强制使用运动疗法对脑卒中患者上肢运动功能的影响

目的研究强制使用运动疗法对脑卒中患者上肢运动功能恢复的影响.方法12例脑卒中偏瘫患者接受强制使用运动疗法治疗,在治疗期间要求患者健侧穿戴吊带和夹板来限制健侧肢体动作,每天清醒时固定时间不少于90%,连续12天.同时接受行为再塑的技巧训练,密集的训练患侧肢体活动,完成日常生活中的动作,连续2周共10个工作日.在治疗前的2周(基线)、治疗前和治疗后用上肢功能测验(UEFT)和简易上肢功能检查(STEF)来评价患者的上肢运动功能.结果患者在治疗前2周的基线期内,在UEFT和STEF上未显现出明显的改善(ES0.21;0.06).但患者在接受2周的强制使用运动疗法治疗后,在UEFT和STEF上显现出较为明显的改善(ES1.24;0.65),其中病程3-6个月的患者比病程＞6个月的患者的改善更为明显(ES1.430.96;0.810.5).结论强制使用运动疗法是改善恢复期和慢性期脑卒中患者上肢运动功能的有效治疗方法.     

上肢康复训练系统在脑卒中偏瘫患者上肢功能康复中的应用

目的:观察上肢康复训练系统对脑卒中患者上肢功能康复的临床疗效。方法:脑卒中偏瘫上肢功能障碍患者42例,分为观察组22例和对照组20例。2组患者均接受常规药物治疗和康复训练。观察组在此基础上加用Rejoyce上肢康复训练。治疗前后采用Fugl-Meyer量表上肢部分(FMA-UE)、Rejoyce手功能测试(RAHFT)和功能独立性评定(FIM)评定2组疗效。结果:治疗4周后,2组FMA-UE、RAHFT及FIM评分治疗前后及组间比较均差异无统计学意义;治疗8周后,2组FMA-UE、RAHFT及FIM评分均较治疗前及治疗4周时明显提高(P0.05,0.01),且观察组更高于对照组(P0.05)。结论:Rejoyce上肢康复训练结合常规康复作业治疗能更好地改善脑卒中恢复期患者偏瘫上肢及手的功能,更有效地提高患者日常生活活动能力。     

中风后的健侧上肢问题

大量证据表明 ,成年人中风后大脑损伤的同侧上肢感觉运动控制也出现异常。一些感觉运动缺损因脑损伤侧的功能不同而异 ,需要精确时序性的快速运动在左半球损伤的患者中对同侧上肢的影响大 ,相反在右半球损伤的患者中对有空间运动需要的同侧上肢影响较大 ,左侧中风的成年人同侧上肢的分离协调动作是正常的 ,但是连续协调动作则异常。中风后同侧上肢的感觉不受影响或仅受轻微影响 ,损伤同侧上肢有肌力缺陷 ,主要表现在右侧半球损伤患者 ,在要求一定时间完成的床功能检查中 ,见损伤同侧操作不能按时完成 ,这种操作缺陷可以反映损伤同侧的运动控制缺陷 ,这种缺陷往往被对侧偏瘫和偏身感觉丧失掩盖 ,集中于特殊运动控制缺陷的干预措施有助于双上肢的功能改善。     

Strength deficits of the paretic lower extremity muscles were the impairment variables that best explained restrictions in participation after stroke

Purpose: To evaluate which measures of physical impairments of both upper extremity (UE) and lower extremity (LE) would predict restrictions in participation with 105 community-dwelling stroke subjects.

Methods: For this cross-sectional, exploratory study, participation was assessed by the daily activity and social role domains of the Assessment of Life Habits (LIFE-H). The potential predictors included measures of physical impairments (UE and LE motor recovery, sensation, motor coordination, and strength deficits).

Results: Step-wise multiple linear regression analyses revealed that, for the daily activity domain, LE strength deficits and UE motor recovery explained 28% of the variance in the LIFE-H scores and LE strength deficits alone explained 22% (F?=?29.5; p< .0001). For the social role domain, LE strength deficits and sensation explained 22% of the variance in the LIFE-H scores and LE strength deficits alone explained 16% (F?=?20.6; p< .0001).

