輔助任務導向訓練對腦卒中早期手功能康復的影響
發(fā)布時間：2018-08-16 09:23
【摘要】：【目的】本研究將針對腦卒中后1-6個月內患者開展康復機器手(Gloreha2)輔助下的抓握類任務導向訓練,以了解該訓練方法在腦卒中早期手功能恢復中的療效,并為相關康復機器手的臨床應用提供參考�！痉椒ā亢Y選2015年7月至2016年11月在廣州醫(yī)科大學附屬第二醫(yī)院康復科住院并符合試驗標準的腦卒中患者40例,隨機分入試驗組和對照組,兩組患者均接受基礎藥物治療和常規(guī)康復訓練,試驗組在康復機器手的輔助下進行任務導向訓練,對照組在治療師的輔助下進行訓練;治療前、后進行患手AROM,FMA(手運動部分),Lindmark(手運動部分),MBI評估;對比治療前后兩組患者上述評估指標的差異�！窘Y果】1.AROM:試驗組在各手指伸展位角度之和、屈曲位角度之和及總關節(jié)活動度,各個手指伸展位角度、屈曲位角度及總關節(jié)活動度,拇食中三指伸展位角度之和、屈曲位角度之和及總關節(jié)活動度之和在治療前后有顯著性差異(p0.05),治療后較治療前改善;對照組在各手指伸展位角度之和、屈曲位角度之和及總關節(jié)活動度,拇食中三指伸展位角度之和、屈曲位角度之和及總關節(jié)活動度之和,各手指總關節(jié)活動度,拇指、食指和小指伸展位角度,拇指、食指、中指、環(huán)指屈曲位角度在治療前后有顯著性差異(p0.05),治療后較治療前改善;中指伸展位角度、環(huán)指伸展位角度和小指屈曲角度在治療前后無顯著性差異(p0.05);治療后試驗組在各手指伸展位角度之和、屈曲位角度之和及總關節(jié)活動度,拇食中三指伸展位角度之和、屈曲位角度之和及總關節(jié)活動度之和,拇指、食指和環(huán)指伸展位角度之和、屈曲位角度之和及總關節(jié)活動度,中指伸展位角度、中指總關節(jié)活動度與對照組相比具有顯著性差異(p0.05);中指屈曲位,小指伸展、屈曲及總關節(jié)活動度兩組間差異無顯著性(p0.05)。2.FMA:試驗組在手指共同屈曲、共同伸展、鉤狀抓握、拇食對捏、柱狀抓握和7項總分治療前后比較有顯著性差異(p0.05),治療后評分高于治療前評分;拇指內收無顯著差異(p0.05);對照組在手指共同屈曲、鉤狀抓握、拇食對捏、球狀抓握和7項總分治療前后比較有顯著性差異(p0.05),治療后評分高于治療前評分,手指共同伸展、拇指內收和柱狀抓握3個亞項治療前后比較無顯著性差異(p0.05);治療后試驗組患者在手指共同伸展、柱狀抓握和球狀抓握3個亞項與對照組相比差異顯著(p0.05),試驗組得分高于對照組;在手指共同屈曲、鉤狀抓握、拇指內收、拇食對捏和7項總分與對照組比較差異不顯著(p0.05)。3.Lindmark:試驗組在手指共同屈曲、共同伸展、鉤狀抓握、拇食對捏、柱狀抓握、球狀抓握和總分治療前后相比有顯著差異(p0.05),治療后優(yōu)于治療前;拇指內收亞項得分治療前后無顯著性差異(p0.05);對照組在鉤狀抓握和7項總分治療前后比較差異顯著(p0.05),治療后優(yōu)于治療前;手指共同屈曲、共同伸展、拇指內收、拇食對捏、柱狀抓握和球狀抓握亞項評分治療前后無顯著性差異(p0.05);治療后試驗組在手指共同屈曲、柱狀抓握、球狀抓握和7項總分較對照組得分高,且差異顯著(p0.05);手指共同伸展、鉤狀抓握、拇指內收、拇食對捏4個亞項與對照組相比差異不顯著(p0.05)。4.MBI:試驗組在進食、穿衣、如廁、洗澡、修飾、步行和總分治療前后比較有顯著性差異(p0.05),治療后評分高于治療前;大便控制、小便控制、上下樓梯和轉移亞項評分治療前后無顯著性差異(p0.05);對照組在穿衣、如廁治療前后比較有顯著性差異(p0.05),治療后得分高于治療前;進食、洗澡、修飾、大便控制、小便控制、步行、上下樓梯、轉移亞項評分治療前后無顯著性差異(p0.05);治療后兩組患者在MBI中的進食、穿衣、如廁、洗澡、修飾、大便控制、小便控制、步行、上下樓梯、轉移和該10項總分組間比較無顯著差異(p0.05)。5.FMA、Lindmark與MBI相關分析:治療前后FMA總分差值與MBI中穿衣、如廁亞項評分差值存在相關關系(p0.05),相關系數分別為0.648和0.515;治療前后FMA總分差值、Lindmark總分差值與MBI總分差值存在相關關系(p0.05),相關系數分別為0.494和0.596。【結論】1.康復機器手(Gloreha2)輔助下的手部任務導向訓練可以改善腦卒中早期患者的手功能,在手指運動能力,柱狀抓握和球狀抓握方面效果較好;2.輔助下的手部任務導向訓練可以提高腦卒中患者的日常生活活動能力;3.基于PEO作業(yè)治療架構理論指導下的輔助任務導向訓練,在腦卒中后早期手功能康復中有效。
[Abstract]:[Objective] To investigate the effect of Grip task-oriented training assisted by Gloreha 2 on early hand function recovery in stroke patients within 1-6 months after stroke, and to provide reference for clinical application of Grip in stroke patients. Forty stroke patients who were hospitalized in the Rehabilitation Department of the Second Affiliated Hospital of Guangzhou Medical University and met the test criteria were randomly divided into the experimental group and the control group. Both groups received basic drug therapy and routine rehabilitation training. The experimental group received task-oriented training with the assistance of rehabilitation robots, while the control group was assisted by therapists. Before and after treatment, AROM, FMA, Lindmark and MBI of the affected hand were evaluated, and the differences of the above indexes between the two groups before and after treatment were compared. [Results] 1. AROM: The sum of the angles of each finger extension, the sum of the angles of flexion and the total joint motion, the angles of each finger extension, the flexion position were compared. There were significant differences in angle and total joint activity, the sum of three fingers extension angle, flexion angle and total joint activity before and after treatment (p0.05), which were improved after treatment; the sum of all fingers extension angles, flexion angle and total joint activity, the angle of three fingers extension in thumb-food, and the angle of three fingers extension in thumb-food were improved after treatment in control group. The sum of the flexion angles and the total joint mobility, the total joint mobility of each finger, the extensional angles of the thumb, index finger and small finger, the flexion angles of the