性和有效性。方法80例偏瘫患儿均采用CIMT进行训练,限制患儿使用健侧上肢,强制反复使用患肢,严格一对一训练,教会家长家庭康复训练方法,保证每天训练时间至少4h,3个月为1疗程。治疗前后评价患儿上肢功能和下肢运动功能。结果80例患儿治疗后上肢功能和下肢运动功能都有明显改善,显效率为85％,总有效率为100％。治疗前后Carroll上肢功能试验（UEFT）评分、Gessell发育量表中大运动功能评分比较差异有统计学意义（P〈0．01）。结论CIMT能改善患儿的关节活动范围,抑制肌张力,预防肢体挛缩变形,同时提高手功能和步行质量。CIMT是偏瘫患儿综合康复治疗中一个有效的治疗手段。     

康复护理对提高偏瘫患者手功能障碍的影响

目的：探讨康复护理对偏瘫患于运动功能及日常生活能力的影响。方法：采用运动疗法、ADL训练、作业疗法等对94例接受偏瘫康复的患手的功能障碍进行1－6个月的康复护理，并用运动功能Fugl-Meyer评价法中腕关节与手的主动运动功能积分及Barther指数积分治疗前，后对偏瘫侧手的运动功能，日常生活活动能力进行评估，比较治疗效果。结果：治疗后94例患手的运动功能，日常生活活动能力均有明显改善（P＜0．005）。结论：康复护理显提高偏瘫患手运动功能及日常生活活动能力。     

颈内动脉系统脑卒中偏瘫患者的持续康复疗效观察

目的探讨对颈内动脉系统脑卒中偏瘫患者进行持续康复的疗效。方法60例颈内动脉系统脑卒中患者随机分为短期康复组和持续康复组,各30例。短期康复组在早期康复1个月后给与指导性康复建议回归家庭;持续康复组继续在卒中病房或具有康复专门机构的社区进行康复治疗。结果治疗后,持续康复组患者的运动功能和日常生活活动能力明显高于短期康复组(P<0.01)。结论持续性康复治疗可以保持康复的连续性,有利于脑卒中偏瘫患者患肢功能和日常生活能力的提高。     

强制性运动疗法对脑卒中后上肢运动障碍的影响

目的研究强制性运动疗法(CIMT)对脑卒中后上肢运动功能康复的效果。方法28例符合CIMT适应症的脑卒中患者分成两组:观察组限制健手的使用,强化训练患侧上肢(CIMT);对照组不限制健手的使用,进行传统神经发育疗法治疗。治疗前后评价两组的Fugl-Meyer上肢运动功能评分。结果Fugl-Meyer评分显示,治疗前后相比有显著性差异(P0.05)。在提高上肢灵活性和上肢的使用方面,观察组与对照组间有显著性差异(P0.05)。结论CIMT能加强脑卒中患者上肢运动功能和日常生活能力的改善。     

Constraint-induced motor relearning after stroke: a naturalistic case report

Constraint-induced movement therapy (CIMT) is a promising approach to promoting recovery of functional arm movement after stroke. However, controlled studies have been limited to persons who sustained strokes at least 1 year before beginning the treatment protocol. This case study documents the neurologic history and motor recovery of a woman whose natural circumstances lend support to the principles of CIMT. The patient sustained a right midpontine vascular infarct and fell simultaneously, fracturing her right humerus. Orthopedic intervention for the fracture mirrored the protocol suggested by proponents of CIMT by immobilizing her right arm. Her significant recovery of left arm use over a 1-year period was more extensive than what would be typically expected after the type of cerebral infarct she incurred. Her case provides the first evidence in the literature that supports the principles of CIMT when it is applied immediately poststroke.     

Constraint-induced movement therapy in the treatment of the upper limb in children with hemiplegic cerebral palsy: a Cochrane systematic review

BACKGROUND: Constraint-induced movement therapy (CIMT) is emerging as a treatment approach for children with hemiplegic cerebral palsy. It aims to increase spontaneous use of the affected upper limb and limit the effects of learned non-use. This review evaluates the effectiveness of CIMT, modified CIMT or Forced use in the treatment of children with hemiplegic cerebral palsy. DESIGN AND METHODS: Systematic Cochrane Review. The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 3), MEDLINE (1966 to August Week 4 2006), CINAHL (1982 to July Week 3 2006), EMBASE (1980 to August 2006), PsychInfo (1985 to August Week 4 2006) and reference lists of all relevant articles were searched. Relevant randomized and controlled clinical trials were systematically reviewed. RESULTS: Three studies met the inclusion criteria. One randomized controlled trial (RCT) showed a trend for positive treatment effect favouring CIMT using the Dissociated Movement subscale of the Quality of Upper Extremity Skills Test. A clinically controlled trial demonstrated a significant treatment effect favouring modified CIMT using the Assisting Hand Assessment at two and six months. Another inconsistently reported trial showed a significant treatment effect at six weeks on the self-care component of the WeeFIM using Forced use. REVIEWERS' CONCLUSIONS: Given the limited evidence, the use of CIMT, modified CIMT and Forced use should be considered experimental in children with hemiplegic cerebral palsy. Further research using adequately powered RCTs, rigorous methodology and valid, reliable outcome measures is essential to provide higher level support of the effectiveness of CIMT for children with hemiplegic cerebral palsy.     