Conclusions: Strength deficits of the LE muscles were the physical impairment variables that best predicted participation in both daily activity and social role domains of the LIFE-H. Although significant, UE motor recovery and LE sensation added little to the explained variance. Future research is needed to determine whether progressive resistance strength training program enhances participation after stroke.

• Implications for Rehabilitation

• Residual strength deficits of the LE muscles were the physical impairments that showed to be the main predictors of restrictions in participation, as determined by the daily activity and social role domains of the LIFE-H 3.1.

• It is possible that stroke individuals would benefit from physical interventions aiming at improving the strength of the LE muscles, when the goal is to enhance participation.

     

脑卒中偏瘫患者健侧上肢运动控制障碍的研究

目的 :研究脑卒中偏瘫患者健侧上肢运动控制障碍对功能恢复的影响。方法 :62例脑卒中偏瘫患者分别在治疗前和治疗 3个月后对健侧上肢进行上肢功能检查 (manualfunctiontest ,MFT) ,用巴塞尔指数 (BarthelIndex ,BI)评测患者的ADL。结果 :①治疗前MFT异常者 49例 (79% ) ;②MFT变化差值上早期康复组高于恢复期康复组 (P <0 .0 0 1 ) ;③MFT正常组 3个月治疗训练后BI值 1 0 0分 ,BI变化差值正常组高于异常组 (P <0 .0 0 1 )。结论 :脑卒中偏瘫患者健侧上肢存在运动控制障碍 ,并影响功能恢复 ,因此脑卒中后早期积极对健侧上肢运动控制障碍评测和治疗是十分重要的     

虚拟现实技术对不同类型脑卒中患者偏瘫上肢功能的影响

目的 观察虚拟厨房上肢训练结合常规作业治疗对不同类型脑卒中(脑出血和脑梗死)恢复期患者偏瘫上肢功能康复的临床疗效.方法 选取脑卒中恢复期偏瘫患者60例,按随机数字表法随机分为治疗组(30例)和对照组(30例).对照组接受常规作业治疗,治疗组在常规作业治疗基础上增加虚拟厨房上肢训练.2组患者均于治疗前和治疗3周后(治疗后)进行上肢运动功能评定(FMA-UE)及以改良巴氏指数(MBI)评定日常生活活动能力,同时记录患肘屈曲/伸展最大等长收缩(MIVC)时肱二、三头肌的表面肌电信号(sEMG),计算相应的协同收缩率(CR),并比较2组的疗效.结果 治疗后,2组患者各项指标与组内治疗前比较,差异均有统计学意义(P＜0.05).治疗后,治疗组的FMA-UE和MBI评分分别为(45.97 ±6.30)分和(70.03±10.62)分,与对照组治疗后的(40.33±8.23)分和(61.87±10.85)分比较,差异均有统计学意义(P＜0.05);治疗后,2组患者患肘屈曲肱二头肌和患肘伸展肱三头肌CR组间比较,差异均无统计学意义(P＞0.05).2组按病变性质分型比较,治疗后,2组中脑出血和脑梗死患者的各项指标与组内同型治疗前比较,差异均有统计学意义(P＜0.05);治疗组脑卒中和脑梗死患者的FMA-UE和MBI评分与对照组同型治疗后比较,差异均有统计学意义(P＜0.05);但2组中脑出血和脑梗死患者的患肘屈曲肱二头肌和患肘伸展肱三头肌CR组间同型比较,差异均无统计学意义(P＞0.05).结论 虚拟厨房上肢康复训练结合常规作业治疗可显著改善不同病变性质脑卒中(脑出血和脑梗死)患者偏瘫上肢的运动功能和日常生活活动能力.     

A home-based rehabilitation program for the hemiplegic upper extremity by power-assisted functional electrical stimulation

Purpose. To assess the effects of daily power-assisted functional electrical stimulation (FES) home program therapy in chronic stroke.

