Effect of constraint-induced movement therapy during acute rehabilitation to reduce arm impairment after ischemic stroke
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摘要: 目的 比较限制诱导运动(constraint-induced movement,CIM)治疗与传统治疗对脑卒中患者肢体功能恢复的作用。 方法 选取安徽省第二人民医院2015年5月—2016年5月收治的缺血性脑卒中患者40例,均合并持续性偏瘫,认知功能正常,保护性运动反应存在,随机分为CIM治疗组和传统治疗组,各20例,采用个性化和循环训练方案进行日常生活的培训,每天2 h,连续10 d。CIM治疗组受试者在10 d的治疗期间每天至少戴6 h的棉垫手套,鼓励患者使用偏瘫的手臂完成日常生活的任务。传统治疗组受试者接受标准的康复治疗。应用上肢运动研究量表(action research arm test,ARAT)、Barthel指数与FIM功能独立性评定表进行评分。 结果 受试者能够完成CIM治疗方案与传统治疗方案的相关测试,无受试者因疼痛或挫折而退出。CIM治疗组ARAT总评分和捏运动量表评分显著高于传统治疗组(均P<0.05)。 结论 对缺血性脑卒中急性康复期患者进行CIM治疗可促进患肢功能恢复,在恢复患肢功能方面可能具有更大的作用,具有一定的推广作用。但还需更大样本长期的研究,以明确其是否优于传统治疗。Abstract: Objective To investigate whether the constraint-induced movement (CIM)therapy is more effective than traditional upper-extremity therapies after ischemic stroke. Methods Forty patients with ischemic stroke involving persistent hemiparesis, evidence of preserved cognitive function, and presence of a protective motor response, persons were enrolled in a pilot randomized, controlled trial that compared CIM with traditional therapies for 10 days, 2 hours a day. Patients in the CIM group wore cotton pad gloves for at least 6 hours a day during the 10-day treatment period, encouraging the patients to use their hemiplegic arms to complete daily tasks. Patients in the traditional treatment group received standard rehabilitation treatment. Differences of ARAT, Barthel Index and FIM between the groups were compared by using student's t tests, constituent ratio by using Chi square tests. Results No subject withdrew because of pain or frustration. The CIM treatment group had significantly higher scores on total ARAT and pinch subscale scores (all P<0.05). Differences in the mean ARAT grip, grasp, and gross movement subscale scores did not reach statistical significance. Conclusions A clinical trial of CIM therapy during acute rehabilitation is feasible. CIM was associated with less arm impairment at the end of treatment. Long-term studies are needed to determine whether CIM early after stroke is superior to traditional therapies.
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Key words:
- Stroke /
- Constraint-induced movement (CIM) /
- Hemiplegia /
- Rehabilitation /
- Activities of daily living
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