作业疗法对脑卒中患者上肢运动功能的影响

目的：比较两种不同的康复治疗技术对存在有上肢运动功能障碍的脑卒中患者的治疗作用。方法：40例脑卒中患者随机分为作业组和对照组各20例,均配合运动疗法,包括主被动运动,运动想象等。作业组增加作业疗法,主要内容为上肢控制能力、关节活动度及精细动作训练。训练前及训练2、4、6及8周时均采用Fugl-Meyer评定量表（FMA）对2组患者上肢运动功能评分。结果：与训练前比较,作业组在介入训练2周后FMA评分持续上升,8周〉4周〉2周;对照组在训练4周后FMA评分开始上升,作业组在各训练时间段FMA评分均高于对照组（均P〈0.05,0.01）。结论：早期介入作业疗法对脑卒中偏瘫患者上肢运动功能的恢复有积极影响。     

Recovery of Patients with a Combined Motor and Proprioception Deficit During the First Six Weeks of Post Stroke Rehabilitation

The objective of this study was to characterize (1) the severity of the proprioception deficit in the affected upper extremity on admission to rehabilitation and (2) the motor and functional recovery during the first six weeks of rehabilitation. Twenty patients who had sustained a hemispheric cerebral vascular accident (CVA) and had a proprioception deficit in addition to a motor deficit of their upper extremity participated in the study. Subjects were assessed for propriocep-tion loss and motor ability of the upper extremity four times (weeks 0, 2, 4, and 6) and for functional ability of the upper extremity and BADL (Basic Activities of Daily Living) on admission and after six weeks. On admission, eight of the patients suffered from a severe deficit, eight patients suffered from a moderate deficit, and four suffered from a mild deficit. By week 6, five patients had improved to the point where no deficit was discerned. Only two patients retained a severe deficit, whereas the remaining 13 patients retained moderate or mild deficits. In addition a significant improvement in the motor and functional ability of the upper extremity was found. Familiarity with these facts should help the clinician to establish more realistic therapeutic goals and to anticipate with greater accuracy the eventual treatment outcome.     

强制运动疗法对脑卒中亚急性期上肢运动功能的影响

目的 评估强制运动疗法(CIMT)对脑卒中后亚急性期患者上肢运动功能的疗效.方法 选择上海市残疾人康复职业培训中心和南通大学附属医院康复医学科收治的脑卒中偏瘫患者63例,按入院先后时间分为治疗组(32例)和对照组(31例),均接受2周的常规康复训练.然后,对照组继续常规康复训练,治疗组接受2周的CIMT治疗.两组均在治...     

强制性运动疗法对脑卒中后上肢运动障碍的影响

目的研究强制性运动疗法(CIMT)对脑卒中后上肢运动功能康复的效果。方法28例符合CIMT适应症的脑卒中患者分成两组:观察组限制健手的使用,强化训练患侧上肢(CIMT);对照组不限制健手的使用,进行传统神经发育疗法治疗。治疗前后评价两组的Fugl-Meyer上肢运动功能评分。结果Fugl-Meyer评分显示,治疗前后相比有显著性差异(P0.05)。在提高上肢灵活性和上肢的使用方面,观察组与对照组间有显著性差异(P0.05)。结论CIMT能加强脑卒中患者上肢运动功能和日常生活能力的改善。     

改制强制性运动疗法对脑卒中上肢运动功能的影响

目的研究改制的强制性运动疗法(mCIMT)对脑卒中偏瘫患者上肢运动功能障碍的疗效。方法选取脑卒中偏瘫患者30例,分成mCIMT组和对照组,每组15例。mCIMT组不限制健手的使用,患肢接受重复、密集的行为再塑的技术强化训练,6 h/d,5 d/周,连续训练2周。对照组采用常规治疗方法进行训练。疗效评测使用运动活动日志(MAL)和简易上肢功能检查(STEF),分别于治疗前、治疗后2周、1个月和3个月进行疗效评定。结果两组治疗2周后MAL指数和STEF分数均明显高于治疗前(P<0-01);mCIMT组在治疗结束1个月和3个月的MAL指数和STEF分数较治疗前均明显提高(P<0-01);治疗组与对照组疗效比较有显著性差异(P<0-05);对照组治疗后1和3个月的MAL指数和STEF分数与治疗前比较均无显著性差异(P>0-05)。结论mCIMT能显著提高脑卒中偏瘫患者的上肢运动功能,其疗效明显优于常规康复方法。     

促进技术与作业疗法对中风患者肢体运动功能的影响

对30例中风患者采用促进技术及作业疗法进行治疗，并采用Fugl-Meyer法评测运动功能。结果表明：治疗后肢体运动功能明显改善；随年龄增长，功能积分逐渐下降；发病至开始治疗时间在半年以内患者功能改善明显，半年以后患者有改善。说明促进技术与作业疗法可改善中风患者的肢体运动功能．     

