摘要
目的探讨强化训练时间对脑卒中偏瘫患者步行功能恢复的影响。方法选取符合入组标准的脑卒中偏瘫住院患者36例，采用随机数字表法按每目训练时间的不同分为40min训练组、80min训练组和120min训练组，每组12例，因失访3例，3组最终完成本研究样本数分别为12、11和10例。各组均在常规康复治疗的基础上进行下肢功能训练，训练时间分别为每日40、80和120min，每周5d，共训练4周。在治疗前及治疗2周和4周后，分别采用Holden步行功能分级（FAC）和下肢Fugl-Meyer运动功能评定法（FMA）进行功能评定，并分别分析和比较强化训练前后3组患者FAC分级、FMA评分及独立步行情况。结果强化训练前，40min训练组、80min训练组和120min训练组三组患者的FAC分别为（1．83±0．94）、（1．734±1．01）和（1．80±1．03）级，FMA分别为（19．174±5．52）、（23．004±4．71）和（19．40±7．90）分；治疗2周后，120min训练组患者的FAC为（3．304±0．48）级较40min训练组[（2．17±0．94）级]明显提高（P〈0．05）。治疗4周后，120min训练组的FAC为（3．80±0．42）级，与80min训练组[（3．184±0．60）级]同时间点比较，差异有统计学意义（P〈0．05）；80min训练组的FAC与40min训练组[（2．674±0．65）级]同时间点比较，差异亦有统计学意义（P〈0．05）。治疗4周后，40rain训练组、80min训练组和120min训练组三组患者的FMA分别为（25．08±4．46）、（28．64±3．56）和（25．90±5．19）分，分别与组内治疗前比较，差异均有统计学意义（P〈0．05）；但强化训练2周和4周后，3组之间FMA两两比较，差异均无统计学意义（P〉0．05）。强化训练前，40rainiJiI练组、80min训练组和120min训练组三组患者中达到独立步行患者所占比例分别为16．67％、18．18％和20．00％；治疗2周后，40min训练组、80rain训练组和120min训练组三组患者中达到独立步行患者所占比例分别为33．33％、36．36％和100％，120min训练组分别较40min训练组和80min训练组均有明显提高（P〈0．05），但40min训练组与80min训练组之间的差异无统计学意义（P〉0．05）。治疗4周后，40min训练组、80rain训练组和120min训练组三组患者中达到独立步行患者所占比例分别为58．33％、90．91％和100．00％，与组内治疗前比较，差异均有统计学意义（P〈0．05）；120min训练组独立步行功能改善的效果较40mitt训练组更为明显（P〈0．05），但40rain训练组和120min训练组分别与80min训练组比较，组间差异均无统计学意义（P〉0．05）。结论强化训练可促进脑卒中患者步行功能的恢复，且训练时间越长，治疗效果越明显。
Objective To investigate the effects of lower limb training at different intensities on the recovery of walking function after stroke. Methods Thirty-six stroke patients were randomly divided into a 40-minutes of training group, an 80-minutes of training group and a 120-minutes of training group. Because of three missing follow- up cases, the final numbers of cases were 12, 11 and 10 cases respectively. All of the patients received lower limb training based on regular rehabilitation therapy, but at the three different intensities： 40 minutes, 80 minutes or 120 minutes a day, five days per week, for 4 weeks. Walking function was assessed using the Holden functional ambula- tion categories （FACs） and the Fugl-Meyer assessment （FMA）. These were carried out before treatment, and after two and four weeks of treatment. Results Before treatment, the average FACs of the three groups were （ 1.83 ± 0.94）, （1.73 ± 1.01） and （1. 80 ± 1.03） respectively. Their average FMA scores were （19. 17 ±5.52）, （ 23.00 ± 4.71 ） and （ 19.40 ± 7.90）. After two weeks of treatment, the average FAC in the 120-minutes training group was （3.30 ± 0.48 ） , significantly higher than in the 40-minutes training group. After four weeks the average FACs in the 40-minutes, 80-minutes and 120-minutes training groups were （2.67 ± 0.65） , （3. 18 ± 0.60） and （3.80 ± 0.42） respectively. The differences between the 120-minutes group and the 80-minutes group as well as be- tween the 80-minutes group and the 40-minutes training group were statistically significant. The average FMA scores of the three groups after four weeks were （25.08 ±4.46）, （28.64 ±3.56） and （25.90 ±5.19） respectively. All the differences were significant compared with pre-trcatment. There were no significant differences in FMA scores a- mong the three groups after two weeks or four weeks of treatment. Before treatment, the proportion of patients able to walk independently in the 40-minutes, 80-minutes and 120-minutes training groups were 16. 7% , 18. 2% and 20.0%. After two weeks the proportions had risen to 33.3% , 36.4% and 100% respectively, so the results in the 120-minutes training group were significantly better. After four weeks of treatment the proportions of the three groups were 58.3% , 90.9% and 100%. All these improvements were significant compared with pre-treatment, but when compared with the 80-minutes training group, neither of the others showed a significant difference. Conduslons Intensive training can accelerate the recovery of walking function of patients after stroke and promote their ability to participate in daily activities.
出处
《中华物理医学与康复杂志》
CAS
CSCD
北大核心
2013年第4期290-294,共5页
Chinese Journal of Physical Medicine and Rehabilitation
关键词
脑卒中
偏瘫
强化训练
步行功能
Stroke
Hemiplegia
Training intensity
Walking ability
