远程科学康复指导及宣教在偏瘫康复中的应用

目的　探索不同阶段的脑卒中偏瘫康复训练结合远程科学康复指导和宣教，对患者肢体运动功能和日常生活能力的影响。方法　选取2020年9月至2021年8月内蒙古自治区人民医院神经内科康复医学组收治的脑卒中恢复期偏瘫患者64例为研究对象，分为远程组和常规组，各32例。常规组患者中，男19例，女13例，年龄（59.78±7.62）岁，病程（28.63±12.45）d；远程组患者中，男20例，女12例，年龄（60.47±7.82）岁，病程（27.47±13.96）d。两组均住院康复4周，后转社区，继续接受社区门诊康复2个月。常规组患者全程接受常规康复治疗；远程组患者全程常规康复治疗+全程远程康复宣教和指导。两组均在内蒙古自治区人民医院治疗前、后及社区门诊康复2个月随访分别评定，采用简化Fugl-Meyer运动功能量表（FMA）评定肢体运动功能，采用功能独立评定量表（FIM）评定日常生活能力。统计方法采用独立样本t检验、配对t检验、χ²检验。结果　治疗4周后两组患者运动功能FMA评分均较治疗前显著提高［远程组（49.31±11.18）分比（29.03±9.18）分，常规组（43.81±11.84）分比（26.78±9.65）分，均P<0.001］，且治疗后远程组较常规组提高较为明显（P=0.038）；日常生活能力FIM评分均显著提高［远程组（62.90±12.60）分比（37.75±10.99）分，常规组（53.56±13.44）分比（38.09±11.64）分，均P<0.001］，且治疗后远程组较常规组提高较为明显（P=0.003）。社区门诊继续康复2个月后，两组患者运动功能FMA评分比治疗后均显著提高［远程组（61.63±12.95）分比（49.31±11.18）分、对照组（51.63±14.58）分比（43.81±11.84）分，均P<0.001］，且远程组较常规组提高均更明显（P=0.002 ）；两组患者日常生活能力FIM评分比治疗后均显著提高［远程组（76.31±15.28）分比（62.90±12.60）分、对照组（62.13±16.65）分比（53.56±13.44）分，均P<0.001］，且远程组较常规组提高更明显（P<0.001）。结论　不同阶段的康复训练结合远程科学的康复宣教和指导能显著提高脑卒中偏瘫患者肢体运动功能和日常生活能力。

Application of remote scientific rehabilitation guidance and education in hemiplegia rehabilitation

Objective　To explore the effects of different stages of stroke hemiplegia rehabilitation training combined with remote scientific rehabilitation guidance and education on the patients' limb motor function and daily living ability. Methods　Sixty-four patients with hemiplegia during the recovery period of stroke admitted to Rehabilitation Medicine Group, Department of Neurology, People's Hospital of Inner Mongolia Autonomous Region from September 2020 to August 2021 were selected and divided into a remote group and a conventional group, with 32 cases in each group. In the conventional group, there were 19 males and 13 females, with an age of (59.78±7.62) and a disease course of (28.63±12.45) days. In the remote group, there were 20 males and 12 females, with an age of (60.47±7.82) and a disease course of (27.47±13.96) days. Both groups received hospitalization rehabilitation for 4 weeks, and were transferred to communities and continued to receive community rehabilitation for 2 months. The conventional group received conventional rehabilitation treatment in the whole process. The remote group received conventional rehabilitation treatment and remote rehabilitation education and guidance in the whole process. Both groups were evaluated before and after the treatment in People's Hospital of Inner Mongolia Autonomous Region and during the 2-month follow-up of community rehabilitation. The simplified Fugl-Meyer Motor Assessment (FMA) was used to assess limb motor function, and the Functional Independence Measure (FIM) was used to assess daily living ability. Independent-sample t test, paired t test, and χ² test were used. Results　Four weeks after the treatment, the scores of FMA and FIM were higher than those before the treatment in the remote group (49.31±11.18) vs. (29.03±9.18) and (62.90±12.60) vs. (37.75±10.99); both P<0.001] and in the conventional group (43.81±11.84) vs. (26.78±9.65) and (53.56±13.44) vs. (38.09±11.64); both P<0.001], and were higher in the remote group than in the conventional group (P=0.038 and 0.003). After 2 months' community rehabilitation, the scores of FMA and FIM were significantly higher than those after the treatment in the remote group (61.63±12.95) vs. (49.31±11.18) and (76.31±15.28) vs. (62.90±12.60) ; both P<0.001] and in the conventional group (51.63±14.58) vs. (43.81±11.84) and (62.13±16.65) vs. (53.56±13.44); both P<0.001], and were higher in the remote group than in the conventional group (P=0.002 and <0.001). Conclusion　Different stages of rehabilitation training combined with remote scientific rehabilitation education and guidance can significantly improve the limb motor function and daily living ability of stroke patients with hemiplegia.