辅助任务导向训练对脑卒中早期手功能康复的影响
发布时间：2018-08-16 09:23
【摘要】：【目的】本研究将针对脑卒中后1-6个月内患者开展康复机器手(Gloreha2)辅助下的抓握类任务导向训练,以了解该训练方法在脑卒中早期手功能恢复中的疗效,并为相关康复机器手的临床应用提供参考。【方法】筛选2015年7月至2016年11月在广州医科大学附属第二医院康复科住院并符合试验标准的脑卒中患者40例,随机分入试验组和对照组,两组患者均接受基础药物治疗和常规康复训练,试验组在康复机器手的辅助下进行任务导向训练,对照组在治疗师的辅助下进行训练;治疗前、后进行患手AROM,FMA(手运动部分),Lindmark(手运动部分),MBI评估;对比治疗前后两组患者上述评估指标的差异。【结果】1.AROM:试验组在各手指伸展位角度之和、屈曲位角度之和及总关节活动度,各个手指伸展位角度、屈曲位角度及总关节活动度,拇食中三指伸展位角度之和、屈曲位角度之和及总关节活动度之和在治疗前后有显著性差异(p0.05),治疗后较治疗前改善;对照组在各手指伸展位角度之和、屈曲位角度之和及总关节活动度,拇食中三指伸展位角度之和、屈曲位角度之和及总关节活动度之和,各手指总关节活动度,拇指、食指和小指伸展位角度,拇指、食指、中指、环指屈曲位角度在治疗前后有显著性差异(p0.05),治疗后较治疗前改善;中指伸展位角度、环指伸展位角度和小指屈曲角度在治疗前后无显著性差异(p0.05);治疗后试验组在各手指伸展位角度之和、屈曲位角度之和及总关节活动度,拇食中三指伸展位角度之和、屈曲位角度之和及总关节活动度之和,拇指、食指和环指伸展位角度之和、屈曲位角度之和及总关节活动度,中指伸展位角度、中指总关节活动度与对照组相比具有显著性差异(p0.05);中指屈曲位,小指伸展、屈曲及总关节活动度两组间差异无显著性(p0.05)。2.FMA:试验组在手指共同屈曲、共同伸展、钩状抓握、拇食对捏、柱状抓握和7项总分治疗前后比较有显著性差异(p0.05),治疗后评分高于治疗前评分;拇指内收无显著差异(p0.05);对照组在手指共同屈曲、钩状抓握、拇食对捏、球状抓握和7项总分治疗前后比较有显著性差异(p0.05),治疗后评分高于治疗前评分,手指共同伸展、拇指内收和柱状抓握3个亚项治疗前后比较无显著性差异(p0.05);治疗后试验组患者在手指共同伸展、柱状抓握和球状抓握3个亚项与对照组相比差异显著(p0.05),试验组得分高于对照组;在手指共同屈曲、钩状抓握、拇指内收、拇食对捏和7项总分与对照组比较差异不显著(p0.05)。3.Lindmark:试验组在手指共同屈曲、共同伸展、钩状抓握、拇食对捏、柱状抓握、球状抓握和总分治疗前后相比有显著差异(p0.05),治疗后优于治疗前;拇指内收亚项得分治疗前后无显著性差异(p0.05);对照组在钩状抓握和7项总分治疗前后比较差异显著(p0.05),治疗后优于治疗前;手指共同屈曲、共同伸展、拇指内收、拇食对捏、柱状抓握和球状抓握亚项评分治疗前后无显著性差异(p0.05);治疗后试验组在手指共同屈曲、柱状抓握、球状抓握和7项总分较对照组得分高,且差异显著(p0.05);手指共同伸展、钩状抓握、拇指内收、拇食对捏4个亚项与对照组相比差异不显著(p0.05)。4.MBI:试验组在进食、穿衣、如厕、洗澡、修饰、步行和总分治疗前后比较有显著性差异(p0.05),治疗后评分高于治疗前;大便控制、小便控制、上下楼梯和转移亚项评分治疗前后无显著性差异(p0.05);对照组在穿衣、如厕治疗前后比较有显著性差异(p0.05),治疗后得分高于治疗前;进食、洗澡、修饰、大便控制、小便控制、步行、上下楼梯、转移亚项评分治疗前后无显著性差异(p0.05);治疗后两组患者在MBI中的进食、穿衣、如厕、洗澡、修饰、大便控制、小便控制、步行、上下楼梯、转移和该10项总分组间比较无显著差异(p0.05)。5.FMA、Lindmark与MBI相关分析:治疗前后FMA总分差值与MBI中穿衣、如厕亚项评分差值存在相关关系(p0.05),相关系数分别为0.648和0.515;治疗前后FMA总分差值、Lindmark总分差值与MBI总分差值存在相关关系(p0.05),相关系数分别为0.494和0.596。【结论】1.康复机器手(Gloreha2)辅助下的手部任务导向训练可以改善脑卒中早期患者的手功能,在手指运动能力,柱状抓握和球状抓握方面效果较好;2.辅助下的手部任务导向训练可以提高脑卒中患者的日常生活活动能力;3.基于PEO作业治疗架构理论指导下的辅助任务导向训练,在脑卒中后早期手功能康复中有效。
[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.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
本文编号：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.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
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