动态腕手矫形器结合改良强制性运动疗法对脑卒中偏瘫患者上肢和手功能障碍的效果

doi:10.3969/j.issn.1006-9771.2024.05.016

Abstract

Abstract:

Objective To observe the effect of wrist-hand orthosis combined with modified constraint-induced movement therapy (mCIMT) on upper limb and hand function in patients with stroke.

Methods From February, 2022 to December, 2023, 32 patients after stroke in Huashan Hospital, Fudan University were randomly assigned to control group (n = 16) and experimental group (n = 16). Both groups underwent routine rehabilitation, and wore constraint glove almost four hours a day. The experimenal group wore dynamic wrist-hand orthosis four hours everyday, additionally; five days every week, for three weeks. They were evaluated with Wolf Motor Function Test (WMFT), Action Reach Arm Test (ARAT), the strength of gripping, Amount of Use (AOU) and Quality of Movement (QOM) of Motor Activity Log (MAL), Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) before and after treatment, while root mean square ratio of affected/healthy extensor muscle of wrist was measured with surface electromyography

Results After treatment, the scores of WMFT, ARAT, MAL-QOM, HAMA and the root mean square ratio of affected/healthy extensor muscle of wrist improved in both groups (|t| > 2.179, P < 0.05), and the improvement of WMFT score and the strength of gripping was greater in the experimental group than in the control group (|t| > 2.343, P < 0.05); the strength of gripping, the scores of MAL-AOU and HAMD improved in the experimental group (|t| > 2.819, P < 0.05).

Conclusion mCIMT assisted with dynamic wrist-hand orthosis could improve upper limb and hand function in stroke patients.

Key words: stroke, modified constraint-induced movement therapy, wrist-hand orthosis, upper limb, hand, motor function, rehabilitation

CLC Number:

R743.3

HUANG Songhua, LING Junqi, GAO Tianhao, HUANG Yijia, BAI Yulong. Effect of wrist-hand orthosis combined with modified constraint-induced movement therapy on upper limb and hand function in patients with stroke[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(5): 606-612.