Perceptions and experiences of two survivors of stroke who participated in constraint-induced movement therapy home programs.

The purpose of this study was to explore and describe the perceptions and experiences of two survivors of stroke who participated in constraint-induced movement therapy (CIMT) home programs. Data sources were analyzed with a phenomenological approach, and common themes were identified. Themes were translated using the Occupational Adaptation frame of reference as a template. Three themes were generated from the data: (a) motivational factors and expectations represented personal desires to increase functional ability and environmental demands that created a press to participate in CIMT; (b) neurorehabilitation as an ongoing process suggested that rehabilitation should continue as long as functional deficits exist; and (c) perceived changes in function represented perceived changes in efficiency, effectiveness, and satisfaction after CIMT. CIMT was found to help the participants in this study become more satisfied with performance and to increase efficiency and effectiveness of function in daily activities.     

改良和传统强制性运动疗法对脑卒中偏瘫患者上肢运动功能疗效的临床观察

目的观察改良强制性运动疗法和强制性运动疗法对脑卒中偏瘫患者手功能和日常生活能力的影响。方法选取58例符合入选标准的脑卒中偏瘫患者,随机分为改良组(27例)和强制组(31例)。强制组和改良组采用限制健侧肢体动作,在治疗期间要求患者穿戴吊带和夹板,每天清醒时固定时间不少于90%,强制组每日6 h,每周训练5d,连续2周;改良组在治疗环境中进行,每日2 h,每周3次,其它时间在日常生活活动中进行训练,连续10周。治疗前、后分别采用简易上肢机能检查量表(STEF)和Barthel指数(BI)评价患者的上肢运动功能。结果两组患者在治疗前,STEF和Barthel指数中的10项评分差异均无统计学意义(P>0.05)。经过治疗后,组内评分比较,差异均有统计学意义(P<0.05);组间比较,STEF差异无统计学意义(P>0.05),BI差异有统计学意义(P<0.01)。结论改良强制性运动疗法和强制性运动疗法可以有效提高偏瘫患者上肢的灵活性和运动速度。改良强制性运动疗法在改善日常生活活动能力方面明显优于强制性运动疗法。     

Short- and long-term outcome of constraint-induced movement therapy after stroke: a randomized controlled feasibility trial

OBJECTIVE: Constraint-induced movement therapy (CIMT) is a method to improve motor function in the upper extremity following stroke. The aim of this trial was to determine the effect and feasibility of CIMT compared with traditional rehabilitation in short and long term. DESIGN: A randomized controlled trial. SETTING: An inpatient rehabilitation clinic. SUBJECTS: Thirty patients with unilateral hand impairment after stroke. INTERVENTION: Six hours arm therapy for 10 consecutive weekdays, while using a restraining mitten on the unaffected hand. MAIN MEASURES: The patients were assessed at baseline, post-treatment and at six-month follow-up using the Wolf Motor Function Test as primary outcome measure and the Motor Activity Log, Functional Independence Measure and Stroke Impact Scale as secondary measurements. RESULTS: The CIMT group (n=18) showed a statistically significant shorter performance time (4.76 seconds versus 7.61 seconds, P= 0.030) and greater functional ability (3.85 versus 3.47, P= 0.037) than the control group (n=12) on the Wolf Motor Function Test at post-treatment assessment. There was a non-significant trend toward greater amount of use (2.47 versus 1.97, P= 0.097) and better quality of movement (2.45 versus 2.12, P=0.105) in the CIMT group according to the Motor Activity Log. No such differences were seen on Functional Independence Measure at the same time. At six-month follow-up the CIMT group maintained their improvement, but as the control group improved even more, there were no significant differences between the groups on any measurements. CONCLUSIONS: CIMT seems to be an effective and feasible method to improve motor function in the short term, but no long-term effect was found.     

