改良太极拳应用于缺血性脑卒中患者康复的临床疗效观察

【作者】 周莉；

【导师】 林殷；

【作者基本信息】 北京中医药大学 ， 中医养生康复学， 2015， 硕士

【摘要】 背景近年来,脑卒中发病率在我国一直居高不下,患者常遗留不同程度的后遗症如肢体偏瘫、言语障碍、情绪情感障碍、认知功能障碍和生活自理能力障碍等,给患者及其家庭带来沉重负担。如何解决这一难题,让脑卒中患者的康复治疗提高疗效,简便易行,节约经济成本,一直是医学研究工作的重点。随着“卒中单元”及“三级康复”等理念的引进,脑卒中康复逐渐规范化、系统化,并逐渐向社区延伸,患者的社区及家庭康复也不再是仅仅停留在健康宣教层面,越来越多的康复方法被开发出来。我国传统医学除中药、针灸及推拿手法外,还包括传统健身术如五禽戏、八段锦和太极拳等,后者一直被人们习练至今。太极拳运动要点与现代康复技术要点相似,在中西医结合康复的大趋势下,太极拳在临床实践中被越来越多的应用。习练太极拳要求动作姿势和缓、呼吸匀慢、静气凝神,是一种运动强度偏低、民间普及程度较高的传统健身功法。太极拳训练不受场地、设备的限制,患者在社区或家居环境中即可开展训练。但是,由于太极拳套路众多,且有些拳式对于有功能障碍的脑卒中患者而言,毕竟难度偏大。本研究使用的太极拳套路是根据脑卒中患者功能状况做出适度修改过的简易24式太极拳拳式,以使其运动特点更符合脑卒中患者的需求,改良太极拳技术仍然基于传统太极拳的意念、呼吸及运动协调配合特点,有着古代哲学思想的渗透及厚重的文化积淀,无论是从中医还是西医角度,都对患者功能改善有提高作用。改良太极拳技术的开发将使我国拥有自主研发的康复技术。鉴于缺血性脑卒中与出血性脑卒中在发病机制与疾病的预后和恢复上各有不同,本研究只针对缺血性脑卒中做初步探讨。目的观察改良太极拳康复技术对缺血性脑卒中偏瘫患者的康复疗效。方法根据随机数字表将纳入患者分成2组,最终共观察40例缺血性脑卒中偏瘫患者,其中试验组21例,对照组19例,对照组给予常规康复训练,试验组在常规康复训练基础上给予改良太极拳康复技术训练,分别于治疗前和治疗后1个月对两组患者进行简易Fugl-Meyer运动功能评价表(Simplified Fugl-Meyer motor function assessment scale,FMA),Berg平衡量表(Berg Balance Scale,BBS), Barthel指数(Barthel index,BI)和脑卒中专门化生存质量量表(Stroke-specific quality of life scale,SSQOL)总分的评分。结果经过1个月康复治疗,两组患者评分结果治疗后组内比较结果显示：试验组和对照组在FMA量表上肢、下肢、总分及Berg量表评分,B1分数,SSQOL总分较治疗前均具有显著性提高(P<0.05)；各指标治疗后与基线差值的组间比较结果显示：试验组在FMA量表上肢及总分,SSQOL总分较对照组显著性提高(P<0.05),Berg量表总分比较显示疗后明显提高,但未显示出统计学差异,P=0.058,两组患者BI评分及FMA下肢评分均显著性提高,无统计学意义(P>0.05)。结论改良太极拳技术能够显著改善缺血性脑卒中患者肢体运动功能及生活质量,明显改善患者平衡功能,提高患者日常生活自理能力,但后续仍需增加样本量作深入研究,以验证当前结论。太极拳的健身作用及治疗作用已被国内外学者研究证实,太极拳姿势训练要点与现代康复技术有很多相似之处,在脑卒中患者不同运动功能阶段也有适合患者习练的拳式,而且从患者运动功能、情绪管理等多方面促进患者全面康复,太极拳这一传统健身术体现着中西医结合康复特色与优势,但是人们习练太极拳应该注意运动要点及防止运动损伤的发生,不宜简单模仿,尤其是脑卒中患者存在的关节控制问题,在习练时更要注意防护。本研究是在前人研究的基础上对太极拳相关姿势进行改良,使太极拳更适应脑卒中患者的习练需求,而且在初步应用于缺血性脑卒中患者治疗上得到了积极的结果。更多还原

