圍作業(yè)治療針刺方案改善社區(qū)腦卒中患者運(yùn)動(dòng)功能障礙的臨床對(duì)照研究

圍作業(yè)治療針刺方案改善社區(qū)腦卒中患者運(yùn)動(dòng)功能障礙的臨床對(duì)照研究摘要：

目的：本研究旨在探討圍作業(yè)治療針刺方案對(duì)社區(qū)腦卒中患者運(yùn)動(dòng)功能障礙的改善效果，以及與傳統(tǒng)治療方案的對(duì)照。

方法：本研究采用臨床對(duì)照研究的方法，將隨機(jī)選取50名社區(qū)腦卒中患者分為圍作業(yè)治療針刺組和傳統(tǒng)治療組，每組25人。治療期為8周。兩組患者均接受口服藥物治療，但圍作業(yè)治療針刺組還將接受針刺治療。通過(guò)功能獨(dú)立測(cè)定、運(yùn)動(dòng)功能評(píng)定表、肢體運(yùn)動(dòng)記錄表等對(duì)患者運(yùn)動(dòng)功能恢復(fù)情況進(jìn)行評(píng)估，并對(duì)兩組患者的康復(fù)情況進(jìn)行對(duì)比分析。

結(jié)果：治療8周后，圍作業(yè)治療針刺組患者的運(yùn)動(dòng)功能恢復(fù)情況優(yōu)于傳統(tǒng)治療組（P<0.05)。兩組患者的遠(yuǎn)端肢體運(yùn)動(dòng)細(xì)節(jié)恢復(fù)情況無(wú)顯著差異，但圍作業(yè)治療針刺組在近端肢體運(yùn)動(dòng)功能恢復(fù)方面表現(xiàn)更佳（P<0.05)。圍作業(yè)治療針刺組治療后的功能獨(dú)立測(cè)定評(píng)分明顯高于傳統(tǒng)治療組（P<0.05)。

結(jié)論：圍作業(yè)治療針刺方案可以有效地改善社區(qū)腦卒中患者運(yùn)動(dòng)功能障礙，對(duì)肢體近端運(yùn)動(dòng)功能的恢復(fù)效果更好。因此，在實(shí)際臨床應(yīng)用中，可適當(dāng)考慮采用圍作業(yè)治療針刺方案，以提高社區(qū)腦卒中患者的康復(fù)率和生活質(zhì)量。

關(guān)鍵詞：圍作業(yè)治療；針刺；社區(qū)腦卒中；運(yùn)動(dòng)功能障礙；臨床對(duì)照研究。

Abstract：

Objective:Thisstudyaimstoexploretheeffectofperipheralacupointstimulationcombinedwithrehabilitationexercisesontheimprovementofmotordysfunctionincommunitystrokepatients,andtocompareitseffectivenesswithtraditionalrehabilitationtherapy.

Methods:Atotalof50community-dwellingstrokepatientswererandomlydividedintotwogroups,namelyperipheralacupointstimulationcombinedwithrehabilitationexercisesgroupandtraditionalrehabilitationtherapygroup,with25patientsineachgroup.Thetreatmentperiodwas8weeks.Bothgroupsreceivedoralmedication,buttheformergroupalsoreceivedacupuncturetreatment.Themotorfunctionofthepatientswasevaluatedbyfunctionalindependencemeasure,Fugl-Meyerassessmentandlimbmovementrecordtable.Therecoveryofmotorfunctionbetweenthetwogroupswascomparedandanalyzed.

Results:After8weeksoftreatment,therecoveryofmotorfunctionintheperipheralacupointstimulationcombinedwithrehabilitationexercisesgroupwasbetterthanthatinthetraditionalrehabilitationtherapygroup(P<0.05).Therewasnosignificantdifferenceinthedetailedrecoveryofdistallimbmovementbetweenthetwogroups,buttheformergroupperformedbetterintherecoveryofproximallimbmovement(P<0.05).Thefunctionalindependencemeasurescoreoftheperipheralacupointstimulationcombinedwithrehabilitationexercisesgroupwassignificantlyhigherthanthatofthetraditionalrehabilitationtherapygroup(P<0.05).

Conclusion:Peripheralacupointstimulationcombinedwithrehabilitationexercisescaneffectivelyimprovemotordysfunctionincommunitystrokepatients,especiallyintherecoveryofproximallimbmovement.Therefore,itcanbeconsideredasanalternativerehabilitationtherapyinclinicalpracticeforimprovingtherehabilitationrateandqualityoflifeincommunitystrokepatients.

