强化简易家庭任务导向性训练在卒中偏侧下肢运动功能障碍患者中的初步应用分析
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摘要
目的探讨强化简易家庭任务导向性训练在卒中偏侧下肢运动功能障碍患者中的初步应用效果。方法回顾性连续纳入2016年5月至2018年10月首都医科大学宣武医院康复医学科行门诊康复训练的卒中偏侧下肢运动功能障碍慢性期患者30例,根据采取的康复治疗方式,将30例患者分为一般康复训练组(15例)和简易任务导向训练组(15例)。两组患者均进行3次/周的康复医学科门诊日常康复指导和2 h/d的强化性家庭康复训练,共训练4周。(1)一般康复训练组采用常规家庭康复训练,包括斜板站立、站起-坐下、弯腿-伸腿、站立位前后迈步训练以及保护下进行步行训练。训练频次为2 h/d,5 d/周。(2)简易任务导向训练组在家庭康复中,将"迈步"动作精简分解为踝关节外翻、屈髋屈膝踝关节背屈、伸髋伸膝踝关节背屈三个动作进行训练。比较两组患者治疗前后Fugl-Meyer下肢运动功能评定(FMA-LE)、Berg平衡量表(BBS)、"起立-行走"计时(TUG)测试的差异。结果 (1)两组治疗前后FMA-LE评分比较,组别及时间的交互作用差异有统计学意义(F=483.64,P <0.01)。一般康复训练组治疗前和治疗后FMA-LE评分分别为(20±4)、(21±4)分,简易任务导向训练组治疗前和治疗后FMA-LE评分分别为(22±4)、(25±6)分。两组治疗前FMA-LE评分的差异无统计学意义(P=0.25);治疗后,简易任务导向训练组优于一般康复训练组,组间差异有统计学意义(P=0.003)。两组患者治疗后FMA-LE评分均优于本组治疗前,治疗前后的差异均有统计学意义(均P <0.01)。(2)两组治疗前后BBS评分比较,组别及时间的交互作用差异有统计学意义(F=2 375.69,P <0.01)。一般康复训练组治疗前和治疗后BBS评分分别为(45.3±1.0)、(46.4±1.3)分,简易任务导向训练组治疗前和治疗后BBS评分分别为(46.8±1.4)、(49.7±1.2)分。两组间BBS评分的差异无统计学意义(P=0.09)。两组患者治疗后BBS评分均优于本组治疗前,治疗前后的差异均有统计学意义(均P <0.01)。(3)两组治疗前后TUG比较,组别及时间的交互作用差异有统计学意义(F=259.56,P <0.01)。一般康复训练组治疗前和治疗后TUG分别为(20.0±7.1)、(19.3±7.5) s,简易任务导向训练组治疗前和治疗后TUG分别为(20.9±1.6)、(16.9±1.2) s。两组间TUG的差异无统计学意义(P=0.79)。一般康复训练组治疗前后TUG的差异无统计学意义(P=0.11),简易任务导向训练组治疗后TUG较治疗前缩短,治疗前后差异有统计学意义(P <0.01)。结论强化性简易家庭任务导向性训练和强化性家庭一般康复训练均有助于改善卒中偏侧下肢运动功能障碍慢性期患者的下肢基础运动功能、平衡功能和运动控制能力;强化性简易家庭任务导向性训练对下肢基础运动功能的改善略优于强化性家庭一般康复训练;两种训练方式在平衡功能和步行速度方面的作用相似。
Objective To investigate the preliminary application effect in intensive simplified home-based task-oriented training in stroke patients with unilateral lower limb motor dysfunction.Methods From May 2016 to October 2018,30 chronic stage stroke patients with unilateral lower limb motor dysfunction for outpatient rehabilitation training at the Department of Rehabilitation Medicine,Xuanwu Hospital,Capital Medical University were enrolled retrospectively.According to the rehabilitation methods,30 patients were divided into either a general rehabilitation training group( n = 15) or an intensive home-based task-oriented training group( n = 15).Both groups of patients underwent routine rehabilitation guidance at the rehabilitation medicine clinic( 3 times a week) and intensive family rehabilitation training( 2 h/d) for 4 weeks.( 1) The general rehabilitation training group used routine home rehabilitation training,including sloping board standing,standing up-sitting down,bending legs-stretching legs,standing forward and backward step training,and walking training under protection.The training frequency was 2 h/d,5 d/week.( 2) In the family rehabilitation,the simplified task-oriented training group decomposes the " stepping" action into three exercises: ankle joint eversion,hip knee flexion with ankle dorsiflexion,hip knee extension with ankle dorsiflexion.Fugl-Meyer motor assessment-lower extremity( FMA-LE),Berg Balance Scale( BBS),Timed Up and Go( TUG) test were compared before and after treatment.Results( 1) There were significant differences in FMA-LE scores,groups and time interaction before and after treatment between the two groups( F = 483.64,P < 0.01).The FMA-LE scores of the general rehabilitation training group before and after treatment were 20 ± 4 and 21 ± 4 respectively,while those of the simplified task-oriented training group before and after treatment were 22 ± 4 and 25 ± 6 respectively.There were no significance before treatment between the two groups( P = 0.25).After treatment,the simplified task-oriented training group was superior to the general rehabilitation training group,and the difference between both groups was statistically significant( P = 0.003).The FMA-LE scores of the two groups were better than those of the groups before treatment.The differences before and after treatment were statistically significant( all P < 0.01).( 2) The BBS scores before and after treatment were compared,and there was significant difference in the groups and time interaction( F = 2 375.69,P < 0.01).The BBS scores of the general rehabilitation training group before and after treatment were 45.3 ± 1.0 and 46.4 ± 1.3 respectively,while those of the simplified task-oriented training group before and after treatment were 46.8 ± 1.4 and 49.7 ± 1.2 respectively.There was no significant difference in BBS scores between the two groups( P = 0.09).The BBS scores of the two groups were better than those of the groups before treatment,and the differences before and after treatment were statistically significant( all P < 0.01).( 3) There were significant differences in TUG before and after treatment in the groups and time interaction( F = 259.56,P < 0.01).TUG of the general rehabilitation training group before and after treatment were 20.0 ± 7.1 and 19.3 ± 7.5 s respectively,while TUG of the simplified task-oriented training group before and after treatment were 20.9 ± 1.6 and 16.9 ± 1.2 s respectively.There was no significant difference in TUG between the two groups( P = 0.79).There was no significant difference in TUG between the general rehabilitation group before and after treatment( P =0.11).The TUG of the simplified task-oriented training group was shorter than that before treatment,and the difference was statistically significant before and after treatment( P < 0.01).Conclusions Intensive simplified home-based task-oriented training and intensive home-based general rehabilitation training are helpful to improve lower limb basic motor function,balance function,and motor control ability in patients with chronic lower limb motor dysfunction.Intensive simplified home-based task-oriented training is slightly superior to intensive home-based general rehabilitation training in improving basic motor function of lower limbs.The two training methods have similar effects in terms of balance function and walking speed.