thumb, index finger, middle finger and ring finger were significantly different before and after treatment (p0.05). The extension angles of the middle finger, the extension angles of the ring finger and the flexion angles of the small finger were improved after treatment. There was no significant difference between before and after treatment (p0.05); after treatment, the sum of the extensional angles of each finger, the sum of the flexion angles and the total joint activity, the sum of the extensional angles of the three fingers in the thumb-food, the sum of the flexion angles and the total joint activity, the sum of the extensional angles of the thumb, index finger and ring finger, the sum of the flexion angles and the total joint activity. There was no significant difference in flexion, extension, flexion and total joint activity between the two groups (p0.05). 2. FMA: The experimental group had joint flexion, joint extension, hook grasp, thumb-food pair pinch, columnar grasp and seven total points and treatments. There was significant difference before and after treatment (p0.05), the score after treatment was higher than that before treatment; there was no significant difference in thumb adduction (p0.05); the control group had significant difference before and after treatment in common flexion of fingers, hook grasp, thumb food pair pinch, ball grasp and seven total points (p0.05), the score after treatment was higher than that before treatment, finger joint extension, thumb joint extension. There was no significant difference between the three subitems of adduction and cylindrical grasp before and after treatment (p0.05); after treatment, there was significant difference between the experimental group and the control group in the three subitems of joint finger extension, cylindrical grasp and ball grasp (p0.05), and the score of the experimental group was higher than that of the control group; joint flexion of the fingers, hook grasp, thumb adduction, thumb-food pair pinch and seven items. There was no significant difference in the total score between the two groups (p0.05). 3. Lindmark: There was no significant difference in the total score between the two groups (p0.05). There was no significant difference in the score of the thumb adduction subitems before and after treatment (p0.05). There was no significant difference between before and after treatment in hook grasp and 7 total points (p0.05), after treatment it was better than before treatment; finger joint flexion, joint extension, thumb adduction, thumb food pair pinch, columnar grasp and ball grasp sub-items score before and after treatment there was no significant difference (p0.05); after treatment, the experimental group common flexion of fingers, columnar grasp, ball grasp and 7 items (p0.05). The total score was higher than the control group, and the difference was significant (p0.05); finger joint extension, hook grasp, thumb adduction, thumb food pair pinch four sub-items compared with the control group was not significant (p0.05). 4. MBI: The experimental group in food, clothing, toilet, bathing, modification, walking and total score before and after treatment were significantly higher than the treatment (p0.05). There was no significant difference in the scores of stool control, urination control, stair climbing and stair moving before and after treatment (p0.05); there was a significant difference in the scores of control group before and after dressing and toileting (p0.05), and the scores after treatment were higher than those before treatment; eating, bathing, modification, stool control, urine control, walking, stair climbing and stair moving before and after treatment. There was no significant difference between the two groups after treatment (p0.05); there was no significant difference between the 10 groupings (p0.05). 