Figures/Tables 9

Table 1

Table 2

Table 3

Table 4

Table 5

Table 6

Table 7

Table 8

Table 9

References 35

[1]	MA Q, LI R, WANG L, et al. Temporal trend and attributable risk factors of stroke burden in China, 1990-2019: an analysis for the Global Burden of Disease Study 2019[J]. Lancet Public Health, 2021, 6(12): e897-e906.
[2]	WU S, WU B, LIU M, et al. Stroke in China: advances and challenges in epidemiology, prevention, and management[J]. Lancet Neurol, 2019, 18(4): 394-405. doi: S1474-4422(18)30500-3 pmid: 30878104
[3]	GUO L, GUO Y, BOOTH J, et al. Experiences of health management among people at high risk of stroke in China: a qualitative study[J]. Nurs Open, 2023, 10(2): 613-622.
[4]	王陇德, 彭斌, 张鸿祺, 等. «中国脑卒中防治报告2020»概要[J]. 中国脑血管病杂志, 2022, 19(2): 136-144.
	WANG L D, PENG B, ZHANG H Q, et al. Brief report on Stroke Prevention and Treatment in China, 2020[J]. Chin J Cerebrov Dis, 2022, 19(2): 136-144.
[5]	PURVA G, SOURYA A, MAHARSHI P, et al. Pertinence of constraint-induced movement therapy in neurological rehabilitation: a scoping review[J]. Cureus, 2023, 15(9): e45192.
[6]	胡义茜, 白玉龙. 强制性运动疗法的作用机制与临床应用研究进展[J]. 中华物理医学与康复杂志, 2020, 42(10): 956-960.
	HU Y Q, BAI Y L. Research on the mechanism and clinical application of constraint-induced movement therapy[J]. Chin J Phys Med Rehabil, 2020, 42(10): 956-960.
[7]	CHRISTIE L J, MCCLUSKEY A, LOVARINI M. Constraint-induced movement therapy for upper limb recovery in adult neurorehabilitation: an international survey of current knowledge and experience[J]. Aust Occup Ther J, 2019, 66(3): 401-412. doi: 10.1111/1440-1630.12567 pmid: 30714621
[8]	李贺, 柴文刚, 徐国兴, 等. 改良强制性使用运动疗法对亚急性期脑卒中患者日常生活活动能力康复疗效的评价[J]. 吉林大学学报(医学版), 2016, 42(6): 1183-1188.
	LI H, CHAI W G, XU G X, et al. Evaluation on curative effect of modified constraint-induced movement therapy in rehabilitation of activity of daily living in patients with sub-acute stroke[J]. J Jilin Univ (Med Ed), 2016, 42(6): 1183-1188.
[9]	张情, 潘世琴, 王丽. 改良强制性运动疗法在脑卒中后上肢功能恢复中应用的研究进展[J]. 中国康复理论与实践, 2016, 22(12): 1395-1398.
	ZHANG Q, PAN S Q, WANG L. Advance in modified constraint-induced movement therapy for upper extremity function recovery after stroke (review)[J]. Chin J Rehabil Theory Pract, 2016, 22(12): 1395-1398.
[10]	TAKAO K, MASANORI M, HIROKI Y, et al. Therapeutic effect of adjuvant therapy added to constraint-induced movement therapy in patients with subacute to chronic stroke: a systematic review and meta-analysis[J]. Disabil Rehabil, 2023, 2023: 1-15.
[11]	ASHAN W, JOCELYN W, CLAIRE H, et al. Delivering constraint-induced movement therapy in stroke rehabilitation requires informed stakeholders, sufficient resources and organisational buy-in: a mixed-methods systematic review[J]. J Physiother, 2023, 69(4): 249-259.
[12]	DONG W, JUNLU X, YING H, et al. The mechanism and clinical application of constraint-induced movement therapy in stroke rehabilitation[J]. Front Behav Neurosci, 2022, 16: 828599.
[13]	彭斌, 刘鸣, 崔丽英. 与时俱进的新指南:«中国急性缺血性脑卒中诊治指南2018»解读[J]. 中华神经科杂志, 2018, 51(9): 657-659.
	PENG B, LIU M, CUI L Y. New evidence, new guideline: interpretation of the Chinese Guidelines For Diagnosis and Treatment of Acute Ischemic Stroke 2018[J]. Chin J Neurol, 2018, 51(9): 657-659.
[14]	TAUB E. Movement in nonhuman primates deprived of somatosensory feedback[J]. Exerc Sport Sci Rev, 1976, 4: 335-374. pmid: 828579
[15]	TAUB E, MILLER N E, NOVACK T A, et al. Technique to improve chronic motor deficit after stroke[J]. Arch Phys Med Rehabil, 1993, 74(4): 347-354.
[16]	HU J, LIU P L, HUA Y, et al. Constraint-induced movement therapy enhances AMPA receptor-dependent synaptic plasticity in the ipsilateral hemisphere following ischemic stroke[J]. Neural Regen Res, 2021, 16(2): 319-324. doi: 10.4103/1673-5374.290900 pmid: 32859791
[17]	HU J, LI C, HUA Y, et al. Constraint-induced movement therapy improves functional recovery after ischemic stroke and its impacts on synaptic plasticity in sensorimotor cortex and hippocampus[J]. Brain Res Bull, 2020, 160: 8-23. doi: S0361-9230(20)30056-3 pmid: 32298779
[18]	LIU P, LI C, ZHANG B, et al. Constraint induced movement therapy promotes contralesional-oriented structural and bihemispheric functional neuroplasticity after stroke[J]. Brain Res Bull, 2019, 150: 201-206. doi: S0361-9230(18)31027-X pmid: 31181321