Methods. A total of 20 consecutively enrolled stroke patients with spastic upper-extremity impairments >1 year after stroke were recruited for this non-blinded randomized controlled trial. Subjects were assigned to control and FES groups and followed for 5 months. The FES group used a power-assisted FES device to induce greater muscle contraction by electrical stimulation in proportion to the integrated electromyography (EMG) signal picked up on surface electrodes. Target muscles were the extensor carpi radialis longus (ECRL) and extensor carpi radialis brevis (ECRB), extensor digitorum communis (EDC), extensor indicis proprius (EIP), and deltoid (Del). Patients underwent 30 ～ 60 min FES sessions at home about 6 days/week. Root mean square (RMS) of ECRL, EDC and Del maximum voluntary EMGs, active range of motion (ROM) of wrist and finger extension and shoulder flexion, modified Ashworth scale (MAS), and clinical tests were investigated before and after FES training.

Results. The FES group displayed significantly greater improvements in RMS, active ROM, MAS and functional hand tests, and was able to smoothly perform activities of daily life using the hemiplegic upper extremities.

Conclusions. Daily power-assisted FES home program therapy can effectively improve wrist and finger extension and shoulder flexion. Proprioceptional sensory feedback might play an important role in power-assisted FES therapy.     

Relationship among trunk control,activities of daily living,and upper extremity function during the first week after stroke in patients with acute cerebral infarction

[Purpose] We aimed to identify the relationship among trunk control, activities of daily living, and upper extremity function during the first week after stroke in patients with acute cerebral infarction. [Participants and Methods] Ninety-five patients with first cerebral infarction were included. Trunk control was assessed using the Postural Assessment Scale for Stroke. Additionally, activities of daily living were evaluated using the Functional Independence Measure, and upper extremity function was assessed using the upper extremity component of the Fugl-Meyer Assessment. Correlation analysis was performed to examine the relationships among these three measures. Furthermore, stepwise multiple regression analysis was performed to investigate the factors affecting activities of daily living. [Results] The total score and two subcategories of the Postural Assessment Scale for Stroke were significantly correlated with the Functional Independence Measure motor values. Stepwise multiple regression analysis revealed age and the Postural Assessment Scale for Stroke as factors influencing the Functional Independence Measure. Moreover, the Postural Assessment Scale for Stroke and upper extremity component of Fugl-Meyer Assessment showed a high correlation. [Conclusion] The trunk control ability assessed using the Postural Assessment Scale for Stroke is strongly correlated with activities of daily living estimated using the Functional Independence Measure in the first week after stroke in patients with acute cerebral infarction. The upper extremity component of Fugl-Meyer Assessment was not identified as a factor affecting the Functional Independence Measure.     

Reasons for recovery after stroke: A perspective based on personal experience

Purpose. The purpose of this study was to learn more about individual beliefs and personal strategies used to support the period of recovery after stroke. It sought to identify the factors that were perceived to be enablers as well as challenges to recovery. Personal actions or experiences, which were perceived to be effective in influencing progress, would be identified.

Method. Qualitative in-depth interviews were carried out with 10 participants (mean age 61.8 years). Time following stroke onset ranged between 6 weeks and 13 months. All participants had some residual activity limitation and three participants had varying degrees of aphasia. The interviews were ～60 – 90 minutes and all data was subjected to content analysis.

Results. Analyses of interview data identified two main themes which were perceived to have influenced progress after stroke. The first related to internal factors such as personal control over progress, optimism and fears of dependency and the second included more external factors, such as the influence of therapeutic interactions and success with a specified marker of independence such as dressing, washing and walking.

Conclusion. An important finding of this study was that individuals all identified a number of specific factors which had supported or hindered their own recovery. There were a diversity of both internal/personal and external factors which may not be surprising, given the complexity of stroke, but all participants stressed the importance of both factors. The findings from this study are preliminary and relate only to this particular group of participants, as such they cannot be generalizable to the stroke population as a whole. However, the interaction between the two themes identified requires further exploration, especially in relation to therapy which could have both a positive and negative influence on personal control. There is a clear need to understand how professionals can, in the first place, take time to identify each individual's preferences and personal goals and secondly, make sure that these are fully addressed in a planned treatment programme. This will ensure that progress in individuals after stroke is supported by professionals with a more eclectic, individualized approach.     