5. FMA, Lindmark and MBI correlation analysis: before and after treatment, the difference between the total score of FMA and the score of clothing and toilet subitems in MBI. The correlation coefficients were 0.648 and 0.515, respectively, and there was a correlation between the total score difference of FMA, Lindmark and MBI before and after treatment (p0.05), the correlation coefficients were 0.494 and 0.596 respectively. [Conclusion] 1. Hand task-oriented training assisted by rehabilitation robot hand (Gloreha2) can improve the early stroke patients. Hand function is better in finger movement ability, columnar grasp and ball grasp; 2. Assisted hand task-oriented training can improve the daily living ability of stroke patients; 3. Assisted task-oriented training based on the theory of PEO occupational therapy framework is effective in the early rehabilitation of hand function after stroke.
【學位授予單位】：廣州醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3
本文編號：2185567
[Abstract]:[Objective] To investigate the effect of Grip task-oriented training assisted by Gloreha 2 on early hand function recovery in stroke patients within 1-6 months after stroke, and to provide reference for clinical application of Grip in stroke patients. Forty stroke patients who were hospitalized in the Rehabilitation Department of the Second Affiliated Hospital of Guangzhou Medical University and met the test criteria were randomly divided into the experimental group and the control group. Both groups received basic drug therapy and routine rehabilitation training. The experimental group received task-oriented training with the assistance of rehabilitation robots, while the control group was assisted by therapists. Before and after treatment, AROM, FMA, Lindmark and MBI of the affected hand were evaluated, and the differences of the above indexes between the two groups before and after treatment were compared. [Results] 1. AROM: The sum of the angles of each finger extension, the sum of the angles of flexion and the total joint motion, the angles of each finger extension, the flexion position were compared. There were significant differences in angle and total joint activity, the sum of three fingers extension angle, flexion angle and total joint activity before and after treatment (p0.05), which were improved after treatment; the sum of all fingers extension angles, flexion angle and total joint activity, the angle of three fingers extension in thumb-food, and the angle of three fingers extension in thumb-food were improved after treatment in control group. The sum of the flexion angles and the total joint mobility, the total joint mobility of each finger, the extensional angles of the thumb, index finger and small finger, the flexion angles of the thumb, index finger, middle finger and ring finger were significantly different before and after treatment (p0.05). The extension angles of the middle finger, the extension angles of the ring finger and the flexion angles of the small finger were improved after treatment. There was no significant difference between before and after treatment (p0.05); after treatment, the sum of the extensional angles of each finger, the sum of the flexion angles and the total joint activity, the sum of the extensional angles of the three fingers in the thumb-food, the sum of the flexion angles and the total joint activity, the sum of the extensional angles of the thumb, index finger and ring finger, the sum of the flexion angles and the total joint activity. There was no significant difference in flexion, extension, flexion and total joint activity between the two groups (p0.05). 