单独和联合应用机械手康复和常规康复治疗脑卒中后偏瘫:一项前瞻性三臂随机研究。

IF 3.4 3区 医学 Q1 REHABILITATION
Betül Başar, Berrin Hüner, Erva Kahraman
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引用次数: 0

摘要

背景:常规康复(CR)和机械手康复(RR)是脑卒中后偏瘫的有效康复选择。结合这两种康复方案可能会对结果产生积极影响。目的:比较单用和联合应用CR和RR治疗脑卒中后偏瘫对手部和上肢功能、痉挛、握力和指尖捏力的影响。设计:三组前瞻性随机对照试验。环境:多学科康复设施。人群:卒中后偏瘫66例。方法:将参与者随机分为RR组、CR组和常规与机械手联合康复组(CR-RR)。对于RR组,使用机器人设备进行被动和主动手指运动计划(每天40分钟)以及基于家庭的康复计划。对于CR组,使用传统的手工治疗技术来改善日常生活活动,并实现弱肌肉的等长收缩(每天60分钟)。对于CR-RR组,60分钟的常规康复后,使用机器人设备进行40分钟的手部康复。两组患者均康复1个月,每周5天。采用Fugl-Meyer上肢评估量表作为评估上肢功能的主要指标。次要结局根据手部功能、上肢和手部运动功能、日常生活活动(ADLs)、上肢痉挛和手部力量进行评估。结果:CR-RR在改善上肢功能、手部功能和ADLs方面明显优于CR和RR。唯一对上肢功能无影响的组是RR组。所有三种康复方案对治疗肩内收肌和肘关节屈肌痉挛无效。虽然这三种方案都有效地减少了手腕、手指和拇指屈肌的痉挛,但与其他组相比,CR的效果明显较差。虽然CR-RR组和RR组在减轻手腕和手指屈肌痉挛方面的结果相似,但CR-RR组在减轻拇指痉挛方面的效果明显优于RR组。CR对握力和尖捏强度没有影响,而CR-RR和RR均显著改善了握力和尖捏强度。结论:RR对上肢功能结果无影响。CR对握力和捏力没有影响,仅对手腕、手指和拇指屈肌痉挛有有限影响。在CR-RR方案中,将常规康复与机器人康复相结合,在卒中后偏瘫患者的日常生活活动、上肢功能、手部功能、手腕、手指和拇指屈肌痉挛、手部握力和指尖捏力方面取得了更好的效果。临床康复影响:卒中后偏瘫患者同时应用RR和CR可获得更好的治疗效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Individual and combined applied robotic hand rehabilitation and conventional rehabilitation for post-stroke hemiplegia: a prospective three-arm randomized study.

Individual and combined applied robotic hand rehabilitation and conventional rehabilitation for post-stroke hemiplegia: a prospective three-arm randomized study.

Individual and combined applied robotic hand rehabilitation and conventional rehabilitation for post-stroke hemiplegia: a prospective three-arm randomized study.

Background: Conventional rehabilitation (CR) and robotic hand rehabilitation (RR) are effective rehabilitation options for post-stroke hemiplegia. Combining these two rehabilitation protocols may positively affect the results.

Aim: To compare the effectiveness of individual and combined applications of CR and RR on hand and upper extremity function, spasticity, grip and tip pinch strength in the treatment of post-stroke hemiplegia.

Design: A three-arm, prospective randomized controlled trial.

Setting: Multidisciplinary rehabilitation facility.

Population: Sixty-six patients with post-stroke hemiplegia.

Methods: Participants were randomized into three groups: RR, CR, and combined conventional and robotic hand rehabilitation (CR-RR). For the RR group, a passive and active finger motion program (40 minutes a day), along with a home-based rehabilitation program, was administered using the robotic device. For the CR group, traditional manual therapy techniques were used to improve activities of daily living and to achieve isometric contractions in weak muscles (60 minutes a day). For the CR-RR group, 60 minutes of conventional rehabilitation was followed by 40 minutes of hand rehabilitation using the robotic device. The patients in all groups were rehabilitated for 1 month, 5 days a week. The Fugl-Meyer Upper Extremity Assessment Scale was used as primary outcome measure for evaluating the upper extremity function. The secondary outcome was evaluated based on hand function, upper extremity and hand motor function, activities of daily living (ADLs), upper extremity spasticity, and hand strength.

Results: CR-RR was significantly more effective than both CR and RR in improving upper extremity function, hand function, and ADLs. The only group that had no effect on upper extremity function was RR. All three rehabilitation protocols were ineffective in treating shoulder adductor and elbow flexor spasticity. While all three protocols effectively reduced spasticity in the wrist, fingers, and thumb flexors, CR was significantly less effective compared to the other groups. Although the CR-RR and RR groups had similar results in reducing wrist and finger flexor spasticity, the CR-RR group was significantly more effective than the RR group in reducing thumb spasticity. CR did not influence grip and tip pinch strength, whereas both CR-RR and RR led to significant improvements.

Conclusions: RR has no effect on upper extremity functional results. CR has no effect on grip and pinch strength and only a limited effect on wrist, finger, and thumb flexor spasticity. Combining conventional rehabilitation with robotic rehabilitation in the CR-RR protocol yields better results in daily living activities, upper extremity function, hand function, wrist, finger, and thumb flexor spasticity, as well as hand grip and tip pinch strength in post-stroke hemiplegia.

Clinical rehabiltation impact: Concomitant application of RR and CR achieves better outcomes in post-stroke hemiplegia.

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来源期刊
CiteScore
8.50
自引率
4.40%
发文量
162
审稿时长
6-12 weeks
期刊介绍: The European Journal of Physical and Rehabilitation Medicine publishes papers of clinical interest in physical and rehabilitation medicine.
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