An observation-based intervention for stroke rehabilitation: experiences of eight individuals affected by stroke

Purpose.?To explore eight individuals’ experiences and responses to taking part in a personalised observation-based intervention for stroke rehabilitation.

Methods.?Eight participants who had experienced a cerebrovascular accident were recruited to a 16-week observation-based intervention. Participants were interviewed face-to-face to explore their responses to, and experiences of, taking part in the intervention. A list of topics, derived from the intervention process and earlier studies provided a provisional structure for the interview. All interviews were transcribed, coded and analysed using inductive content analysis to explore the impact of the observational intervention for these participants.

Results.?Three main themes emerged: physical function, behaviour change and DVD content. Lower order themes were also identified. These included: interaction with the physiotherapist; ability to complete tasks; and increased motivation to (re)engage in activities of everyday living.

Conclusion.?The findings suggest that a programme of action observation, linked to individualised and meaningful motor behaviours can provide a valid intervention for individuals affected by stroke by serving as a motivating agent to (re)engage in activities which they had believed they could not perform following their stroke. There was also evidence for positive affect on psychological wellbeing and motor function.     

Intra- and inter-rater reliability of Fugl-Meyer Assessment of Lower Extremity early after stroke

BackgroundThe Fugl-Meyer Assessment of Lower Extremity (FMA-LE) is a widely used and recommended scale for evaluation of post-stroke motor impairment. However, the reliability of the scale has only been established by using parametric statistical methods, which ignores the ordinal properties of the scale.ObjectiveTo determined intra- and inter-rater reliability of the FMA-LE at item and summed score level early after stroke.MethodsSixty patients (mean age 65.9 years, median FMA-LE 29 points) admitted to the hospital due to stroke were included. The FMA-LE was simultaneously, but independently, scored by three experienced and trained physical therapists randomly assigned into pairs, on two consecutive days, between 4 to 9 days post stroke. A rank-based statistical method for paired ordinal data was used to assess the level of agreement and systematic and random disagreements.ResultsThe item-level reliability was high (percentage of agreement [PA] ≥75%). Two items (ankle dorsiflexion during flexor synergy and normal reflex activity) showed some systematic disagreement in intrarater analysis. A satisfactory intrarater reliability (PA ≥70%) was reached for all summed scores when a 1- or 2-point difference was accepted between ratings.ConclusionThe FMA-LE is a reliable tool for assessment of motor impairment both within and between raters early after stroke. The scale can be recommended not only for use in Spanish speaking countries, but also internationally. A unified international use of FMA-LE would allow comparison of stroke recovery outcomes worldwide and thereby potentially improve the quality of stroke rehabilitation.     

Measuring upper limb capacity in patients after stroke: reliability and validity of the stroke upper limb capacity scale

Houwink A, Roorda LD, Smits W, Molenaar IW, Geurts AC. Measuring upper limb capacity in patients after stroke: reliability and validity of the Stroke Upper Limb Capacity Scale.

Objective

To investigate the interrater reliability and construct validity of the Stroke Upper Limb Capacity Scale (SULCS).

Design

Cohort study.

Setting

Inpatient department of a rehabilitation center.

Participants

Patients after stroke (N=21; mean age ± SD, 61.7±7.9y; 57% men), undergoing inpatient rehabilitation.

Interventions

Not applicable.

Main Outcome Measures

The SULCS was administered by occupational therapists (OTs) within 6 weeks after stroke (t1), 3 months after t1 by the same OT (t2), and within 1 week after t2 by another OT (t3). Interrater reliability, the repeatability between different raters, was assessed by calculating the intraclass correlation coefficient (ICC) based on the scores at t2 and t3. Construct validity, indicating agreement with hypotheses concerning the construct that is being measured, was assessed with Spearman rank correlation coefficient (ρ). The SULCS scores were cross-sectionally correlated with those of the Action Research Arm Test (ARAT) and the Rivermead Motor Assessment (RMA) at t1, and longitudinally with the respective change scores between t1 and t2.

