Butler Andrew, Blanton Sarah, Rowe Veronica, Wolf Steven
Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA.
J Neurol Phys Ther. 2006 Sep;30(3):148-56. doi: 10.1097/01.npt.0000281952.93934.6b.
The Functional Tone Management (FTM) arm training program uses repetitive task practice, stretching, and electrical stimulation as patients with moderate upper extremity hemiparesis wear a dynamic hand orthosis to retrain grasp and release of objects. The case study quantitatively evaluates the extent to which FTM training improved function and quality of life in a patient who met criteria for which the device was intended.
The participant, a 44-year-old male in the chronic stage of stroke recovery with moderate right upper extremity motor impairment, was trained for 10 days over a 2-week period by a licensed clinician with extensive experience in FTM training methods. Measurements were taken over 3 baseline visits, then immediately preintervention, postintervention, and at a 3-month follow-up. The outcome measures, following the International Classification of Functioning, Disability, and Health (ICF) Model, included the: Fugl-Meyer assessment (FMA) (upper extremity portion), UE range of motion (ROM), Modified Ashworth scale, Wolf Motor Function Test (WMFT), and the Motor Activity Log (MAL). Health related quality of life was measured using the Stroke Impact Scale (SIS).
The participant showed limited gains in upper extremity function immediately postintervention. Increases in AROM occurred in forearm supination and wrist flexion and extension, but no improvements were noted in finger ROM. A slight decrease in tone was found in forearm pronators (1 to 0) and wrist flexors (1+ to 1). WMFT values for the more affected upper extremity did not change immediately after training, but a 17% reduction in time occurred at follow-up, with improvements, most notably in the tasks of lifting a pencil and lifting a paper clip. No changes occurred in UE-FMA scores immediately following the intervention, however, a 17% improvement was measured at followup. A slight improvement in MAL scores was noted but not to a level of independent functional use of the impaired upper extremity. SIS scores improved in the domains of strength, communication, mobility, social participation, hand recovery, and overall physical component, while decreases were seen in the ADL/IADL, hand function, emotion, and cognitive domains.
The case study indicates that for this patient with chronic, moderate upper extremity impairment following stroke, a 2-week FTM training regimen resulted in modest changes occurring as a decrease in impairment, with functional improvement and improved quality of life. Further investigation of the innovative training program should be undertaken before the efficacy of its use can be ascertained amongst patients with limitations comparable to the participant.
功能张力管理（FTM）上肢训练计划采用重复性任务练习、伸展和电刺激，同时中度上肢偏瘫患者佩戴动态手部矫形器以重新训练抓握和松开物体的能力。本案例研究定量评估了FTM训练对一名符合该设备适用标准的患者的功能和生活质量改善程度。
参与者是一名44岁男性，处于中风恢复慢性期，右上肢存在中度运动障碍，由一位在FTM训练方法方面经验丰富的持牌临床医生在两周内进行了10天的训练。在3次基线访视时进行测量，然后在干预前、干预后以及3个月随访时立即测量。按照国际功能、残疾和健康分类（ICF）模型，结果测量指标包括：Fugl-Meyer评估（FMA）（上肢部分）、上肢活动范围（ROM）、改良Ashworth量表、Wolf运动功能测试（WMFT）以及运动活动日志（MAL）。使用中风影响量表（SIS）测量与健康相关的生活质量。
干预后立即，参与者在上肢功能方面有有限的改善。主动活动范围（AROM）在前臂旋后、腕关节屈伸方面有所增加，但手指ROM未见改善。在前臂旋前肌（从1级降至0级）和腕屈肌（从1+级降至1级）发现肌张力略有下降。训练后，受影响更严重的上肢的WMFT值没有立即改变，但在随访时时间减少了17%，在拿起铅笔和拿起回形针等任务中有明显改善。干预后立即，上肢FMA评分没有变化，但在随访时提高了17%。MAL评分有轻微改善，但未达到受损上肢独立功能使用的水平。SIS评分在力量、沟通、活动能力、社会参与、手部恢复和整体身体成分等领域有所改善，而在日常生活活动/工具性日常生活活动、手部功能、情绪和认知领域则有所下降。
该案例研究表明，对于这名中风后慢性中度上肢损伤的患者，为期两周的FTM训练方案导致了适度的变化，表现为损伤减轻、功能改善和生活质量提高。在确定该创新训练方案在与参与者情况类似的有局限性的患者中的疗效之前，应进一步对其进行研究。
