【摘要】 目的:明确脑卒中后三级康复干预对肌张力转归和肢体功能恢复的动态变化规律,为脑卒中康复训练和功能预测提供依据。方法:选择80例发病3周内的脑卒中偏瘫患者,随机分为两组:对照组、康复组。采用改良Ashworth进行肌张力评定,Brunnstrom分级评定肢体功能恢复,分别在入组时、病程1个月、3个月和6个月时进行评定。结果:①肌张力变化:入组时,康复组肌张力改良Ashworth0级的上肢、下肢在病程1个月时分别有69.2%、90.5%升高到1级或以上;但随病程延长至3、6个月时,呈现为向0级转归的趋势,至病程6个月时,上下肢肌张力1级或以上的比例分别降低到38.4%,42.9%;对照组在整个病程中由0级转归为1级或以上的比例呈持续增加趋势,至病程6个月时,上下肢分别升高到81.5%和90.5%。肌张力1级或以上的上肢、下肢在整个病程中向0级转归的比例持续增高,病程6个月时,上、下肢分别有64.3%和68.4%转归为0级。②肢体功能:康复组上、下肢Brunnstrom分级随病程延长不断提高(P<0.05),而对照组仅在病程1个月时有所提高,至病程3个月和6个月时,无明显提高(P>0.05);并且康复组在病程3、6个月时,较对照组相应病程明显增加(P<0.05)。结论:三级康复干预的早期有助于诱发软瘫肌肉张力出现,持续康复干预则抑制肌张力增高,促使高肌张力转归为正常;并促进肢体功能恢复,提高日常生活活动能力。更多还原

【Abstract】 Objective:To determinate the effects of 3-phase rehabilitation intervention on turnover of muscle tone and recovery of motor function of limbs in hemiplegia after stroke. Method:80 hemiplegic patients(less than 3 weeks) were randomly divided into rehabilitation group and control group. Modified Ashworth was used to assess the muscle tone and Brunnstrom grade was applied to evaluate the motor function of limbs at pre-treatment and 1,3,6 month post-treatment. Result:①muscle tone: in rehab group,muscle tone of 69.2% and 90.5% patients in upper and lower extremity with Ashworth grade 0 developed to grade 1 or more from pre-treatment to 1 month post-treatment. With elongation of time course of treatment to 3 and 6month post-treatment,muscle tone of these patients showed a trend to decrease to grade 0. Up to 6 months post-treatment,the percents of the patients with grade 1 or more reduced to 38.4% and 42.9% respectively in upper and lower extremity. In rehabilitation group,muscle tone in upper and lower extremity with grade 1 or more turnover continuously to grade 0 during the whole course of treatment.Up to 6 months post-treatment,muscle tone of 64.3% and 68.4% patients decreased from grade 1 or more to grade 0 respectively. But in control group,only 23.1% and 15.8% reduced to grade 0 at 1 month post-treatment. Afterwards,there were no significant changes in muscle tone with elongation of treatment course. ②Motor function of limbs: Brunnstrom Grade of rehab group increased more significantly at 1,3 and 6 months post-treatment than pre-treatment(P<0.05),but there was a little increase in control group at 1 month after treatment,and there was no trend to increase at 3 months and 6 months. Conclusion: The early training of rehabilitation intervention can induce occurrence of muscle tone of hemiplegic extremities. The continuous rehabilitation can inhibit high muscle tone and promote muscle tone turnover to normal,and improve ADL and motor function of extremities.更多还原