Results

The SULCS (range, 0–10) had a high ICC (.94; 95% confidence interval, .86–.97) and strong cross-sectional correlation with both the ARAT and the RMA (ρ=.91 and ρ=.85, respectively), while the respective change scores showed a strong correlation with the ARAT (ρ=.71) and a moderate correlation with the RMA (ρ=.48).

Conclusions

The SULCS has good interrater reliability and construct validity.     

The inclination for conscious motor control after stroke: validating the Movement-Specific Reinvestment Scale for use in inpatient stroke patients

Purpose: Stroke survivors are inclined to consciously control their movements, a phenomenon termed “reinvestment”. Preliminary evidence suggests reinvestment to impair patients’ motor recovery. To investigate this hypothesis, an instrument is needed that can reliably assess reinvestment post-stroke. Therefore, this study aimed to validate the Movement-Specific Reinvestment Scale (MSRS) within inpatient stroke patients.

Method: One-hundred inpatient stroke patients (<1 year post-stroke) and 100 healthy peers completed the MSRS, which was translated to Dutch for the study purpose. To assess structural validity, confirmatory factor analysis determined whether the scale measures two latent constructs, as previously reported in healthy adults. Construct validity was determined by testing whether patients had higher reinvestment than controls. Reliability analyses entailed assessment of retest reliability (ICC), internal consistency (Cronbach’s alpha), and minimal detectable change.

Results: Both structural and construct validity of the MSRS were supported. Retest reliability and internal consistency indices were acceptable to good. The minimal detectable change was adequate on group level, but considerable on individual level.

Conclusions: The MSRS is a valid and reliable tool and suitable to assess the relationship between reinvestment and motor recovery in the first months post-stroke. Eventually, this may help therapists to individualize motor learning interventions based on patients’ reinvestment preferences.

• Implications for rehabilitation

• This study showed that the Movement-Specific Reinvestment Scale (MSRS) is a valid and reliable tool to objectify stroke patients’ inclination for conscious motor control.

• The MSRS may be used to identify stroke patients who are strongly inclined to consciously control their movements, as this disposition may hinder their motor recovery.

• Eventually, the MSRS may enable clinicians to tailor motor learning interventions to stroke patients’ motor control preferences.

     

三级康复治疗改善脑卒中患者肢体运动功能的临床研究

目的探讨规范三级康复治疗对于脑卒中患者肢体运动功能的影响。方法将82例脑卒中患者随机分为康复组和对照组，康复组给予规范的三级康复治疗，对照组不给予规范的三级康复治疗，但神经内科常规治疗同康复组。分别于入选时、病后1个月末、3个月末和6个月末采用简化Fugl-Meyer运动功能评分法对患者肢体运动功能进行评测。结果康复组治疗后各阶段的肢体运动功能评分均明显高于对照组（P〈0．05），差异有统计学意义。康复组入组时以及病后1个月、3个月和6个月时肢体运动功能分别相当于正常人的26．10％、42．52％、65．62％和83．7l％，而对照组分别为：18．5l％、24．85％、37．24％和45．84％。结论规范三级康复治疗对于脑卒中患者各阶段肢体运动功能的改善具有明显的促进作用。     

Responsiveness and validity of the Motor Activity Log in patients during the subacute phase after stroke

Purpose.?To investigate the responsiveness and cross-sectional and longitudinal validity of the Motor Activity Log (MAL) in the subacute phase after stroke.

Method.?Data were collected pre-intervention, post-intervention, and at 3-month follow-up evaluations from 30 patients with stroke participating in a randomized trial of forced use. Assessments included MAL, the Fugl-Meyer test, the 16-hole peg test, grip strength, the Action Research Arm Test, and the Motor Assessment Scale. Measurements of responsiveness were effect size, standardized response mean (SRM), and responsiveness ratio (RR). Relationships between the MAL and the other measures were determined with Spearman correlations.

Results.?The MAL is responsive to change, with effect size, SRM, and RR?>?1.0 at the 3-month follow-up, and SRM and RR?>?1.0 at post-intervention. Correlations at the separate test occasions between MAL and the other measures were mostly close to 0.50, which shows fair to moderate construct validity. Correlations between changes in MAL and in the other measures were weaker than cross-sectional relationships.

