强制性运动疗法训练对脑卒中后上肢运动功能障碍的疗效及疗效时限研究

赵娟 刘培乐 王瑜元 南向亮 从洋洋 白玉龙

摘 要 目的：观察强制性运动疗法（constraint-induced movement therapy， CIMT）训练对脑卒中后上肢运动功能障碍的疗效及疗效时限。方法：采用前瞻性、单盲、随机、对照研究方法，将患者分为试验组和对照组2组，对试验组患者进行CIMT训练，对对照组患者进行常规运动疗法训练，时间均为3周。分别于训练前、训练后和训练结束后3个月时使用上肢简化Fugl-Meyer运动功能量表（Fugl-Meyer Motor Assessment， FMA）和工具性日常生活活动能力量表（Instrumental Activities of Daily Living Scale， IADLS）对患者进行功能评定。结果：训练前2组患者的上肢简化FMA和IADLS评分均无显著差异（P均>0.05）。单因素重复测量方差分析结果显示，在训练和随访中，2组患者的上肢简化FMA和IADLS评分均有显著改善（P均≤0.001），且組间比较均无显著差异（P均>0.05）。使用训练后和训练结束后3个月时与训练前的评分差值作图可见，随访期2组患者的上肢简化FMA和IADLS评分均呈持续改善状态，但对照组患者2评分的改善趋势随时间延长而减缓（斜率减小），试验组患者2评分的改善趋势则未发生显著变化（斜率基本不变）。结论：与常规运动疗法训练相比，3周的CIMT训练并不能进一步改善脑卒中后上肢运动功能障碍患者的上肢运动功能和工具性日常生活活动能力。不过，CIMT训练效果的持续性可能更好。

关键词 强制性运动疗法 脑卒中 偏瘫

中图分类号：R493； R743.3 文献标志码：B 文章编号：1006-1533（2021）03-0047-06

*基金项目：①上海市卫生健康委员会科研课题青年项目（20154Y0047、20164Y0235、20204Y0442）；②上海市科学技术委员会重点项目（17511107802）

Study on the effect and the duration of effect of constraint-induced movement therapy training on upper limb dysfunction after stroke*

ZHAO Juan1， 2， LIU Peile1， WANG Yuyuan1， NAN Xiangliang2， CONG Yangyang1， BAI Yulong1**（1. Department of Rehabilitation Medicine， Northern Division of Huashan Hospital， Fudan University， Shanghai 201907， China； 2. Department of Rehabilitation Therapy， Shanghai Third Rehabilitation Hospital， Shanghai 200436， China）

ABSTRACT Objective： To observe the immediate and long-term effect of constraint-induced movement therapy （CIMT） training on upper limb dysfunction after stroke. Methods： The enrolled patients were randomly divided into an experimental group and a control group using a prospective， single-blinded and randomized controlled trail method. The experimental group underwent CIMT training for 3 weeks while the control group underwent routine exercise therapy training for 3 weeks. Upper limb Fugl-Meyer Motor Assessment （FMA） and Instrumental Activities of Daily Living Scale （IADLS） were used for functional evaluation before， after and 3 months after the training. Results： There were no significant differences in upper limb FMA and IADLS scores between the two groups before the training （P>0.05）. During the training and follow-up， the upper limb FMA and IADLS scores in both groups were significantly improved （P≤0.001） as revealed by single-factor repeated measure analysis of variance. There were no significant differences between the two groups in the improvement of upper limb FMA and IADLS scores immediately after or 3 months after training （P>0.05）. The increment in upper limb FMA and IADLS scores immediately after or 3 months after training was plotted and the plot showed that upper limb FMA and IADLS scores were continuously improved during the follow-up in both groups. The growth potential of the two scores in the control group slowed down （slope decreased）， while remained strong in the experimental group （slope remained basically unchanged）. Conclusion： Compared with conventional exercise therapy training， the 3 weeks CIMT training did not further improve the motor function of upper extremity or instrumental activities of daily living in post-stroke patients. However， the effect of CIMT training may have a better persistence than conventional exercise therapy training.

KEY WORDS constraint-induced movement therapy； stroke； hemiparalysis

脑卒中是临床上的常见疾病，具有高致死率、高致残率等特点。3/4以……