| 1. BackgroundStroke has been one of the major fatal disease by the world health organization because of its high incidence, high mortality and high morbidity. In the USA,-795 000 people experience a new or recurrent stroke each year. Approximately 610 000 of these are first attacks, and 185 000 are recurrent attacks. Mortality data from 2007 indicate that stroke accounted for≈1 of every 18 deaths in the United States. On average, every 40 seconds, someone in the United States has a stroke. In China, a big developing countries with rapid development of economy and living standard and in the period of to elder society,has a huge elderly population and has become the highest incidence of stroke in the entire Asian-Pacific region. According to the high morbidity and mortality of stroke in China, the world health organization has predicted that the number of death stroke-induced, and if keep the mortality not increasing the number of death stroke-induced reach 4 million. In patients with stroke survivors, the prognosis of aged over 65 patients’ prognosis is very poor and more than 80% of the patients have different degrees of permanent neurological damage, performance on body function, psychological and social function. The decrease of activity of daily living, mental status change and social communication ability degradation directly affect the patients’ quality of life among the majority of patients after stroke, especially physical dysfunction playing a decisive role. Among body dysfunction, hemiplegia is the most common. While patients with hemiplegia after stroke, the side of the brain central nervous system lesions lost the control of the low central and cause the contralateral limb movement, sensory dysfunction. Many clinical study about hemiplegia after stroke existing, up to 85% of patients show an initial deficit in the arm and three to six months later, problems remain in 55% to 75% of patients. However,75 to 83 percent of surviving stroke patients can learn to walk again. This discrepancy might be due to several reasons. First, three quarters of strokes occur in the region supplied by the middle cerebral artery, therefore, the upper limb will be affected in a large number of patients. Second, functional recovery of the arm includes grasping, holding, and manipulating objects, which requires the recruitment and complex integration of muscle activity from shoulder to fingers. In contrast, a minimal amount of recovery of the hemiplegic leg may be sufficient to obtain functional ambulation. Furthermore, secondary complications such as inferior subluxation of the glenhumeral joint, shoulder-hand syndrome, soft tissue lesions, and painful shoulder frequently hinder rehabilitation of the hemiplegic arm. In addition to the above reasons, there is an important reason that when hemiplegia patients have the upper and lower limb dysfunction at the same time, upper limb function rehabilitation is often ignored by patients and their families. So, after half a year more than 66% of the patients still have varying degrees of upper limb dysfunction in clinical. For patients with hemiplegia, however, the recovery of upper limb function and hand fine activity is directly related to their ability of daily life, such as eating, dressing, wash your face, which influence the patient’s quality of life seriously. During the stroke recovery, arm and hand movement function plays a decisive role in the self-efficacy and the self-ability. So, the upper limb function and hand function recovery in patients with hemiplegia has been the emphasis and difficulty. Hand craft training, centered on the activities of the patient’s arm and hand, into the patient’s creativity and imagination, is an art therapy method to find the patients’ moto potential and their own imagination.Hand craft training has 100 years of clinical treatment history. After the First World War, hand craft training being the form of operation treatment began to used in the treatment of limb dysfunction. In the 1930 s, hand craft training was considered to be one of the basic physical therapy. Being a new adjuvant therapy with the combination of medicine and art, hand craft training is a creative art therapy including rich and colorful hand-made content, such as weaving,pottery= and porcelain, painting, calligraphy, silk flowers, paper cutting, clay, wool felt, beads, and so on, which aims to finish making handicraft by learning to obtain the physical and psychological treatment. Hand craft training coming from homework, belonging to the special operation treatment, embody a concentrated reflection of homework therapy core idea-to help patients back to family and society as soon as possible. But compared with homework and other traditional rehabilitation treatment, manual therapy has its own characteristics: ① Artistry, Hand craft training is a part of the traditional art and culture and completing the handmade is handmade works of art colour, therefore handmade training, also known as hand craft treatment. ② Creativity, Under the guidance of a therapist, patients complete their own style of manual work with their creativity, such as crochet, ceramic production, clay dolls, and so on. ③ Interesting, handmade contents are rich and colorful, being classified according to different age, occupation and gender selection, and center on patient preferences.④ Activity form diversity, Based on the patient’s preferences and manual finished product size, patients can choose make handmade formation between independent and group activity, for different treatment form gaining different meaning. ⑤ Continuity, completing the manual finished product as the guidance, planning production task every day can strengthen the sense of responsibility while patients perform hand craft training, which can keep a good treatment of sustainability. ⑥ Sociality, Groups form of therapy and manual finished product of artistic expression bring different experience of interpersonal communication for patients. At the same time, the finished hand-made products exhibition and giving others a present can well reflect the social value of the patients.2. Object:Due to the side of the central nervous system damage, stroke patients with hemiplegia have limb movement and sensory dysfunction. And especially, upper limb function in patients with hemiplegia is relatively fine, and exists larger area of the brain function, therefore its clinical recovery is slow. However, during the early rehabilitation time the hemiplegic patients and their families focus on lower limb movement mainly. In fact,1 month after stroke, with the extension of