Conclusions.?The MAL is a responsive measure of daily hand use in patients participating in rehabilitation in the subacute phase after stroke. Correlations of construct validity indicate that daily hand use may need to be measured separately from body function and activity capacity, in line with the underlying constructs of International Classification of Functioning, Disability and Health. To strengthen our findings, they should be repeated in larger samples of patients.     

Assessments in Australian stroke rehabilitation units: a systematic review of the post-stroke validity of the most frequently used

Purpose.?In Australia, stroke is the leading cause of adult disability. For most stroke survivors, the recovery process is challenging, and in the first few weeks their recovery is supported with stroke rehabilitation services. Stroke clinicians are expected to apply an evidence-based approach to stroke rehabilitation and, in turn, use standardised and validated assessments to monitor stroke recovery. In 2008, the National Stroke Foundation conducted the first national audit of Australia's post acute stroke rehabilitation services and findings identified a vast array of assessments being used by clinicians. This study undertook a sub-analysis of the audit's assessment tools data with the aim of making clinically relevant recommendations concerning the validity of the most frequently selected assessments.

Method.?Data reduction ranked the most frequently selected assessments across a series of sub-categories. A serial systematic review of relevant literature using Medline and the Cumulative Index to Nursing and Allied Health Literature identified post-stroke validity ranking.

Results.?The study found that standardised and non-standardised assessments are currently in use in stroke rehabilitation. It recommends further research in the sub-categories of strength, visual acuity, dysphagia, continence and nutrition and found strengths in the sub-categories of balance and mobility, upper limb function and mood.

Conclusions.?This is the first study to map national usage of post-stroke assessments and review that usage against the evidence. It generates new knowledge concerning what assessments we currently use post stroke, what we should be using and makes some practical post stroke clinical recommendations.     

上肢康复机器人结合常规康复训练对急性期脑卒中患者上肢功能的疗效研究

目的:观察上肢康复机器人结合常规康复训练对急性期脑卒中患者上肢运动功能的改善情况。方法:将50例脑卒中患者随机分为对照组和观察组,对照组每天进行2次常规康复训练,观察组每天进行1次常规康复训练及1次上肢康复机器人训练,每周治疗5d,共4周,治疗前后分别用Fugl-Meyer(上肢部分,FMA-UE)、改良日常生活能力(MBI)、肩关节主动关节活动度评价康复效果。结果:治疗后,2组患者的FMA-UE、肩关节主动关节活动度和MBI评估均有明显提高(P0.05),上肢康复机器人结合常规康复训练组的FMA-UE和肩关节前屈、水平内收、水平外展主动关节活动度与对照组相比提高更加明显(P0.05)。结论:上肢康复机器人结合常规康复训练对急性期脑卒中患者上肢功能有明显改善作用。     

The reliability of the wolf motor function test for assessing upper extremity function after stroke

OBJECTIVE: To examine the reliability of the Wolf Motor Function Test (WMFT) for assessing upper extremity motor function in adults with hemiplegia. DESIGN: Interrater and test-retest reliability. SETTING: A clinical research laboratory at a university medical center. PATIENTS: A sample of convenience of 24 subjects with chronic hemiplegia (onset >1yr), showing moderate motor impairment. INTERVENTION: The WMFT includes 15 functional tasks. Performances were timed and rated by using a 6-point functional ability scale. The WMFT was administered to subjects twice with a 2-week interval between administrations. All test sessions were videotaped for scoring at a later time by blinded and trained experienced therapists. MAIN OUTCOME MEASURE: Interrater reliability was examined by using intraclass correlation coefficients and internal consistency by using Cronbach's alpha. RESULTS: Interrater reliability was.97 or greater for performance time and.88 or greater for functional ability. Internal consistency for test 1 was.92 for performance time and.92 for functional ability; for test 2, it was.86 for performance time and.92 for functional ability. Test-retest reliability was.90 for performance time and.95 for functional ability. Absolute scores for subjects were stable over the 2 test administrations. CONCLUSION: The WMFT is an instrument with high interrater reliability, internal consistency, test-retest reliability, and adequate stability.