【Abstract】 BackgroundIn recent years,the incidence of stroke has been high in our country.The patients often have different degrees of sequelea,such as limb hemiplegia,speech disorder,mood and feeling disorders,cognitive dysfunction and the dysfunction of ADL, etc.,and these sequeleas bring heavy burden to patients and their families.How to solve these problems,and let the stroke rehabilitation treatment to improve curative effect,be more convenient,save the economic costs,has been the focus of the medical workers. With the introduction of ideas,such as "stroke unit" and "the standardized tertiary rehabilitation",stroke rehabilitation gradually gets more standardized,systematic,and gradually extends to the community,the community and family rehabilitation in patients no longer just stay at the health education level,more and more rehabilitation methods have been developed.The traditional Chinese medicine include not only the traditional Chinese medicine materials,acupuncture and massage,but also traditional physical training approachs,such as WuQinXi,BaDuanJin and Tai Chi, etc.Tai Chi exercise has been in use today.Tai Chi’s movement points are similar with modern rehabilitation technology’s main points.Under the comprehensive trend of Chinese and western rehabilitation, tai chi is more and more used in clinical practice.Practicing Tai Chi asks for moving slowly,breathing slowly,paying attention and concentration, etc.,it has characteristics such as low exercise intensity,and high popularity.Tai Chi training is also not limited by venue,equipment,patients can begin training in the community or home.But Tai Chi has many routines,and some boxing types are difficult to complete for patients with stroke,we modify simple 24 style Tai Chi’s some types appropriately according to the function of patients with stroke in this study,and make its movement characteristics more in line with the needs of patients with stroke.The improvement of modified Tai Chi technology is still based on the idea of traditional Tai Chi,the thought,breathing and movement are coordinating.Modified Tai Chi technology also has penetration of ancient philosophy and thick culture.The modified Tai Chi can improve patients’function,from the perspective of either traditional chinese medicine or western medicine.The development of modified Tai Chi technology will make our country have own rehabilitation technology.Because there are differences between ischemic stroke and hemorrhagic stroke in the pathogenesis,disease prognosis and recovery,this preliminary study is only about ischemic stroke.ObjectiveTo explore the effect of Modified Tai Chi for patients with ischemic stroke.MethodsAll the included ischemic stroke patients were randomly divided into control group and a Tai Chi group,and there are 40 patients at last.Patients in the control group (n=19) received conventional rehabilitation exercise.Patients in the Tai Chi group (n=21) received conventional rehabilitation exercise plus modified Tai Chi exercise.The treating course lasted one month.The Simplified Fugl-Meyer motor function assessment scale (FMA),the Berg Balance Scale (BBS), BI(Barthel index) and SSQOL were assessed before and after treatment.ResultsThere were significant differences in the scores of FMA,BBS,BI and SSQOL(P<0.05) after treatment within both groups.Compared with the control group,the Tai Chi group showed significant improvement in scores of upper limb’s FMA,total scores of FMA and SSQOL (P<0.05). For the scores of BBS, the Tai Chi group revealed improvement but without statistical difference (P=0.058).There were not differences in the scores of BI and lower limb’s FMA(P>0.05) between the Tai Chi group and control group.ConclusionThe current results indicated that Tai Chi may improve the motor function,balance function,the ADL and quality of life for patients with ischemic stroke and high-quality studies are still in need to confirm these results.Tai Chi’s fitness function and treatment function has been confirmed by the domestic and foreign scholars.Tai Chi postures have training points,and have many similarities with modern rehabilitation techniques.Tai Chi have suitable types for stroke patients with different stages of motor function also,and promotes patients’comprehensive rehabilitation from the patients’ motor function,emotion management aspects and so on.Tai Chi’s traditional fitness embodies advantages of the traditional chinese rehabilitation and modern rehabilitation,but people should pay attention to practicing Tai Chi on movement points and prevent the occurrence of sports injury,can’t simply imitate,especially in patients with stroke,who have joint control failure,more attention should be paid to protection when practicing.This study is on the basis of predecessors’research,and improve the Tai Chi’s related position,make the Tai Chi to meet the requirements of stroke patients’motor function,and positive results were obtained preliminarily on ischemic stroke.更多还原