强制性诱导运动疗法在偏瘫儿童中的临床应用

目的探讨强制性诱导运动疗法对偏瘫患儿功能恢复的影响。方法30例小儿脑瘫痉挛型偏瘫、颅脑外伤偏瘫患儿，随机分为治疗组和对照组。两组均进行有目的作业治疗。治疗组使用连手棉袖套限制健侧上肢。疗程12周。在治疗前1周及治疗后，用上田敏偏瘫上肢功能评价法分级与Brunnstrom偏瘫手功能评价法进行评测。结果治疗组患肢及手功能的恢复程度优于对照组。结论强制性诱导运动疗法对改善患侧肢体运动功能有显著疗效。     

Kinematic and clinical analyses of upper-extremity movements after constraint-induced movement therapy in patients with stroke: a randomized controlled trial

OBJECTIVE: To study the effects of constraint-induced movement therapy (CIMT) relative to traditional intervention on motor-control strategies for upper-arm reaching and motor performance at the impairment and functional levels in stroke patients. DESIGN: Two-group randomized controlled trial (RCT); pretreatment and posttreatment measures. SETTING: Rehabilitation clinics. PARTICIPANTS: Forty-seven stroke patients (mean age, 55y) 3 weeks to 37 months postonset of a first-ever cerebrovascular accident. INTERVENTIONS: Forty-seven patients received either CIMT (restraint of the less affected hand combined with intensive training of the more affected upper extremity) or traditional intervention (control treatment) during the study. The treatment intensity was matched between the 2 groups (2h/d, 5d/wk for 3wk). MAIN OUTCOME MEASURES: Outcomes were evaluated using (1) kinematic variables of reaching movement used to describe the control strategies for reaching, (2) the Fugl-Meyer Assessment (FMA) of motor-impairment severity, and (3) the Motor Activity Log (MAL) evaluating the functional ability of the upper extremity. RESULTS: After treatment, the CIMT group showed better strategies of reaching control than the control group (P<.03). The CIMT group also showed less motor impairment on the FMA (P=.019) and higher functional ability on the MAL (P<.001). CONCLUSIONS: This study is the first RCT to show differences in motor-control strategies as measured by kinematic variables after CIMT versus traditional intervention. In addition to improving motor performance at the impairment and functional levels, CIMT conferred therapeutic benefits on control strategies determined by kinematic analysis.     

Application of constraint-induced movement therapy for an individual with severe chronic upper-extremity hemiplegia

BACKGROUND AND PURPOSE: Constraint-induced movement therapy (CIMT) has been documented to improve motor function in the upper extremity of people with mild hemiparesis. The use of CIMT has not been documented for people with severe hemiparesis. This case report describes a CIMT program for an individual with severe upper-extremity deficits as a result of stroke. CASE DESCRIPTION: The client was a 53-year-old woman who had a stroke 15 years previously and had no isolated movement in her right upper extremity. METHODS: The client completed a 3-week CIMT program during which she restrained her left upper extremity and participated in intensive training of her right upper extremity. Task practice and shaping were the primary techniques used for training. OUTCOMES: Increased scores were noted from pretreatment to posttreatment on the Motor Activity Log, Graded Wolf Motor Function Test (GWMFT), and Fugl-Meyer Evaluation of Physical Performance. Further progress on the GWMFT was noted at the 6-month follow-up. Fugl-Meyer test scores remained higher than at pretreatment, but Motor Activity Log scores returned to near baseline by the 6-month follow-up. The speed of performance on the GWFMT did not change. Although some scores increased, the client reported and demonstrated no progress in functional use of the involved upper extremity at the end of the program. DISCUSSION: This case report describes the use of CIMT with an individual who had severe chronic motor deficits as a result of stroke. Further investigation of CIMT, as well as investigation of CIMT in combination with other motor recovery interventions, is warranted.     

Revisiting constraint-induced movement therapy: are we too smitten with the mitten? Is all nonuse "learned"? and other quandaries

Constraint-induced movement therapy (CIMT) has gained considerable popularity as a valuable treatment for a hemiparetic upper extremity. This approach is compatible with the emerging notion that task-oriented or functionally oriented retraining of the impaired limb provides evidence to support its utility. This article first provides a historical perspective on the development of CIMT. An overview model of how learned nonuse of the hemiparetic limb occurs and can be overcome with CIMT is discussed, and then a more detailed model that incorporates critical issues requiring considerably more basic and applied scientific exploration is described. Among the issues considered are the extent to which hemiparetic limb nonuse and subsequent modes of delivery to overcome it are governed by structure-function deficits rather than being attributable primarily to behavioral phenomena; the relative importance of the intensity of training; the need to better balance unimanual and bimanual upper-extremity task practice; the role of psychosocial and cultural factors in fostering patient compliance; the optimization of modes of delivery; and the reevaluation of the constellation of components contributing to successful outcomes with this treatment. Finally, the strengths, uncertainties, and limitations associated with CIMT are examined.