Objective To investigate the preliminary application effect in intensive simplified home-based task-oriented training in stroke patients with unilateral lower limb motor dysfunction.Methods From May 2016 to October 2018,30 chronic stage stroke patients with unilateral lower limb motor dysfunction for outpatient rehabilitation training at the Department of Rehabilitation Medicine,Xuanwu Hospital,Capital Medical University were enrolled retrospectively.According to the rehabilitation methods,30 patients were divided into either a general rehabilitation training group( n = 15) or an intensive home-based task-oriented training group( n = 15).Both groups of patients underwent routine rehabilitation guidance at the rehabilitation medicine clinic( 3 times a week) and intensive family rehabilitation training( 2 h/d) for 4 weeks.( 1) The general rehabilitation training group used routine home rehabilitation training,including sloping board standing,standing up-sitting down,bending legs-stretching legs,standing forward and backward step training,and walking training under protection.The training frequency was 2 h/d,5 d/week.( 2) In the family rehabilitation,the simplified task-oriented training group decomposes the " stepping" action into three exercises: ankle joint eversion,hip knee flexion with ankle dorsiflexion,hip knee extension with ankle dorsiflexion.Fugl-Meyer motor assessment-lower extremity( FMA-LE),Berg Balance Scale( BBS),Timed Up and Go( TUG) test were compared before and after treatment.Results( 1) There were significant differences in FMA-LE scores,groups and time interaction before and after treatment between the two groups( F = 483.64,P < 0.01).The FMA-LE scores of the general rehabilitation training group before and after treatment were 20 ± 4 and 21 ± 4 respectively,while those of the simplified task-oriented training group before and after treatment were 22 ± 4 and 25 ± 6 respectively.There were no significance before treatment between the two groups( P = 0.25).After treatment,the simplified task-oriented training group was superior to the general rehabilitation training group,and the difference between both groups was statistically significant( P = 0.003).The FMA-LE scores of the two groups were better than those of the groups before treatment.The differences before and after treatment were statistically significant( all P < 0.01).( 2) The BBS scores before and after treatment were compared,and there was significant difference in the groups and time interaction( F = 2 375.69,P < 0.01).The BBS scores of the general rehabilitation training group before and after treatment were 45.3 ± 1.0 and 46.4 ± 1.3 respectively,while those of the simplified task-oriented training group before and after treatment were 46.8 ± 1.4 and 49.7 ± 1.2 respectively.There was no significant difference in BBS scores between the two groups( P = 0.09).The BBS scores of the two groups were better than those of the groups before treatment,and the differences before and after treatment were statistically significant( all P < 0.01).( 3) There were significant differences in TUG before and after treatment in the groups and time interaction( F = 259.56,P < 0.01).TUG of the general rehabilitation training group before and after treatment were 20.0 ± 7.1 and 19.3 ± 7.5 s respectively,while TUG of the simplified task-oriented training group before and after treatment were 20.9 ± 1.6 and 16.9 ± 1.2 s respectively.There was no significant difference in TUG between the two groups( P = 0.79).There was no significant difference in TUG between the general rehabilitation group before and after treatment( P =0.11).The TUG of the simplified task-oriented training group was shorter than that before treatment,and the difference was statistically significant before and after treatment( P < 0.01).Conclusions Intensive simplified home-based task-oriented training and intensive home-based general rehabilitation training are helpful to improve lower limb basic motor function,balance function,and motor control ability in patients with chronic lower limb motor dysfunction.Intensive simplified home-based task-oriented training is slightly superior to intensive home-based general rehabilitation training in improving basic motor function of lower limbs.The two training methods have similar effects in terms of balance function and walking speed.
