Kautz Steven A, Duncan Pamela W, Perera Subashan, Neptune Richard R, Studenski Stephanie A
Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville FL, 32608, USA.
Neurorehabil Neural Repair. 2005 Sep;19(3):250-8. doi: 10.1177/1545968305279279.
Determine whether a rehabilitation program targeting functional motor recovery of persons with poststroke hemiparesis improved motor coordination.
A subgroup of 20 persons with poststroke hemiparesis (n = 11 in intervention and n =9 in control group) was investigated from within a larger randomized controlled single-blind clinical trial of 100 patients. Motor coordination was measured using a pedaling task, and subjects in the intervention group pedaled during an intensive broad-based home exercise program that targeted flexibility, strength, balance, and endurance. Coordination variables based on paretic leg pedal forces and EMG of 4 thigh muscles were measured while pedaling pre- and postintervention.
Despite extensive pedaling practice, up to 30 half-hour sessions that were progressively more intense, there was no effect (P > 0.05) of the intervention on percent of total work done by the paretic leg, quantitative measures of EMG, or pedaling speed. However, walking speed was improved and pedaling and walking faster were associated after the intervention.
There is no evidence of improved locomotor coordination postintervention. The increased walking and pedaling speed was likely achieved by a more proficient use of the same impaired pattern without EMG timing changes, likely because of increased strength and endurance postintervention. A more task-specific intervention may be required to improve coordination, consistent with principles of use-dependent plasticity.
确定一项针对中风后偏瘫患者功能运动恢复的康复计划是否能改善运动协调性。
从一项针对100名患者的大型随机对照单盲临床试验中选取了20名中风后偏瘫患者作为亚组（干预组11人，对照组9人）进行研究。使用蹬踏任务来测量运动协调性，干预组的受试者在一项以灵活性、力量、平衡和耐力为目标的强化基础广泛的家庭锻炼计划中进行蹬踏。在干预前后蹬踏过程中，测量基于患侧腿蹬踏力和4块大腿肌肉肌电图的协调性变量。
尽管进行了广泛的蹬踏练习，包括多达30次逐渐增加强度的半小时训练，但干预对患侧腿完成的总工作量百分比、肌电图的定量测量或蹬踏速度均无影响（P>0.05）。然而，干预后步行速度有所提高，且蹬踏和步行速度加快存在关联。
没有证据表明干预后运动协调性得到改善。步行和蹬踏速度的提高可能是通过更熟练地使用相同的受损模式而实现的，肌电图时间没有变化，这可能是由于干预后力量和耐力增加所致。可能需要一种更具任务针对性的干预措施来改善协调性，这与使用依赖可塑性的原则相一致。
