运动康复训练对帕金森病患者运动障碍的康复效果研究
运动康复训练对帕金森病患者运动障碍的康复效果研究
Study on the rehabilitation efficacy effect of Exercise rehabilitation training on dyskinesia of patients with Parkinson's disease
Abstract
Objective:Dyskinesia is the main cause of disability in patients with Parkinson's disease, which seriously affects the quality of life of the patients with Parkinson's disease.Parkinson's disease is a common dyskinesia of middle and old people,also known as tremor paralysis.Its pathological features are the d egeneration of dopaminergic neurons in the substantia nigra pars compacta,and the formation of Lewy bodies.The main clinical manifestations are resting tremor,rigidity,bradykinesia and other symptoms[1].In this article,the rehabilitation effect of Parkinson's disease on the improvement of dyskinesia in Parkinson's patients was studied by combining exercise rehabilitation training and routine rehabilitation training in order to find an effective rehabilitation method for Parkinson's patients.
Methods:Thirty patients with Parkinson's disease who were rehabilitated in Sichuan Provincial Rehabilitation Hospital(from January2017to June2017)were randomly selected and divided into15groups:exercise rehabilitation group and routine rehabilitation group.In the sports rehabilitation group,sports rehabilitation training was added while receiving regular rehabilitation training.The two groups were evaluated for rehabilitation before receiving rehabilitation treatment,2weeks after rehabilitation,6weeks after rehabilitation, and8weeks after rehabilitation.The assessment includes:the timing of the Parkinson's disease patients(TUG)[2],Unified Parkinson's Disease Rating Scale(UPDRS)III[3],Webster's Parkinson's disease evaluation form[4].
Result:（1）There was no significant difference in the TUG test time between the exercise recovery group and the conventional rehabilitation group(p>0.05)before Rehabilitation therapy；The time of TUG test was equal between the exercise rehabilitation group and the conventional rehabilitation group after receiving2weeks of rehabilitation training.There was a decrease,but there was no significant difference(p>0.05);TUG test time was significantly reduced in the exercise rehabilitation group and the routine rehabilitation group after6weeks and8weeks of rehabilitation training(p<0.05).The reduction rate in the exercise rehabilitation group was better than that in the conventional rehabilitation.(2)The UPDRS III scores of patients in the exercise rehabilitation group and the conventional rehabilitation group were not significantly different(p>0.05),and they were comparable befor rehabilitation therapy；The UPDRS III scores of the exercise rehabilitation group and the general rehabilitation group were similar after two weeks of rehabilitation training.However,there
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was no significant difference(p>0.05);UPDRS III scores were significantly reduced in the exercise rehabilitation group and the conventional rehabilitation group after6weeks and8 weeks of rehabilitation training(p<0.05).The reduction rate in the exercise rehabilitation group was better than that in the conventional rehabilitation group.(3)There was no significant difference(P>0.05)between Webster scores before Rehabilitation therapy in patients with exercise rehabilitation and conventional rehabilitation groups(p>0.05)；Webster scores decreased in both exercise rehabilitation group and routine rehabilitation group after two weeks of rehabilitation training.However,there was no significant difference(p>0.05);after 6weeks and8week of rehabilitation training,Webster scores were significantly reduced in the exercise rehabilitation group and the conventional rehabilitation group(p<0.05).The reduction rate in the exercise rehabilitation group was better than that in the conventional rehabilitation group.
Conclusion:After8weeks of rehabilitation training in the exercise rehabilitation group and the conventional rehabilitation group,the scores of Parkinson's disease patients were significantly improved,but the improvement in the exercise rehabilitation group was more obvious,indicating that at the same time of traditional rehabilitation therapy increase exercise rehabilitation training can improve Parkinson's patient's movement disorders and improve the quality of life.