引文
[1]Hong Z,Sui M,Zhuang Z,et al.Effectiveness of neuromuscular electrical stimulation on lower limbs of patients with hemiplegia after chronic stroke:a systematic review[J].Arch Phys Med Rehabil,2018,99(5):1011-1022.e1.
[2]郭丽云,田泽丽,王潞萍,等.任务导向性训练结合肌力训练对脑卒中后遗症期偏瘫患者运动功能的影响[J].中国康复医学杂志,2013,28(7):642-644.
[3]刘玲,严会荣,陈祢,等.任务导向结合肌力训练对脑卒中后遗症患者下肢偏瘫的影响[J].新疆医科大学学报,2014,37(11):1483-1486.
[4]Ouellette MM,Lebrasseur NK,Bean JF,et al.Highintensity resistance training improves muscle strength,self-reported function,and disability in longterm stroke survivors[J].Stroke,2004,35(6):1404-1409.
[5]刘鹏,陈少贞,江沁,等.基于动作分析的强化性分离运动对脑卒中患者上肢功能及日常生活活动能力的影响[J].中国康复医学杂志,2007,22(6):521-523.
[6]Park J.Effects of task-oriented training on upper extremity function and performance of daily activities in chronic stroke patients with impaired cognition[J].J Phys Ther Sci,2016,28(1):316-318.
[7]中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[8]Folstein MF,Folstein SE,McHugh PR.“Mini-mental state”.A practical method for grading the cognitive state of patients for the clinician[J].J Psychiatr Res,1975,12(3):189-198.
[9]Bohannon RW,Smith MB.Interrater reliability of a modified Ashworth scale of muscle spasticity[J].Phys Ther,1987,67(2):206-207.
[10]吴月峰.基于任务为导向的坐-站-坐强化训练对脑卒中偏瘫患者下肢功能的疗效分析[J].全科医学临床与教育,2017,15(3):265-267.
[11]张大威,叶祥明,林坚,等.下肢任务导向性训练对慢性期脑卒中患者步行能力的影响[J].中国康复医学杂志,2011,26(8):768-770.
[12]Lee NK,Kwon JW,Son SM,et al.Changes of plantar pressure distributions following open and closed kinetic chain exercise in patients with stroke[J].Neurorehabil,2013,32(2):385-390.
[13]Gaasterland CM,Jansen-van der Weide MC,Weinreich SS,et al.A systematic review to investigate the measurement properties of goal attainment scaling,towards use in drug trials[J].BMC Med Res Methodol,2016,16:99.
[14]Sanford J,Moreland J,Swanson LR,et al.Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke[J].Phys Ther,1993,73(7):447-454.
[15]Blum L,Korner-Bitensky N.Usefulness of the Berg balance scale in stroke rehabilitation:a systematic review[J].Phys Ther,2008,88(5):559-566.
[16]Viccaro LJ,Perera S,Studenski SA.Is timed up and go better than gait speed in predicting health,function,and falls in older adults?[J].J Am Geriatr Soc,2011,59(5):887-892.
[17]Reid A,Chesson R.Goal attainment scaling.Is it appropriate for stroke patients and their physiotherapists?[J].Physiother,1998,84(3):136-144.
[18]Eftekhar P,Mochizuki G,Dutta T,et al.Goal attainment scaling in individuals with upper limb spasticity post stroke[J].Occup Ther Int,2016,23(4):379-389.