2. FMA: The experimental group had joint flexion, joint extension, hook grasp, thumb-food pair pinch, columnar grasp and seven total points and treatments. There was significant difference before and after treatment (p0.05), the score after treatment was higher than that before treatment; there was no significant difference in thumb adduction (p0.05); the control group had significant difference before and after treatment in common flexion of fingers, hook grasp, thumb food pair pinch, ball grasp and seven total points (p0.05), the score after treatment was higher than that before treatment, finger joint extension, thumb joint extension. There was no significant difference between the three subitems of adduction and cylindrical grasp before and after treatment (p0.05); after treatment, there was significant difference between the experimental group and the control group in the three subitems of joint finger extension, cylindrical grasp and ball grasp (p0.05), and the score of the experimental group was higher than that of the control group; joint flexion of the fingers, hook grasp, thumb adduction, thumb-food pair pinch and seven items. There was no significant difference in the total score between the two groups (p0.05). 3. Lindmark: There was no significant difference in the total score between the two groups (p0.05). There was no significant difference in the score of the thumb adduction subitems before and after treatment (p0.05). There was no significant difference between before and after treatment in hook grasp and 7 total points (p0.05), after treatment it was better than before treatment; finger joint flexion, joint extension, thumb adduction, thumb food pair pinch, columnar grasp and ball grasp sub-items score before and after treatment there was no significant difference (p0.05); after treatment, the experimental group common flexion of fingers, columnar grasp, ball grasp and 7 items (p0.05). The total score was higher than the control group, and the difference was significant (p0.05); finger joint extension, hook grasp, thumb adduction, thumb food pair pinch four sub-items compared with the control group was not significant (p0.05). 4. MBI: The experimental group in food, clothing, toilet, bathing, modification, walking and total score before and after treatment were significantly higher than the treatment (p0.05). There was no significant difference in the scores of stool control, urination control, stair climbing and stair moving before and after treatment (p0.05); there was a significant difference in the scores of control group before and after dressing and toileting (p0.05), and the scores after treatment were higher than those before treatment; eating, bathing, modification, stool control, urine control, walking, stair climbing and stair moving before and after treatment. There was no significant difference between the two groups after treatment (p0.05); there was no significant difference between the 10 groupings (p0.05). 5. FMA, Lindmark and MBI correlation analysis: before and after treatment, the difference between the total score of FMA and the score of clothing and toilet subitems in MBI. The correlation coefficients were 0.648 and 0.515, respectively, and there was a correlation between the total score difference of FMA, Lindmark and MBI before and after treatment (p0.05), the correlation coefficients were 0.494 and 0.596 respectively. [Conclusion] 1. Hand task-oriented training assisted by rehabilitation robot hand (Gloreha2) can improve the early stroke patients. Hand function is better in finger movement ability, columnar grasp and ball grasp; 2. Assisted hand task-oriented training can improve the daily living ability of stroke patients; 3. Assisted task-oriented training based on the theory of PEO occupational therapy framework is effective in the early rehabilitation of hand function after stroke.
【學位授予單位】：廣州醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3
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