摘要： 目的 探讨改良强制性运动疗法（mCIMT）对急性脑卒中患者日常生活活动能力的康复疗效。方法 共60 例急性缺血性卒中偏瘫患者随机分为常规康复治疗组（对照组，30 例）和改良强制性运动疗法组（30 例）。两组患者分别于治疗前和治疗后2、6 和12 周时，采用改良Barthel 指数（mBI）、简化Fugl-Meyer 运动功能评价量表（FMA）和Berg 平衡量表（BBS）评价患者日常生活活动能力和运动功能。结果 两组患者治疗后2、6 和12 周时mBI（P = 0.004，0.000，0.000）、FMA 上肢功能评分（均P = 0.000）、BBS 评分（P = 0.005，0.000，0.000）均高于治疗前，FMA 下肢功能评分仅治疗后6 和12 周时高于治疗前（均P = 0.000）。与对照组相比，mCIMT 组患者治疗后2、6 和12 周时mBI（均P = 0.000）、FMA（上肢：均P = 0.000；下肢：均P = 0.000）、BBS（均P = 0.000）评分亦不同程度增加。结论 改良强制性运动疗法对急性脑卒中患者偏瘫侧肢体的运动功能恢复具有积极作用，可改善日常生活活动能力、提高平衡能力，从而提高患者生活质量，且疗效优于常规康复训练。

关键词: 卒中, 运动疗法, 日常生活活动, 康复

Abstract: Objective  To observe the rehabilitation effect of modified constraint-induced movement therapy (mCIMT) on activities of daily living (ADL) in patients with acute ischemic stroke.  Methods  A total of 60 patients in acute stage of cerebral stroke with limb dysfunction admitted in Ruijin Hospital from December 2012 to May 2013, were randomly divided into routine rehabilitation treatment group (control group, N = 30) and mCIMT group (N = 30). Control group was given routine rehabilitation training, 60 min each time, twice per day, 5 d per week; mCIMT group received mCIMT treatment with the similar frequency. After 2-week training, all patients were transferred to rehabilitation center for 4-week continous training. The total treatment period was 6 weeks. All of those patients received assessment before treatment and 2 weeks, 6 weeks, 12 weeks after treatment on the ability of daily living and motor function, including the modified Barthel Index (mBI), Fugl-Meyer Assessment (FMA) and Berg Balance Scale (BBS).  Results  Patients in both groups got increased mBI (P = 0.004, 0.000, 0.000), FMA (upper limb: P = 0.000, for all) and BBS scores (P = 0.005, 0.000, 0.000) 2, 6, 12 weeks after treatment. FMA (lower limb) score was increased 6 and 12 weeks after treatment (P = 0.000, for all). Compared to the control group, patients in mCIMT group got increased mBI (P = 0.000, for all), FMA (upper limb: P = 0.000, for all; lower limb: P = 0.000, for all) and BBS scores (P = 0.000, for all) 2, 6, 12 weeks after treatment.  Conclusions  mCIMT has positive therapeutic effects on the motor function of limbs in hemiplegic patients with stroke in acute stage, which can improve the balance ability and the ability of daily life, so as to raise the quality of life of patients. The efficacy of mCIMT is superior to general routine rehabilitation treatment.

Key words: Stroke, Exercise therapy, Activities of daily living, Rehabilitation