time, upper limb dysfunction plays more and more important influence on patients quality of life and self-efficacy. From the middle of 20th century, hand craft training being widely applied to the limb dysfunction in patients with rehabilitation, many western researchers in succession said "handmade training is one of the main form of physical therapy" in the authority of the academic journal at that time.The purpose of this clinical research was to investigate the effects of handcraft training for upper limb and hand functional recovery in hemiplegic patients with separation movement compared with operation treatment.3. Objects and methods48 stroke patients with hemiplegia were recruited from the rehabilitation, neurology, neurosurgery departments from April 1,2014-June 1,2015 to participate in this clinical study. Participants were randomly divided into experimental group and control group. In the treatment group, there were 11 males and 13 females,9 cerebral hemorrhage and 15 cerebral infarction, in which, the average age was 52.67+/ 14.74 years old, the average stroke duration was 52.50+/-15.39 days, the Simple Mental State Examination (MMSE) score was 27.41+/-2.73 on average.Randomly divided into two groups with 24 patients, there is no significant difference in general data between the two groups such as gender, age, nature, course of stroke and cognitive function etc. (P>0.05) Each participant must be assessed with the Brunnstrom stage before the training and after 4 weeks training. Fugl-Meyer assessment of upper extremity (FMA-UE) assess upper limb function of patients, which can be divided into 10 categories,33 events, the maximum of 2 points. In this scale the upper limbs assessments was a total of 66 points, and each check content respectively as 0, I,2 points, according to the completion situation the highest is 2 points. Modified Barthel Index (MBI) assess patients’ activities of daily living, and the total score is 100 points in this scale. The Simple Test for Evaluating hand Function assess arm and hand fine activity function, which includes 10 check program and the total score is 100 points. When patients perform the duty of every grasp or put, therapists who were responsible for the evaluation need precise timing, so not just test ability, grasp or put, also test the upper extremity and hand speed and flexibility. We assessed the FMA-UE, STEF, MBI of two groups before training, after two weeks, after four weeks. The experimental group and control group were accepted neurology necessary medication, exercise therapy, physical therapy, acupuncture and other conventional rehabilitation. As to arm and hand movement function treatment, the control group practice traditional treatment for 30 minutes such as nail plate, roller, books and other training. The experimental group, are enforcing system manual training for 30 minutes. Hand craft training contents of the experimental group were provided by the rehabilitation medicine of southern medical university manual treatment team, which includes silk flowers, crochet, sand painting, figure painting, knead, yan paper painting on paper, weaving, small carpenter series and so on. According to different size and difficulty, the design each series of handmade is divided into a variety of handmade samples. Before the trial, we did a clinical investigation that distribute to all over the country more than 70 rehabilitation therapists with hand craft bag freely, by collecting the opinions of more than 70 therapists, and choose rubbing paper paintings, silk flowers as a training manual intervention. Patient who was out the stage with stage Ⅳ-Ⅴ choose rubbing paper paintings, who was out the stage with stage VI choose silk flowers. According to its design on paper, canvas size rubbing paper paintings is divided into-several series, and screen flowers also have sunflower, roses, tulips, butterfly orchid and other options, therefore experimental group patients can choose the most appropriate hand craft bag according to favorite in the corresponding series of hand craft bags. Under the guidance of a therapist, can play to their creativity, shape change for their handmade. Doing hand craft training was mainly in the form of individual production in a separate room for treatment, also in the form of group training to promote the communication between the patients weekly. Before training, patients could exercise some action such as grasping the scissors, turning over the paper to being more skilled. During the total training, the therapists would be a supervisor, in case the patients injured by improper use of tools.4. Results:After 4 weeks, scores of FMA-UE、STEF and MBI of two groups were all raised significantly (P<0.05), and scores of FMA-UE(48.45±3.93)、STEF(68.45±10.76)、 MBI(71.87±8.69) of experimental group were significantly greater than scores of FMA-UE(46.54±1.97)、STEF(59.16±8.37)、MBI (66.67±8.29) of the control group (P<0.05).5. Conclusion:In this study, we use handmade training in patients with hemiplegia after stroke in upper extremity and hand movement function training, and after 4 weeks of training, FMA-UE, STEF, MBI scores ratings of experimental are higher than the control group (P< 0.05), which suggested that hand craft training can significantly improve upper limb and hand function and activity of daily living of hemiplegic patients with separation movement. Compared with the traditional operation treatment, hand craft training is an interesting exercise and learning training, patients can be independent choice in the corresponding manual series. Manual product oriented, keeping a good continuity of patients, giving full play to the patients in the process of making creativity, hand craft training not only improve the patient’s arm and hand movement function, also improve effects on motor function recovery in patients with other functions such as cognition, emotion, the function of social communication and so on. This clinical study proved that the system of manual training can obviously improve the existing separatist movement of upper limbs and hand movement function in patients with cerebral apoplexy hemiplegia, improve their ability of daily life. Hand craft training is a kind of traditional art, with a rich material sources, without special training time and site requirements. And some hand crafts were associated with life skills, professional behavior. As a kind of combination of medicine and art creative activity, can be popularized in clinical rehabilitation therapy, especially in the community, home rehabilitation. |
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