Wu Ching-yi, Lin Keh-chung, Chen Hsieh-ching, Chen I-hsuen, Hong Wei-hsien
Department of Occupational Therapy and Graduate Institute of Clinical Behavioral Science, Chang Gung University, Taoyuan, Taiwan.
Neurorehabil Neural Repair. 2007 Sep-Oct;21(5):460-6. doi: 10.1177/1545968307303411. Epub 2007 Jun 29.
Motor control of the upper extremity during unilateral and bimanual functional tasks and functional change during daily activities were evaluated in patients with stroke treated with modified constraint-induced movement therapy (mCIMT).
In a pre-post randomized, controlled trial, 30 stroke patients received 2 hours of mCIMT or traditional rehabilitation (TR) for 3 weeks. Motor control of the upper extremity was evaluated using kinematic analysis in unilateral and bilateral tasks. Kinematic variables included spatial and temporal movement efficiency and type of movement control (preplanned control, representing well-learned movement, or feedback-guided control). Functional outcomes were evaluated using the Motor Activity Log (MAL) and the Functional Independence Measure (FIM).
Patients receiving mCIMT showed more temporally (P = .013) and spatially (P = .011) efficient movement and more preplanned movement control (P = .009) during the bimanual task, and greater gains in FIM (P = .004) and MAL scores (amount of use: P < .0001, and quality of movement: P = .012) than patients in the TR group. Patients receiving mCIMT produced more ballistic/preplanned reaching movement than did patients receiving TR (P = .023) during the unilateral task; but there were no group differences in temporal or spatial efficiency in unilateral task performance.
Relative to TR, mCIMT produced a greater improvement in functional performance and motor control. Improvement of motor control after mCIMT was based on improved spatial and temporal efficiency, apparently more salient during bimanual rather than unilateral task performance. This suggests that bilateral task performance should potentially be emphasized in kinematic study of changes in motor control after mCIMT.
对接受改良强制性运动疗法（mCIMT）治疗的中风患者在单侧和双侧功能任务期间的上肢运动控制以及日常活动中的功能变化进行评估。
在一项前后对照的随机对照试验中，30名中风患者接受了为期3周、每周2小时的mCIMT或传统康复治疗（TR）。使用运动学分析评估上肢在单侧和双侧任务中的运动控制。运动学变量包括空间和时间运动效率以及运动控制类型（预计划控制，代表熟练掌握的运动，或反馈引导控制）。使用运动活动日志（MAL）和功能独立性测量（FIM）评估功能结果。
与TR组患者相比，接受mCIMT的患者在双侧任务期间表现出更高效的时间（P = .013）和空间（P = .011）运动以及更多的预计划运动控制（P = .009），FIM（P = .004）和MAL评分（使用量：P < .0001，运动质量：P = .012）的改善更大。在单侧任务期间，接受mCIMT的患者比接受TR的患者产生更多的弹道式/预计划伸展运动（P = .023）；但在单侧任务表现的时间或空间效率方面没有组间差异。
相对于TR，mCIMT在功能表现和运动控制方面有更大改善。mCIMT后运动控制的改善基于空间和时间效率的提高，在双侧任务表现中比单侧任务表现更明显。这表明在mCIMT后运动控制变化的运动学研究中可能应强调双侧任务表现。