[19]	JINXU Y, LEI L, WENZHAO Z, et al. A novel low-pressure robotic glove based on CT-optimized finger joint kinematic model for long-term rehabilitation of stroke patients[J]. IEEE Trans Neural Syst Rehabil Eng, 2024, 32: 53-62.
[20]	JIAMING Z, XIANJUN X, QIZU J, et al. The effect and safety of constraint-induced movement therapy for post-stroke motor dysfunction: a meta-analysis and trial sequential analysis[J]. Front Neurol, 2023, 14: 1137320.
[21]	马红梅, 王宝兰. 脑卒中后手运动功能评定方法的研究进展[J]. 医学综述, 2021, 27(14): 2830-2835.
	MA H M, WANG B L. Research progress in evaluation methods of hand motor function after cerebral apoplexy[J]. Med Recapitul, 2021, 27(14): 2830-2835.
[22]	DANIEL YUAN-LEE L, HWA-SEN L, RAYE CHEN-HUA Y. A bidirectional fabric-based soft robotic glove for hand function assistance in patients with chronic stroke[J]. J Neuroeng Rehabil, 2023, 20(1): 120.
[23]	JUNPEI K, TOMOYA K, TAKASHI S, et al. Effect of a restrictive orthosis on the paralyzed hand in combination with constraint-induced movement therapy in a patient with chronic stroke: a case report[J]. Disabil Rehabil, 2023, 46(9): 1911-1915.
[24]	NIJENHUIS S M, PRANGE-LASONDER G B, STIENEN A H, et al. Effects of training with a passive hand orthosis and games at home in chronic stroke: a pilot randomised controlled trial[J]. Clin Rehabil, 2017, 31(2): 207-216. doi: 10.1177/0269215516629722 pmid: 26869596
[25]	BARRY J G, ROSS S A, WOEHRLE J. Therapy incorporating a dynamic wrist-hand orthosis versus manual assistance in chronic stroke: a pilot study[J]. J Neurol Phys Ther, 2012, 36(1): 17-24.
[26]	FLÁVIA PESSONI F M R, PAT M, ANA CAROLINA Z, et al. Enhancing function after radial nerve injury with a high-profile orthosis and a bio-occupational orthotic framework[J]. J Hand Ther, 2019, 33(1): 134-139.
[27]	NOWOTNY J, EL-ZAYAT B, GORONZY J, et al. Prospective randomized controlled trial in the treatment of lateral epicondylitis with a new dynamic wrist orthosis[J]. Eur J Med Res, 2018, 23(1): 43. doi: 10.1186/s40001-018-0342-9 pmid: 30219102
[28]	STUCK R A, MARSHALL L M, SIVAKUMAR R. Feasibility of SaeboFlex upper-limb training in acute stroke rehabilitation: a clinical case series[J]. Occup Ther Int, 2014, 21(3): 108-114. doi: 10.1002/oti.1369 pmid: 24760593
[29]	WOO Y, JEON H, HWANG S, et al. Kinematics variations after spring-assisted orthosis training in persons with stroke[J]. Prosthet Orthot Int, 2013, 37(4): 311-316. doi: 10.1177/0309364612461050 pmid: 23112278
[30]	LANNIN N A, CUSICK A, HILLS C, et al. Upper limb motor training using a Saebo™ orthosis is feasible for increasing task-specific practice in hospital after stroke[J]. Aust Occup Ther J, 2016, 63(6): 364-372.
[31]	MIDHA D, ARUMUGAM N. Therapeutic effect of multi-channel transcranial direct current stimulation (M-tDCS) on recovery of cognitive domains, motor functions of paretic hand and gait in subacute stroke survivors: a randomized controlled trial protocol[J]. Neurosci Insights, 2022, 17: 26331055221087741.
[32]	杨名珍, 黄崧华, 白玉龙. 动态腕手矫形器应用于慢性期脑卒中患者上肢及手功能康复的疗效[J]. 中国康复理论与实践, 2019, 25(11): 1361-1364. doi: 10.3969/j.issn.1006-9771.2019.11.019
	YANG M Z, HUANG S H, BAI Y L. Application of a dynamic wrist-hand orthosis for upper limb and hand function rehabilitation in chronic stroke patients[J]. Chin J Rehabil Theory Pract, 2019, 25(11): 1361-1364.
[33]	凌骏麒, 蒋留军, 白玉龙. 腕-手矫形器在脑卒中患者手功能障碍康复治疗中的应用研究进展[J]. 上海医药, 2023, 44(13): 48-51, 109.
	LING J Q, JIANG L J, BAI Y L. Research progress in the application of wrist-hand orthosis in the rehabilitation of stroke patients with hand dysfunction[J]. Shanghai Med Pharm J, 2023, 44(13): 48-51, 109.
[34]	YANAN Z, GONGLIANG L, LONG Y, et al. Effects of a 3D-printed orthosis compared to a low-temperature thermoplastic plate orthosis on wrist flexor spasticity in chronic hemiparetic stroke patients: a randomized controlled trial[J]. Clin Rehabil, 2019, 34(2): 194-204.
[35]	SERDAR A, JOAN L P, PIET L, et al. SCRIPT passive orthosis: design and technical evaluation of the wrist and hand orthosis for rehabilitation training at home[J]. IEEE Int Conf Rehabil Robot, 2013, 2013: 6650401.