Key words:Parkinson's disease;Exercise rehabilitation;Dyskinesia;Rehabilitation effect
运动康复训练对帕金森病患者运动障碍的康复效果研究
目录
摘要.......................................................................................................................................I Abstract...................................................................................................................................II 1绪论.. (1)
1.1选题依据 (1)
1.2研究的目的和意义 (1)
1.2.1研究目的 (1)
1.2.2研究意义 (2)
2文献研究 (3)
2.1运动康复 (3)
2.1.1运动康复的定义 (3)
2.1.2运动康复的理论基础 (3)
2.1.3运动康复训练内容和方法 (4)
2.2帕金森病 (5)
2.2.1帕金森病简述 (5)
2.2.2国内外研究现状 (6)
2.2.3帕金森病康复治疗情况 (8)
3研究对象与方法 (10)
3.1研究对象 (10)
3.1.1纳入标准 (10)
3.1.2排除标准 (10)
3.1.3脱落标准 (10)
3.1.4一般资料 (10)
3.2研究方法 (11)
3.2.1实验内容 (12)
3.2.2评估工具 (15)
3.2.3文献资料法 (15)
3.2.4统计学分析 (15)
4研究结果 (16)
4.1帕金森患者计时-起步行走实验（TUG）时间比较 (16)
4.2帕金森患者UPDRSⅢ量表评分比较 (16)
4.3韦氏帕金森病评定量表评分比较 (17)
5分析与讨论 (18)
结论 (20)
参考文献 (21)
附录A“帕金森病的诊断”标准 (25)
附录B改良Hoehn-Yahr分级标准 (26)
附录C牵伸训练 (27)
附录D统一帕金森病评定量表Ⅲ部分 (29)
附录E韦氏帕金森病评定量表 (32)
攻读硕士学位期间发表学术论文情况 (34)
致谢 (35)
1绪论
帕金森病又称震颤麻痹,是中老年人中常见的慢性神经系统退行性疾病。主要病变部位在黑质纹状体。震颤、肌强直、运动减少、姿势与平衡障碍是此病的主要表现。随着人口老化社会的到来和生活水平的提高,帕金森病的发病率也呈上升趋势[5]。假如不及时治疗或者治疗不当，将会对患者的生活质量造成严重影响，甚至日常生活都需要家人帮助，并出现多种并发症。
帕金森病的运动障碍，需要长期的康复治疗，对家庭和社会造成巨大的压力[6]。因此，本文以运动康复训练结合传统康复训练为例，通过对照研究比较，以期寻找一种疗效佳、康复周期短的康复手段，提高帕金森病患者的日常生活能力、减轻家庭和社会的压力。
1.1选题依据
帕金森病是中老年人常见的一种慢性疾病，近年来帕金森病的发病率也在逐年上升。据统计，65岁以上老年人群发病率为1%-2%、85岁以上为3%-5%[7]。在不同年龄段发病率也不同，60岁0.25%、65岁0.5%、70岁1%、75岁1.5%、80岁2.5%、85岁3.5%-4.0%[8]；而全年龄段发病率为8-18/10万人口/年、65岁以上年龄段50/10万人口/年、75岁以上年龄段为150/10万人口/年、85岁以上年龄段为400/10万人口/年[8]。导致帕金森病患者致残的主要原因是运动障碍，于是如何提高帕金森患者的运动功能成为现帕金森病康复讨论的热点。
运动康复也被称为体疗，对肢体功能障碍的患者采取运动的手段，使患者在身体、精神上得到恢复，使其回归正常生活的方法[9]。国外对于运动康复的研究已有多年的历史并在临床上广泛应用，而我国关于运动康复训练的报道鲜见。有研究表明运动康复训练对于脑卒中患者运动障碍有显著疗效，但对于帕金森病的康复还处于初级阶段。帕金森病由于中脑黑质致密部、蓝斑神经元色素脱失，黑质色素变淡及出现路易小体等原因，导致患者出现肢体障碍，致使生活质量下降，尽早介入康复治疗可以减少致残率，改善帕金森病患者的日常活动能力。
1.2研究的目的和意义
1.2.1研究目的
帕金森病患者的运动障碍表现在，运动减少、运动迟缓、运动启动困难和速度减慢、运动变换困难等。笔者对纳入的30名帕金森患者进行了8周的康复治疗，总结分析实