[19]Turner-Stokes L.Goal attainment scaling(GAS)in rehabilitation:a practical guide[J].Clin Rehabil,2009,23(4):362-370.
[20]Maeshima S,Ueyoshi A,Osawa A,et al.Mobility and muscle strength contralateral to hemiplegia from stroke[J].Am J Phys Med Rehab,2003,82(6):456-462.
[21]Simpson B,Mccluskey A,Lannin N,et al.Feasibility of a home-based program to improve handwriting after stroke:a pilot study[J].Disabil Rehabil,2016,38(7):673-682.
[22]Lee NK,Kwon JW,Son SM,et al.Changes of plantar pressure distributions following open and closed kinetic chain exercise in patients with stroke[J].NeuroRehabilitation,2013,32(2):385-390.
[2]郭丽云,田泽丽,王潞萍,等.任务导向性训练结合肌力训练对脑卒中后遗症期偏瘫患者运动功能的影响[J].中国康复医学杂志,2013,28(7):642-644.
[3]刘玲,严会荣,陈祢,等.任务导向结合肌力训练对脑卒中后遗症患者下肢偏瘫的影响[J].新疆医科大学学报,2014,37(11):1483-1486.
[4]Ouellette MM,Lebrasseur NK,Bean JF,et al.Highintensity resistance training improves muscle strength,self-reported function,and disability in longterm stroke survivors[J].Stroke,2004,35(6):1404-1409.
[5]刘鹏,陈少贞,江沁,等.基于动作分析的强化性分离运动对脑卒中患者上肢功能及日常生活活动能力的影响[J].中国康复医学杂志,2007,22(6):521-523.
[6]Park J.Effects of task-oriented training on upper extremity function and performance of daily activities in chronic stroke patients with impaired cognition[J].J Phys Ther Sci,2016,28(1):316-318.
[7]中华神经科学会,中华神经外科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[8]Folstein MF,Folstein SE,McHugh PR.“Mini-mental state”.A practical method for grading the cognitive state of patients for the clinician[J].J Psychiatr Res,1975,12(3):189-198.
[9]Bohannon RW,Smith MB.Interrater reliability of a modified Ashworth scale of muscle spasticity[J].Phys Ther,1987,67(2):206-207.
[10]吴月峰.基于任务为导向的坐-站-坐强化训练对脑卒中偏瘫患者下肢功能的疗效分析[J].全科医学临床与教育,2017,15(3):265-267.
[11]张大威,叶祥明,林坚,等.下肢任务导向性训练对慢性期脑卒中患者步行能力的影响[J].中国康复医学杂志,2011,26(8):768-770.
[12]Lee NK,Kwon JW,Son SM,et al.Changes of plantar pressure distributions following open and closed kinetic chain exercise in patients with stroke[J].Neurorehabil,2013,32(2):385-390.
[13]Gaasterland CM,Jansen-van der Weide MC,Weinreich SS,et al.A systematic review to investigate the measurement properties of goal attainment scaling,towards use in drug trials[J].BMC Med Res Methodol,2016,16:99.
[14]Sanford J,Moreland J,Swanson LR,et al.Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke[J].Phys Ther,1993,73(7):447-454.
[15]Blum L,Korner-Bitensky N.Usefulness of the Berg balance scale in stroke rehabilitation:a systematic review[J].Phys Ther,2008,88(5):559-566.
[16]Viccaro LJ,Perera S,Studenski SA.Is timed up and go better than gait speed in predicting health,function,and falls in older adults?[J].J Am Geriatr Soc,2011,59(5):887-892.
[17]Reid A,Chesson R.Goal attainment scaling.Is it appropriate for stroke patients and their physiotherapists?[J].Physiother,1998,84(3):136-144.
[18]Eftekhar P,Mochizuki G,Dutta T,et al.Goal attainment scaling in individuals with upper limb spasticity post stroke[J].Occup Ther Int,2016,23(4):379-389.
[19]Turner-Stokes L.Goal attainment scaling(GAS)in rehabilitation:a practical guide[J].Clin Rehabil,2009,23(4):362-370.
[20]Maeshima S,Ueyoshi A,Osawa A,et al.Mobility and muscle strength contralateral to hemiplegia from stroke[J].Am J Phys Med Rehab,2003,82(6):456-462.
[21]Simpson B,Mccluskey A,Lannin N,et al.Feasibility of a home-based program to improve handwriting after stroke:a pilot study[J].Disabil Rehabil,2016,38(7):673-682.
[22]Lee NK,Kwon JW,Son SM,et al.Changes of plantar pressure distributions following open and closed kinetic chain exercise in patients with stroke[J].NeuroRehabilitation,2013,32(2):385-390.