اثر محدودیت درمانی اجباری در بهبود عملکرد دست بیماران سکته مغزی: مرور ادغام یافته

نوع مقاله : مقاله پژوهشی

نویسندگان

1 دانشجوی کارشناس ارشد آموزش پزشکی، دانشکده آموزش پزشکی، دانشگاه علوم پزشکی شهید بهشتی تهران ، ایران

2 دکترای کاردرمانی، عضو هیئت علمی و مدیر گروه کاردرمانی دانشگاه علوم بهزیستی و توانبخشی

3 دانشجوی دکترای کاردرمانی، عضو هیئت علمی گروه آموزش کاردرمانی دانشکده علوم توانبخشی دانشگاه علوم پزشکی شهید بهشتی

10.22037/jrm.2013.1100117

چکیده

مقدمه و اهداف
هدف از محدودیت اجباری، پیشرفت استفاده از اندامی است که به دنبال سکته مغزی دچار اختلال عملکردی شده است. در محدودیت اجباری برای درمان اندام فوقانی، اندام کمتر آسیب دیده برای چندین ساعت در روز به مدت 2 هفته متوالی محدود می شود. هدف از این مطالعه بررسی اثر محدودیت اجباری در بهبود عملکرد دست بیماران سکته مغزی با استفاده از مرور مقالات چاپ شده در بین سالهای 2000 تا 2013 است.
مواد و روش ها
روش مرور ادغام یافته برای بررسی مطالعاتی که در زمینه اثر بخشی محدودیت درمانی اجباری در بهبود عملکرد دست بیماران سکته مغزی در بین سالهای 2000 تا 2013 صورت گرفته انجام شد. در این مرور سایت های ایرانی SID و  Magiran و سایت های خارجیPedro- OT  BibSys- OT seeker- OTDbase-   Science direct- Pub med- Elsevier مورد بررسی قرار گرفتند و برای آنالیز محتوای مقالات از رویکرد کیفی استفاده شد.
نتیجه گیری
بالغ بر 268 مقاله در زمینه سکته مغزی و عملکرد اندام فوقانی یافت شد. 200 مقاله به دلیل عدم همخوانی موضوعی و پرداختن به روشهای مختلف بهبود عملکرد اندام فوقانی مانند: دارویی ، فیزیوتراپی و رویکردهای کاردرمانی حذف شد. 68 مقاله باقی مانده در زمینه بهبود عملکرد دست بیماران سکته مغزی بودند که از این تعداد، 43 مقاله اختصاصاً به بررسی حرکت درمانی ناشی از محدودیت پرداخته بودند از بین آنها 9 مقاله به دلیل انجام محدودیت درمانی در بیمارانی غیر از سکته مغزی مانند فلج مغزی، ضربه های مغزی و انجام آزمایش روی موش آزمایشگاهی از مطالعه خارج شدند. نهایتاً 36 مقاله با توجه به معیار های ورود انتخاب شدند.
این مرور با تجمیع نتایج مطالعات انجام شده نشان داد که محدودیت درمانی در همه مراحل حاد، تحت حاد و مزمن بیماری با پیش فرض وجود حرکات اکستنشن اکتیو در انگشتان و مچ و حرکات پسیو حداقل 90 درجه فلکشن و ابداکشن در شانه و 45 درجه چرخش خارجی شانه و 45 درجه سوپینیشن و پرونیشن در ساعد و داشتن عملکرد شناختی مناسب(ارزیابی عملکرد شناختی MMSE=20 to 24 ) قابل اجراست و نسبت به درمانهای روتین توانبخشی در بهبود توانایی های عملکردی اندام فوقانی بیماران سکته مغزی و غلبه بر سندرم عدم استفاده آموخته شده موثرتر است. ولی تاثیر آن در کینماتیک حرکات و کیفیت زندگی نیاز به بررسی های بیشتری دارد.

کلیدواژه‌ها


عنوان مقاله [English]

Effects of Constraint- Induced Movement Therapy (CIMT) on improvement of upper-limb and hand function in stroke patients: an integrative review

نویسندگان [English]

  • Zahra shafiee 1
  • Mehdi Rassafiani 2
  • Mehdee Rezaee 3
1 MSc of Medical Education, Shahid Beheshti University Of Medical Sciences. Tehran. IranIran
2 Assistant Professor Director of the Research Committee IROTA Delegate to WFOT (First Alter) Department of Occupational Therapy, The University of Social Welfare and Rehabilitation Sciences ,Tehran, Iran
3 Member Of Occupational Therapy Department, Faculty Of Rehabilitation Sciences, Shahid Beheshti University Of Medical Sciences, Tehran, Iran
چکیده [English]

Background and Aim: The aim of constraint-induced movement therapy (CIMT) is improving use of the upper limb that is functionally impaired after stroke. In CIMT to treat the use of upper limb impairment, application of the less severely affected arm is restricted for many hours each weekday over 2 consecutive weeks. The aim of this study was to investigate the effects of constraint-induced movement therapy on improvement of upper limb and hand function in stroke patients by integrative review of published articles since 2000- 2013.
Materials and Methods: An integrative review of published articles regarding the effectiveness of constraint- induced movement therapy in promotion of hand function in stroke patients since 2000- 2013 was used in this study. We reviewed Iranian databases such as SID and MagIran and foreign databases such as Pedro, OT Bib Sys, OT seeker, OTD base, Sciencedirect, Pubmed, Elsevier. We used a qualitative approach for content analysis.
Results: Over 268 papers were found regarding stroke and upper limb function, 200 articles of those used different ways to improve upper limb function, such as medication, physiotherapy, occupational therapy approaches and were rejected, the remained 68 articles were dedicated to the study of constraint- induced movement therapy. Among these articles, 43 papers were about the effects of constraint induced movement therapy on development of upper extremity. 9 articles were excluded due to using of Constraint Induced Movement Therapy on head injury patients and lab rat. Finally, 36 articles were selected according to the criteria of entry.
Conclusion: The aggregate results of a review of studies showed that constraint induced movement therapy improves function of upper extremity at every stages of stroke (acute, sub acute and chronic) with a prerequisite of having active extension of wrist and finger, passive 90 ° flexion and abduction and 45°external rotation of the shoulder, 45° pronation and supination and having good cognitive function (MMSE =20 to 24). This method is more effective than traditional rehabilitation method in improving upper extremity functional abilities of stroke patients and overcoming the learned nonuse syndrome. But its impact on quality of life and movement kinematics requires further investigations.

کلیدواژه‌ها [English]

  • Stroke
  • Hand function
  • constraint-induced movement therapy
  • integrative review
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