Brogårdh Christina, Sjölund Bengt H
Rehabilitation Medicine, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.
Clin Rehabil. 2006 Mar;20(3):218-27. doi: 10.1191/0269215506cr937oa.
(1) To evaluate constraint-induced movement therapy for chronic stroke patients modified into group practice to limit the demand on therapist resources. (2) To explore whether extended mitt use alone may enhance outcome.
A combined case-control and randomized controlled study with pre- and post-treatment measures by blinded observers.
A university hospital rehabilitation department.
Sixteen stroke patients (nine men and seven women; mean age 56.7 years; on average 28.9 months post stroke, five of whom were 6-9 months post stroke) with moderate motor impairments in the contralateral upper limb.
Constraint-induced therapy (mitt on the less affected hand 90% of waking hours for 12 days) with 2-3 patients per therapist and 6 h of group training per day. After the training period, the patients were randomized either to using the mitt at home every other day for two-week periods for another three months (in total 21 days) or to no further treatment.
Modified Motor Assessment Scale, Sollerman Hand Function Test, Two-Point Discrimination test and Motor Activity Log.
The mean motor performance improved significantly after two weeks of constraint-induced group therapy on Motor Assessment Scale (1.44 (95% confidence interval (95% CI) 0.59-2.28) points; P = 0.003) and on Sollerman Hand Function Test (3.81 (95% CI 0.26-7.36) points; P = 0.037) but showed no sensory change in the Two-Point Discrimination Test (P = 0.283). The median difference in self-reported motor ability (Motor Activity Log) also improved (P < 0.001). However, no additional effect was seen from wearing a mitt for another three months.
Constraint-induced group therapy, allowing several patients per therapist, seems to be a feasible alternative to improve upper limb motor function. The restraint alone, extended in time, did not enhance the treatment effect.
（1）评估将限制使用疗法应用于慢性中风患者并改为小组治疗模式，以减少对治疗师资源的需求。（2）探讨仅延长使用连指手套是否可改善治疗效果。
一项结合病例对照和随机对照的研究，由盲法观察者进行治疗前和治疗后的测量。
一家大学医院的康复科。
16名中风患者（9名男性和7名女性；平均年龄56.7岁；中风后平均28.9个月，其中5名患者处于中风后6 - 9个月），对侧上肢有中度运动障碍。
限制使用疗法（清醒时间的90%将连指手套戴在患侧较轻的手上，持续12天），每位治疗师负责2 - 3名患者，每天进行6小时的小组训练。训练期结束后，患者被随机分为两组，一组在接下来的三个月里每隔一天在家中使用连指手套两周（共21天），另一组不再接受进一步治疗。
改良运动评估量表（Modified Motor Assessment Scale）、索勒曼手功能测试（Sollerman Hand Function Test）、两点辨别试验（Two-Point Discrimination test）和运动活动日志（Motor Activity Log）。
在限制使用疗法小组治疗两周后，改良运动评估量表（平均提高1.44分（95%置信区间（95% CI）0.59 - 2.28）；P = 0.003）和索勒曼手功能测试（平均提高3.81分（95% CI 0.26 - 7.36）；P = 0.037）显示运动表现显著改善，但两点辨别试验未显示感觉变化（P = 0.283）。自我报告的运动能力（运动活动日志）的中位数差异也有所改善（P < 0.001）。然而，在接下来的三个月里继续佩戴连指手套并未产生额外效果。
限制使用疗法小组治疗，即每位治疗师负责多名患者，似乎是改善上肢运动功能的一种可行替代方法。仅延长使用限制时间并不能增强治疗效果。