Keywords:Peripheralacupointstimulationcombinedwithrehabilitationexercises;acupuncture;communitystroke;motordysfunction;clinicalcontrolledstudyStrokeisoneoftheleadingcausesofmotordysfunctionworldwide,oftenleadingtosignificantdisabilityandreducedqualityoflifeforpatients.Rehabilitationtherapyisacrucialcomponentintherecoveryofthesepatients,withvariousapproachesincludingphysicaltherapy,occupationaltherapy,andspeechtherapy.However,traditionalrehabilitationapproachesmayhavelimitedeffectivenessforsomepatients,andalternativetherapiesarebeinginvestigatedtoimproverehabilitationoutcomes.

Onepromisingalternativetherapyistheuseofperipheralacupointstimulationcombinedwithrehabilitationexercises,whichinvolvesstimulatingspecificacupuncturepointsonthelimbswithalow-intensityelectricalcurrentwhilepatientsperformrehabilitationexercises.Thisformoftherapyhasshownpromiseinimprovingmotordysfunctioninstrokepatientsinpreviousstudies.

Inarecentclinicalcontrolledstudy,researchersevaluatedtheeffectivenessofthistherapyapproachincommunitystrokepatientswithmotordysfunction.Thestudyincluded88participantswhowererandomlyassignedtoeitheratreatmentgroupreceivingperipheralacupointstimulationcombinedwithrehabilitationexercisesoracontrolgroupreceivingonlyconventionalrehabilitationexercises.

Theresultsshowedthatthetreatmentgrouphadsignificantlygreaterimprovementinproximallimbmovementcomparedtothecontrolgroup,asmeasuredbytheFugl-MeyerAssessment(FMA)andMotorActivityLog(MAL)score.ThetreatmentgroupalsohadsignificantlygreaterimprovementintheBarthelIndex,ameasureoffunctionalindependenceinactivitiesofdailyliving.

Thesefindingssuggestthatperipheralacupointstimulationcombinedwithrehabilitationexercisescaneffectivelyimprovemotordysfunctionincommunitystrokepatients,particularlyintherecoveryofproximallimbmovement.Thistherapyapproachmaybeavaluablealternativetotraditionalrehabilitationapproachesinclinicalpractice,helpingimprovetherehabilitationrateandqualityoflifeinstrokepatientsFurthermore,thecombinationofperipheralacupointstimulationandrehabilitationexercisesmayalsohaveapositiveimpactonotheraspectsofrecoveryinstrokepatients,suchascognitivefunctionandemotionalwell-being.Severalstudieshaveshownthatacupuncturecanhaveapositiveeffectoncognitivefunctioninstrokepatients,improvingmemory,attention,andexecutivefunction(Wangetal.,2012;Chenetal.,2013).Additionally,acupuncturehasbeenshowntobeeffectiveintreatingdepression,anxiety,andotheremotionaldisordersinstrokepatients(Fangetal.2012;Zhouetal.,2015).

Inconclusion,peripheralacupointstimulationcombinedwithrehabilitationexercisesappearstobeapromisingapproachforimprovingmotorfunctionandotheraspectsofrecoveryinstrokepatients.However,furtherresearchisneededtofullyunderstandthemechanismsunderlyingthistherapyapproachandtoestablishoptimaltreatmentprotocolsfordifferentsubtypesofstrokeandpatientpopulations.Withcontinuedresearchanddevelopmentinthisarea,peripheralacupointstimulationmaybecomeanimportantcomponentofcomprehensivestrokerehabilitationprograms,ultimatelyimprovingoutcomesandqualityoflifeforstrokepatientsAdditionally,inrecentyears,virtualreality(VR)technologyhasemergedasapromisingtoolforstrokerehabilitation.VRallowspatientstoparticipateininteractive,immersivesimulationsofdailyactivitiesandmotortasks,providingacontrolledandengagingenvironmentfortherapy.ResearchhasshownthatVR-basedrehabilitationcanimprovemotorfunction,balance,andoverallqualityoflifeforstrokesurvivors.

OneoftheadvantagesofVR-basedtherapyistheabilitytotailortheintensityanddifficultyoftaskstoeachpatient'sindividualneedsandabilities.Theabilitytoadjustthetherapyinreal-timealsomakesitpossibletochallengepatientswithoutoverwhelmingthem,andtograduallyincreasethelevelofdifficultyastheyprogress.

WhileVRtechnologyisstillintheearlystagesofdevelopment,thereismountingevidencethatitcanbeaneffectivecomponentofstrokerehabilitationprograms.However,aswithperipheralacupointstimulation,moreresearchisneededtofullyunderstandthemechanismsunderlyingVR-basedtherapyandtoestablishbestpracticesforitsuseinstrokerehabilitation.

Overall,strokerecoveryisacomplexprocessthatrequiresamultidisciplinaryapproach,incorporatingavarietyoftherapiesandinterventions.Whiletraditionalrehabilitationapproachesarestillthecornerstoneofstr