低频重复经颅磁刺激结合作业疗法对卒中患者 上肢功能恢复的疗效

目的:探究低频重复经颅磁刺激(r TMS)结合作业疗法(OT)治疗后卒中患者的上肢痉挛和运动功能的变化。方法:选择卒中后伴上肢偏瘫患者47例,按Brunnstrom分期量表分为3期组(12例)、4期组(15例)、5期组(20例),进行低频r TMS结合OT治疗15 d。在治疗前、治疗后及30 d随访时对受影响的上肢痉挛和运动功能进行评估。结果:所有患者治疗后及30 d后随访发现MAS评分和WMFT评分明显下降(P<0.01),FMA评分明显提高(P<0.01),4期组最明显。同时发现偏瘫上肢痉挛改善的患者较未改善的患者上肢运动功能提高更明显。结论:卒中后伴有上肢偏瘫的患者经低频r TMS结合OT治疗15 d后可明显改善受损上肢的偏瘫和运动功能,其中Brunnstrom偏瘫分期为4期的患者受益最明显。且改善受损上肢的痉挛症状有助于提高其运动功能。     

Occupational Performance Coaching adapted for Stroke Survivors (OPC-Stroke): A Feasibility Evaluation

ABSTRACT

Background: The majority of stroke survivors experience participation restrictions, that is problems with meaningful involvement in life situations. Effective interventions to promote participation following stroke are needed. Purpose: The purpose of this study was to examine the acceptability, potential effectiveness, and essential elements of Occupational Performance Coaching adapted for stroke survivors (OPC-Stroke). Methods: A case study approach was used. Four participants were recruited to receive OPC-Stroke. Outcome measures were administered pre and postintervention. Semistructured interviews were conducted postintervention to explore participants’ experiences of OPC-Stroke. Results: Two participants reported improvements in goal performance, goal satisfaction, and overall participation. Two participants appeared to have difficulty understanding the approach and withdrew from the study. Conclusion: OPC-Stroke was feasible to deliver and shows promise as an intervention for improving participation following stroke. Further research is needed to determine the effectiveness of OPC-Stroke and characteristics of stroke survivors who may benefit most from this intervention.     

Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized Crossover Trial

Objective

We investigated the treatment effects of a home-based rehabilitation program compared with clinic-based rehabilitation in patients with stroke.

不同上肢限制法对脑卒中偏侧肘屈肌活跃性和平衡的影响

目的 观察偏瘫上肢施加不同的限制方法,在站立位姿势维持及常速步行中,对偏瘫上肢肘屈肌活跃性和平衡稳定的即刻效应.方法 2018年9月至12月,南京医科大学附属苏州科技城医院住院或门诊治疗的脑卒中患者14例,分别于无限制、肘伸直型支具固定、健手辅助患侧上肢伸直于身后、健手辅助患侧肩前屈90°4种条件下,采用无线表面肌电设...     

Virtual Reality for Upper Limb Rehabilitation in Subacute and Chronic Stroke: A Randomized Controlled Trial

Objective

To evaluate the effectiveness of reinforced feedback in virtual environment (RFVE) treatment combined with conventional rehabilitation (CR) in comparison with CR alone, and to study whether changes are related to stroke etiology (ie, ischemic, hemorrhagic).

Electroacupuncture for Poststroke Spasticity: Results of a Pilot Pragmatic Randomized Controlled Trial

ContextPeople with spasticity that occurred between 30 days and one year after stroke onset with a baseline Modified Ashworth Scale (MAS) ≥1.ObjectivesTo determine the practicality of a pragmatic parallel-group open-labeled randomized controlled trial and to collect preliminary data of effectiveness and safety of electroacupuncture (EA) for poststroke spasticity.MethodsEligible participants were randomly allocated to the intervention group (EA plus usual care) or the control group (usual care alone) at a 1:1 ratio with block sizes of six. Participants received EA three times a week for four weeks, then were followed up for another four weeks. Participants' retention and adherence in the trial were assessed to determine the practicality of trial design. Clinical outcome measures were the change scores of MAS, Fugl-Meyer Assessment of motor performance and Barthel Index, and adverse events.ResultsSeventy-two people were screened for eligibility, and 30 of them were recruited and randomized. At the end, 25 participants followed the trial protocol and were included in our final data analyses using an intention-to-treat approach. No significant between-group difference was detected for the change scores of MAS, Fugl-Meyer Assessment, or Barthel Index at the end of treatment or end of follow-up. Eighteen participants reported 37 adverse events, but none of the participants was deemed related to EA.ConclusionIt is feasible to conduct a full-scale trial to precisely evaluate the effectiveness and safety of EA for treating poststroke spasticity; however, longer treatment and follow-up phases should be considered in the full-scale trial.     

Occupation-Based Strategy Training for Adults With Traumatic Brain Injury: A Pilot Study

Objective

To evaluate, before undertaking a larger trial, feasibility of the study processes to determine the effectiveness of occupation-based strategy training for producing changes on trained real-world behaviors, and to determine whether far transfer of training effects to measures of real-world impact, including participation in everyday life, could be achieved.

Design

Partially randomized controlled trial with pre- and postintervention assessments done by assessors masked to the treatment arm.

Setting

Testing occurred at a research institute, interventions at participants' homes.