组别	n	卒中类型(梗死/出血)	偏瘫侧(左/右)
对照组	16	11/5	7/9
试验组	16	14/2	7/9
χ²/t值		1.646	0.001
P值		0.200	0.999

组别	n	测试	$\bar{x} \pm s$	t值	P值
对照组	16	前测	56.56±10.50	-4.122	0.001
		后测	59.00±9.28
试验组	16	前测	50.00±19.23	-3.308	0.001
		后测	58.87±12.54
训练前均值差			6.56±18.98	-1.198	0.243
训练后均值差			0.12±11.42	-0.032	0.975

组别	n	测试	$\bar{x} \pm s$	t值	P值
对照组	16	前测	46.00±9.91	-4.388	< 0.001
		后测	49.12±8.35
试验组	16	前测	42.06±16.73	-2.779	0.014
		后测	50.62±7.80
训练前均值差			3.93±20.21	0.810	0.425
训练后均值差			1.50±9.85	-0.525	0.604

组别	n	测试	$\bar{x} \pm s$	t值	P值
对照组	16	前测	8.22±7.80	-1.363	0.193
		后测	9.10±7.60
试验组	16	前测	9.54±8.88	-4.872	< 0.001
		后测	13.39±10.49
训练前均值差			1.32±11.51	-0.448	0.658
训练后均值差			4.28±11.77	-1.324	0.196

组别	n	测试	$\bar{x} \pm s$	t值	P值
对照组	16	前测	2.66±1.08	-1.992	0.065
		后测	2.94±1.02
试验组	16	前测	2.50±1.28	-4.394	< 0.001
		后测	3.07±1.08
训练前均值差			0.16±1.73	0.385	0.703
训练后均值差			0.13±1.42	-0.353	0.726

Effect of wrist-hand orthosis combined with modified constraint-induced movement therapy on upper limb and hand function in patients with stroke

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 9

References 35

Related Articles 15

Metrics

Comments

Recommended 0

组别	n	测试	$\bar{x} \pm s$	t值	P值
对照组	16	前测	2.91±1.07	-2.595	0.020
		后测	3.17±0.88
试验组	16	前测	2.90±1.30	-3.170	0.006
		后测	3.46±0.99
训练前均值差			0.01±1.56	0.044	0.965
训练后均值差			0.28±1.08	-0.860	0.397

组别	n	测试	$\bar{x} \pm s$	t值	P值
对照组	16	前测	4.75±2.67	3.184	0.006
		后测	3.50±2.09
试验组	16	前测	4.18±2.66	3.151	0.007
		后测	2.75±2.26
训练前均值差			0.56±3.66	0.596	0.555
训练后均值差			0.75±3.51	0.972	0.339

组别	n	测试	$\bar{x} \pm s$	t值	P值
对照组	16	前测	8.68±3.77	1.978	0.067
		后测	6.81±3.50
试验组	16	前测	9.06±6.08	2.819	0.013
		后测	5.81±3.86
训练前均值差			0.37±6.67	-0.210	0.835
训练后均值差			1.00±6.04	0.766	0.450

组别	n	测试	$\bar{x} \pm s$	t值	P值
对照组	16	前测	0.54±0.24	-2.241	0.041
		后测	0.70±0.41
试验组	16	前测	0.47±0.28	-2.179	0.046
		后测	0.64±0.33
训练前均值差			0.06±0.35	0.698	0.491
训练后均值差			0.05±0.52	0.426	0.673

