Effects of Modified Constraint-Induced Movement Therapy on Stroke Patients

Abstract

腦中風所遺留下的感覺動作缺損，可能會影響生活功能及降低生活品質，復健介入已 成為中風照護的重要一環，但治療成效亟待驗證。本研究探討改良式侷限誘發動作治 療是否較傳統的復健治療更能改善中風偏癱側上肢動作功能、日常生活功能及健康相 關生活品質。本試驗採臨床控制、前測－後測的實驗設計，將20位初發單側腦中風遺 有輕癱患者隨機分配至改良式侷限誘發動作治療組或傳統治療組。於三週的療程裡， 改良式侷限誘發動作治療組患者的健側上肢每日以手套侷限六小時，患側上肢從事每 週五天、每天兩小時的密集練習；傳統治療組患者接受一般復健的功能訓練。成效評 量採用傅格－梅爾動作復原評估表、動作活動量表、功能獨立測驗以及中風影響量表 ，以評估動作功能、日常生活功能以及健康相關生活品質的改善。統計分析部分則計 算各量表的進步指數，並採用t檢定檢驗兩組差異的顯著性。在傅格－梅爾評估量表 、動作活動量表以及功能獨立測驗上，改良式侷限誘發動作治療組的改善均顯著較大 。在腦中風後活動與社會參與度方面，侷限誘發動作治療組患者主要在與生理功能相 關的面向改善幅度顯著大於傳統治療組。改良式侷限誘發動作治療可以有效改善患者 的動作能力，並提昇生活獨立性以及患肢的使用頻率與品質，但對於健康相關生活品 質的提升仍有待進一步的研究來發展有效的復健方案，並評估介入成效。 Stroke is the leading cause of disability and is frequently accompanied by substantial loss of motor function. The purpose of this study was to investigate whether modified constraint-induced movement therapy (mCIMT) is more effective than traditional rehabilitation in restoring motor function, improving activities of daily living functioning and promoting health- related quality of life in stroke patients. Twenty unilateral first-ever stroke patients were assigned to either the mCIMT group ( immobilization of the less-affected arm 6-hour per day combined with intensive training of the affected arm 2-hour per weekday) or the control group of traditional treatment for a period of 3 weeks. The outcome measures included Fugl-Meyer Assessment (FMA), Motor Activity Log (MAL), Functional Independence Measure (FIM) and Stroke Impact Scale (SIS) to evaluate the treatment effects on body function, activity, and participation. Patients in the mCIMT group exhibited significant improvement of motor function and activity performance in real-life environment than traditional therapy group. The mCIMT group also showed significant improvement in the physical domains of health-related quality of life. The finding of this study supported the therapeutic benefits of mCIMT for improving motor and daily functioning and for overcoming learned nonuse. Further study is needed to develop effective rehabilitation programs that improve health-related quality of life after stroke.