Participants

People (N=13) with chronic traumatic brain injury (TBI), 7 in the experimental group (mean age, 42.6y; mean time post-TBI, 9.8y; 4 men) and 6 in the control arm (mean age, 40.5y; mean time post-TBI, 10.8y; 3 men), were assessed immediately before and after the intervention phase.

Intervention

Occupation-based strategy training, an adapted version of the Cognitive Orientation to daily Occupational Performance (CO-OP), was provided in two 1-hour sessions per week for 10 weeks.

Main Outcome Measures

Canadian Occupational Performance Measure, Dysexecutive Questionnaire, Mayo-Portland Adaptability Inventory-4 Participation Index, and Assessment of Motor and Process Skills.

Results

The study processes (testing and intervention) were acceptable to all participants. Evidence of far transfer was found as the experimental group improved significantly more than the control group on performance and satisfaction with performance ratings on untrained goals (P<.05), and reported increased levels of participation (P<.01).

Conclusions

Findings must be interpreted with caution since the sample is small and comparisons are made with a no-treatment control. Nevertheless, they suggest that the training is feasible and a larger trial warranted.     

急性脑梗死针刺与运动疗法对上肢运动功能的影响

目的：探讨急性脑梗死早期针刺及运动疗法后上肢运动功能恢复的程度及与其功能性活动的关系。方法：132例首发脑梗死偏瘫患者分为综合组和对照组各66例，均按神经内科常规处理，并进行运动疗法，综合组同时按照中医辩证法对患者上肢施以针刺。结果：治疗2月后，上肢运动功能积分．患腕主动活动范围．功能独立性评定量表中进食、梳洗、穿脱上衣等评分与治疗前比较，2组均提高（P〈0．05），综合组各项评分明显优于对照组（P〈0．05）。结论：脑梗死患者早期采用综合疗法可以明显促进日常生活能力的最大程度恢复，对患者预后有良好的影响。     

Effect of a Novel Perturbation-Based Pinch Task Training on Sensorimotor Performance of Upper Extremity for Patients With Chronic Stroke: A Pilot Randomized Controlled Trial

ObjectiveTo investigate the effects of perturbation-based pinch task training on the sensorimotor performance of the upper extremities of patients with chronic stroke via a novel vibrotactile therapy system.DesignA single-blinded randomized controlled trial.SettingA university hospital.ParticipantsPatients with chronic stroke (N=19) randomly assigned into either an experimental group or a control group completed the study.InterventionsIn addition to 10 minutes of traditional sensorimotor facilitation, each participant in the experimental group received 20 minutes of perturbation-based pinch task training in each treatment session, and the controls received 20 minutes of task-specific motor training twice a week for 6 weeks.Main Outcome MeasuresThe scores for the primary outcome, Semmes-Weinstein monofilament (SWM), and those for the secondary outcomes, Fugl-Meyer Assessment (FMA), amount of use, quality of movement (QOM) on the Motor Activity Log (MAL) scale, and box and block test (BBT), were recorded. All outcome measures were recorded at pretreatment, post treatment, and 12-week follow-up.ResultsThere were statistically significant between-group differences in the training-induced improvements revealed in the SWM results (P=.04) immediately after training and in the BBT results (P=.05) at the 12-week follow-up. The changes in muscle tone and in the QOM, SWM, and BBT scores indicated statistically significant improvements after 12 sessions of treatment for the experimental group. For the control group, a significant statistical improvement was found in the wrist (P<.001) and coordination (P=.01) component of the FMA score.ConclusionsThis study indicated that the perturbation-based pinch task training has beneficial effects on sensory restoration of the affected thumb in patients with chronic stroke.     

阴极经颅直流电刺激改善脑卒中患者上肢功能障碍的系统评价

目的系统评价阴极经颅直流电刺激(c-tDCS)对脑卒中患者上肢功能障碍的康复效果。方法计算机检索Cochrane Central Register of Controlled Trials、PubMed、EMbase、Web of Science、Ovid、中国生物医学文献、中国知网、万方数据和维普数据库中关于c-tDCS改善脑卒中患者上肢功能障碍的随机对照试验,同时检索已纳入文献的参考文献。检索时间从建库至2013 年7 月。2 名独立的研究人员依据Cochrane 协作网推荐的偏倚风险评估方法,对纳入文献的质量进行严格评估及资料提取,对符合标准的随机对照试验进行Meta 合并分析。统计分析采用RevMan 5.1 软件。结果共纳入10 篇。Meta 分析显示,c-tDCS作用于病灶侧初级运动区后,患者的Fugl-Meyer 运动功能量表上肢部分评分与假刺激组相比,差异无统计学意义[WMD=0.11, 95%CI: -5.77~5.99, Z=0.04, P=0.97],c-tDCS 作用于病灶侧初级运动区对患者Jebsen 手功能的作用效果与假刺激组相比,差异无统计学意义[WMD=-1.52, 95%CI: -4.94~1.90, Z=0.87, P=0.38 ]。纳入文献质量的Jadad 评分,低质量2 篇,高质量8 篇。结论目前,没有证据显示c-tDCS比假刺激更有效地改善脑卒中患者上肢运动功能障碍。