[1]	WEI Tianyuan, LIN Yufan, HE Yi, SONG Mingjie, LI Chaojinzi, ZHANG Qingsu, DU Xiaoxia. Effect of computer-assisted training on post-stroke dysarthria [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(5): 520-525.
[2]	XU Dongyan, WANG Weining, PAN Li, LIU Gang, LIU Jiapeng, WU Yi, ZHU Yulian. Effect of enriched environment theory-based multisensory feedback gait training on walking function in stroke patients [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(5): 526-534.
[3]	XIONG Xingxiu, ZHANG Zhenghui, DENG Chunyan, LI Yunbo, CHEN Zhenpeng, LI Yuanjie, SONG Jing. Effect of combination of partial body weight support and functional electrical stimulation on lower limb motor function after stroke [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(5): 554-559.
[4]	CUI Zhigang, JIN Taoran, LIU Sihai, WANG Fei, LIU Kemin, LI Jianjun. Factors related to re-falling of knee range of motion after arthrolysis for post-traumatic knee stiffness [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(5): 565-569.
[5]	WEI Ning, ZENG Yanling, JIANG Na, ZHANG Qian, YI Xiaozhe, WANG Jianyun, WANG Dengting, ZHANG Yan, PEI Hongbo, HUANG Chaorong. Impact of parental efficacy in doctor-patient communication on rehabilitation outcomes for children with autism spectrum disorder [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(5): 577-585.
[6]	YANG Yaru, YANG Jian, QIU Fubing, SONG Beibei, WANG Shaopu, XIAO Xiaofei, PENG Yifeng. Health benefits of home-based exercise rehabilitation for people with severe disabilities in Shenzhen, China [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(5): 586-590.
[7]	TANG Letian, LIU Yushu, YANG Yaru, CUI Liangbo, XIAO Xiaofei. Construction of undergraduate curriculum courses of assistive technology using World Health Organization Rehabilitation Competency Framework [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(5): 591-597.
[8]	ZHANG Qing, LI Yanqun, JIA Wenrong, LIU Qiaoyun, JIANG Ruilin. Research on framework, core content and priority areas of international policy of healthcare, rehabilitation and education services for children with hearing and speech impairments [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 373-380.
[9]	LENG Qing, ZHANG Ying, ZHANG Weifeng. Survey on competency status of hearing and speech rehabilitation professionals in Jiangsu, China [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 389-396.
[10]	JIANG Na, WEI Ning, ZENG Yanling, ZHANG Qian, YI Xiaozhe, CHEN Wanqiang, JING Yuzhen, JI Jing, GUO Xusheng, PEI Hongbo, WANG Jianyun. Influencial factors of average hospitalization costs of rehabilitation inpatients based on quantile regression model [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 397-403.
[11]	YANG Rong, WANG Qian, ZI Yang, CHEN Yiting, LI Yingcai, LENG Jun. Brain-computer interface technology used in rehabilitation medicine in the last decade: a visualized analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 416-423.
[12]	ZHENG Jianling, LIU Huilin, ZHU Lin, GU Bin, YAN Ruxiu, ZHAO Qi, SONG Luping. Effect of early intelligent assisted walking under suspension protection on motor and walking function for stroke patients [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 431-436.
[13]	CUI Tiantian, YANG Yulin, CUI Tengteng, MA Lihong. Effect of different intensive training on upper limb motor function in children with cerebral palsy: a network meta-analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 437-448.
[14]	SU Zhaoyin, KANG Weihan, LIU Yatao, LÜ Yuan, Michael NERLICH. Relationship between physical activity levels and stroke risk among middle-aged and older adults in China based on CHARLS data [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 449-453.
[15]	LIU Xing, ZHOU Yumei, XU Huili, PENG Jianying, XIE Zheshu, XING Limin, ZHAO Jun. Structural equation model of influencing factors of anticipatory grief among main caregivers of young and middle-aged patients with severe stroke [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(4): 454-461.