以感觉刺激为导向的易化技术对脑卒中后上肢功能康复效果的影响

目的 作业治疗中强化以感觉刺激为导向的易化技术对脑卒中后上肢功能康复效果的影响。方法 回顾性分析2018年6月至2020年5月收治的脑卒中偏瘫软瘫期及痉挛期患者60例,分为治疗组(n=30)和对照组(n=30)。2组患者均接受常规康复,治疗组在此基础上在作业治疗中强化运用Brunnstrom技术、Bobath技术、Rood技术、神经肌肉本体感觉促通技术等易化技术,尤其强化应用其中的感觉刺激成分,通过口令、刷擦、轻拍、按压、挤压、牵伸、冷水、温水、抗阻、控住等措施刺激视听觉、浅感觉、本体感觉、复合感觉等多感觉通路,治疗12周。采用简式Fugl-Meyer运动功能评定量表(Fugl-Meyer Assessment Scale,FMA)上肢部分对2组患者治疗前及治疗后6周、12周运动功能进行评分,采用改良Barthel指数(modified Barthel index, MBI)对2组患者治疗前及治疗6周、12周日常生活活动(activities of daily living,ADL)能力进行评分,采用功能活动问卷(the Functional Activities Questionary, FAQ)对2组患者出院半年时工具性ADL能力进行评分;采用Brunnstrom分期对2组患者治疗12周部分分离运动期及分离运动期所占比率进行评定。结果 2组治疗6周、12周与治疗前相比均有较明显的效果,治疗组运动能力和ADL能力评分均优于对照组, 2组治疗12周运动能力和ADL能力评分均明显优于治疗6周(均P<0.01)。出院半年时工具性ADL能力,治疗组明显优于对照组(P<0.01)。患者上肢运动功能恢复达Brunnstrom 4期及以上的发生率,治疗组明显优于对照组(均P<0.01),表明在康复训练中强化感觉刺激使患者能获得更好的康复治疗效果。结论 在作业治疗中运用易化技术尤其强化易化技术中的感觉刺激成分,能够明显促进脑卒中偏瘫患者的运动功能康复进程,明显改善患者上肢的运动功能,提高其日常生活活动能力。

Effect of enhanced sensory stimulation-oriented facilitation technique in the rehabilitation of upper limb function after stroke

Objective To explore the influence of strengthening facilitation technique guided by sensory stimulation on the rehabilitation effect of upper limb function in stroke patients on occupational therapy. Methods Sixty patients with paraplegia and spasms during stroke that were treated in our department from June 2018 to May 2020 were selected as the subjects of the study. These patients were divided into therapy group(n=30)and control group(n=30). Both groups received routine rehabilitation on this basis. The therapy group were given strenghening facilitation techniques such as Brunnstrom technique, Bobath technique, Rood technique, PNF(propriceptive neuromuscular facilitation)technique, especially strengthening the application of the sense of stimulation ingredients to stimulate multi-sensory paths such as visual hearing, shallow sensations, ontogenal sensations, composite sensations and by password, brushing, tapping, pressing, extrusion, stretching, cold water, warm water, resistance, control and other measures, the treatment period was 12 weeks. Fugl-Meyer Assessmont Scnle(FMA)-upper limb was used to examine the rate the motor function of 2 groups of patients before and 6 weeks and 12 weeks after treatment. Ability of ADL(activities of daily living)was scored in 2 groups of patients before and 6 weeks and 12 weeks after treatment using an improved Barthel index scale(modified Barthel index, MBI). In strumental ADL ability 2 groups half a year after discharge using Functional Activity Questionnaires(FAQ), the Brunnstrom stage was used to determine the rate the proportion of partial separation exercise period and separation exercise period at 12 weeks of treatment in 2 groups. Results 2 groups after 6 weeks and 12 weeks had significant effects compared to pre-treatment,and the exercise ability and ADL ability of the therapy group were better than that of the control group, the exercise ability and ADL ability of the two groups after 12 weeks were better than those of the group after 6 weeks(all P<0.01). In strumental ADL ability of the therapy group was better than that of the control group(P<0.01). In 2 groups half a year after discharge, there were significantly more cases of patients with upper limb movement function recovery up to Brunnstrom 4 and above treatment group than in 2 groups(all P<0.01), it was shown that strengthening sensory stimulation in rehabilitation training could enable the patients to obtain better rehabilitation results. Conclusion The use of facilitation technique in occupational therapy, especially the strengthening of the sensational stimulation component of facilitation technique, can significantly promote the process of motor function rehabilitation in patients with paraplegia with stroke paraplegia, significantly improve the movement function of the upper limbs of patients, and improve ADL ability.