| Objective: Through the function training on the injured limbs and that onthe bilateral to stroke hemiplegia patients, with observing and comparing theimprovement of motor function and Activity of daily Living, to figure out abetter rehabilitation caring method to reduce the patients' physical and mentalsuffering and shorten the progress of motor function's rehabilitation, so as toimprove their activity of living at the largest scale to make the return to theirfamily and society early.Methods: Taking60stroke hemiplegia patients as research objectives,who have been hospitalized and convalesced during December in2010toOctober in2011, from Department of Internal Neurology and Acupuncture ofChinese Medicine Hospital affiliated of Hebei Medical University. The60were randomized into Experimental Group (EG) and Control Group (CG),bothwere arranged routine remedy and caring, which including loweringintracranial pressure, controlling hydrocephalus, regulating blood pressure,improving cerebral blood circulation, promoting cerebral metabolism,protecting nerve and other treatment and elementary nursing procedures. TheCG (Control Group) took the normal training methods for injured limbs,including anti-spasm body position placing in acute phase, regular positionchanging, passive movements of injured limbs, training on joints andsit-and-up training etc; When spasm appeared, Patients took the normalmethods doing initiative movements, including grasp of strength training,applying stand-up bed, lower limbs weight-bearing training and gravitycenter's transferring training. When stroke patients can control any oneindividual activity, they took the training on standing-up standing in balancewalking and activity of daily living (ADL). The EG (Experimental Group),based on the injured limbs training, were to take the training of the uninjured limbs and compensatory training and merge them into every phases. As to theun-handedness hemiplegia patients, the voluntary movements of uninjuredlimbs took priority, maintaining normal muscle strength and the range of jointswith activities of every joint; While, as to the handedness hemiplegiapatients,the uninjured limbs training was aimed at daily life activities,including the primary ADL(Activity of Daily Living) and instrumentalADL(Activity of Daily Living),such as in-bed activities, wheel-chairactivities,self-care activities,reading and writing,electric and telephoneusing,walking(including walker or rollator assisted), going up and down stairsand coordination of two hands.The motor function and ADL (Activity of Daily Living) should beevaluated respectively at admission time,1month after symptom and3months after symptom, to confirm the improving degree of motor function andjudge rehabilitation and nursing effects. The evaluation of limbs motorfunction applied Fugl-Meyer scale to evaluate the states (50for total,33forupper extremity and17for lower extremity) of the patients' upper and lowerextremity. Each state was divided into3levels, marked as0score for totallynon-executed,1score for partial executed and2scores for completelyexecuted,100score for total (66for upper extremity, and34for lowerextremity). The evaluation of ADL (Activity of Daily Living) applied BarthelIndex standardized by England, including dinning, bathing, cleaning, dressing,defecating and urinating, toileting, bed and chair transferring, floor-levelmoving and going-up stairs. Each can be marked as3score,2score,1scoreand0score respectively in terms of the necessity of assistance and its level.Arranging and putting the achieved data to SPSS and creating data base, thenanalyzing by the application of SPSS13.0.Results: After rehabilitation the motor function and ADL (Activity ofDaily Living) of60patients are better, but the EG (Experimental Group) isapparently better than that of CG (Control Group).1. Motor function comparison between CG and EGThe motor function score of EG is, respectively,23.84+4.57(at admission time),55.72+9.89(1month after symptom), and78.47+7.11(3months after symptom). The motor function score of CG is, respectively,22.96+3.41(at admission time),45.43+6.70(1month after symptom),64.07+6.07(3months after symptom). Repeated measures show that motorfunction evaluation score varies with different motor function trainingmethods, F=37.233, P＜0.01,the motor function score of EG is apparentlybetter than that of CG;and motor function evaluation score varies withdifferent evaluation time, F=1499.084, P＜0.01,. There is an interactionbetween evaluation time and processing methods, F=31.233, P＜0.01. It isconsidered that there are group differences in different motor functiontrainings. Motor function evaluation score of stroke hemiplegia patients' varieswith different training methods and different time.2. Comparison of Activity of Daily Living (ADL) between CG and EGThe barthel index of EG is, respectively,4.25±1.41(at admission time),11.06±1.34(1month after symptom), and14.97±2.01(3months aftersymptom). The barthel index of CG is, respectively,4.50±1.26(at admissiontime),9.57±2.12(1month after symptom),12.39±2.06(3months aftersymptom). Repeated measures show that barthel index varies with differentmotor function training methods, F=9.608, P＜0.01, the barthel index of EG isapparently better than that of CG; and barthel index varies with differentevaluation time, F=1840.991, P＜0.01. There is an interaction betweenevaluation time and processing methods, F=42.127, P＜0.01. It is consideredthat there are group differences in different motor function trainings. Thebarthel index of stroke hemiplegia patients' varies with different trainingmethods and different time.Conclusion: Motor function and ADL (Activity of Daily Living) ofpatients of both group were promoted, with EG got better result than CG did,that is, the result gotten by training on motor function of both sides is betterthan that gotten by training on motor function of injured side.Motor function training of both limb sides can effectively improve themotor function's rehabilitation of stroke hemiplegia patients. The2Motor function evaluation scores after motor function training are higher than that ofat admission time, otherwise, motor function rehabilitation degree in1monthafter symptom degree is greater; motor function trainings on both limb sidescan also effectively promote ADL of stroke hemiplegia patients'. The2Barthel Indexes after motor function training are higher than that of atadmission time, otherwise, the ADL rehabilitation degree in3month remainsto improve continuously. |
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