脑卒中患者采用力反馈感知康复训练后手指运动功能障碍恢复效果评价

doi:10.13481/j.1671-587X.20240426

摘要/Abstract

摘要：

目的探讨力反馈感知康复训练对脑卒中后手指运动功能障碍患者手指运动功能的影响，为力反馈感知康复训练的临床应用和推广提供依据。方法 86例脑卒中后手功能障碍患者随机分为试验组（n=43）和对照组（n=43），其中试验组和对照组各脱落3例，最终80例患者纳入本研究。2组患者在进行40 min常规康复训练基础上，对照组患者进行常规手功能训练20 min，试验组患者进行力反馈感知康复训练20 min，每天1次，每周5 d，共6周。治疗前后采用上肢动作研究量表（ARAT）、握力、改良Ashworth量表（MAS）、手指总主动活动度（TAM）、Fugl-Meyer上肢运动功能评定量表（FMA-UL）手运动部分和Barthel指数（BI）评定量表评价患者手功能恢复情况。结果治疗前2组患者ARAT评分、握力、MAS分级、TAM、FMA-UL手运动部分评分和BI评分比较差异均无统计学意义（P>0.05）。与治疗前比较，治疗6周后2组患者ARAT评分、握力、TAM、FMA-UL手运动部分评分和BI评分均升高（P<0.05），MAS分级差异无统计学意义（P>0.05）。与对照组比较，治疗6周后试验组患者ARAT评分中抓评分、握评分和治疗前后ARAT总评分差值升高（P<0.05），治疗后TAM及治疗前后握力差值、TAM差值和FMA-UL手运动部分评分差值升高（P<0.05），但ARAT评分中捏评分、粗大运动评分及MAS分级和治疗前后BI评分差值差异无统计学意义（P>0.05）。结论力反馈感知康复训练有助于改善脑卒中后手指运动功能障碍患者的手指运动功能。

关键词: 力反馈感知, 脑卒中, 手指运动功能障碍, 康复治疗

Abstract:

Objective To discuss the effect of the force feedback perceptual rehabilitation training on finger motor function of the patients with finger motor dysfunction after stroke， and to provide the basis for the clinical application and promotion of the force feedback perceptual rehabilitation training. Methods A total of 86 patients with hand dysfunction after stroke were randomly divided into experimental group （n=43） and control group （n=43），and 3 cases in each group fell off from the experiment， and 80 cases were ultimately completed. On this basis， the patients in two groups received the conventional rehabilitation training for 40 min. The patients in control group received the conventional hand function training for 20 min， while the patients in experimental group received the force feedback perception rehabilitation training for 20 min， once per day， 5 days per week， for a total of 6 weeks. The hand function recovery of the patients were evaluated before and after treatment by Action Research Arm Test （ARAT），grip strength， modified Ashworth scale （MAS）， total active motion （TAM）， Fugl-Meyer motor function assessment-upper limb （FMA-UL） finger motor part score，and Barthel index （BI）. Results Before treatment， there were no statistically significant differences in ARAT total score， grip strength， MAS grade， TAM， FMA-UL finger motor part score， and BI score of the patients between two groups （P>0.05）. After treated for 6 weeks， the ARAT scores， grip strengths， TAM， FMA-UL finger motor part scores， and BI scores of the patients in two groups were all increased than those before treatment （P<0.05）， while the MAS grades of the patients had no significant differences （P>0.05）. After treated for 6 weeks， compared with control group，the grasp score and grip score in ARAT score， and the difference of total ARAT score of the patients in experimental group were increased （P<0.05）， the TAM after treatment and the differences of grip strength， TAM， and FMA-UL finger motor part score of the patients before and after treatment were increased （P<0.05）， while the pinch scores and gross movement scores in ARAT score， MAS grades， and the differences of BI score before and after treatment had no significant differences（P>0.05）. Conclusion Force feedback perceptual rehabilitation training is helpful in improving the finger motor function of the patients with finger motor dysfunction after stroke.

Key words: Force feedback perceptual, Stroke, Finger motor dysfunction, Rehabilitation treatment

中图分类号:

R743.3

连雅雯,李莹华,徐国兴,解希曦,李贞兰. 脑卒中患者采用力反馈感知康复训练后手指运动功能障碍恢复效果评价[J]. 吉林大学学报(医学版), 2024, 50(4): 1116-1122.

Yawen LIAN,Yinghua LI,Guoxing XU,Xixi XIE,Zhenlan LI. Evaluation of recovery effect of finger motor dysfunction in patients with stroke after treated with force feedback perceptual rehabilitation training[J]. Journal of Jilin University(Medicine Edition), 2024, 50(4): 1116-1122.

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Group	Grasp score			Grip score
Group	Before treatment	After treatment	Difference value	Before treatment	After treatment	Difference value
Control	6.00(3.25,10.75)	10.00(9.00,13.00)^*	3.50(2.00,6.00)	5.00(2.00,8.00)	8.00(6.00,10.00)^*	2.00(0.25,4.00)
Experimental	8.00(5.00,11.00)	14.00(12.25,18.00)^*△	5.00(3.00,8.00)	7.00(3.00,9.00)	10.00(8.25,12.00)^*△	2.00(0.00,4.00)
Group	Pinch score			Gross movement score
Group	Before treatment	After treatment	Difference value	Before treatment	After treatment	Difference value
Control	2.00(0.25,6.00)	5.00(3.25,10.00)^*	2.50(2.00,4.00)	1.50(0.00,4.75)	5.00(3.00,6.75)^*	2.00(0.25,3.75)
Experimental	3.00(0.00,5.50)	7.00(4.00,10.00)^*	4.00(1.00,6.00)	2.50(0.00,4.75)	6.00(3.25,9.00)^*	2.50(0.00,5.75)
Group	Total score
Group	Before treatment		After treatment		Difference value
Control	14.50(6.25,29.25)		27.00(23.00,41.25)^*		11.50(7.25,17.75)
Experimental	19.50(9.00,31.25)		35.50(29.25,46.00)^*		14.50(9.00,22.50)^△

Group	Grip strength
Group	Before treatment	After treatment	Difference value
Control	0.20(0.00,2.70)	2.20(0.60,3.58)^*	0.75(0.50,1.45)
Experimental	0.25(0.00,3.20)	3.15(1.65,5.68)^*	1.95(1.30,2.68)^△

Group	TAM
Group	Before treatment	After treatment	Difference value
Control	187.50(138.25,527.25)	489.00(281.25,650.25)^*	113.00(60.75,213.00)
Experimental	180.00(112.00,575.50)	543.50(427.75,776.75)^*△	215.50(108.75,360.50)^△

Group	FMA-UL finger motor part score
Group	Before treatment	After treatment	Difference value
Control	3.50(2.00,7.00)	8.00(5.00,10.75)^*	3.00(1.25,4.00)
Experimental	3.00(2.00,8.00)	9.00(7.00,12.75)^*	4.50(3.00,6.00)^△

Group	BI
Group	Before treatment	After treatment	Difference value
Control	17.50(10.00,30.00)	25.00(20.00,35.00)^*	5.00(0.00,10.00)
Experimental	20.00(11.25,30.00)	30.00(20.00,35.00)^*	5.00(5.00,13.75)