Bravi Lori, Stoykov Mary Ellen
Rehabilitation Institute of Chicago, Northwestern University Sensory Motor Performance Program, Chicago, Illinois, USA.
Top Stroke Rehabil. 2007 Nov-Dec;14(6):68-73. doi: 10.1310/tsr1406-68.
Chronic upper extremity hemiparesis following stroke is a significant impairment that can limit a person's independence in all aspects of ADL, IADL, and functional mobility. Although recovery of functional independence may be more efficient using traditional compensatory techniques, these therapeutic methods often do not encourage integration of the hemiparetic arm and hand. In contrast, the task-oriented approach to motor recovery of poststroke hemiparesis emphasizes integration of the impaired limb into all functional tasks via skill-based training. Cortical changes have been documented following skill-based training of the upper limb in the healthy animal model. Additionally, the combination of subthreshold cortical stimulation combined with skill-based forelimb training in the induced-stroke rat model has demonstrated better outcomes than training alone. Preliminary research with human stroke survivors using task-oriented training and subthreshold cortical stimulation has shown promising results. The purpose of this article is to introduce an upper limb training protocol that was used in a national multisite trial that compares cortical stimulation in conjunction with taskoriented training to training alone.
中风后慢性上肢偏瘫是一种严重的功能障碍，会限制患者在日常生活活动（ADL）、工具性日常生活活动（IADL）以及功能移动性等各方面的独立性。虽然使用传统的代偿技术恢复功能独立性可能更有效，但这些治疗方法往往无法促进偏瘫侧手臂和手部的整合。相比之下，针对中风后偏瘫运动恢复的任务导向方法强调通过基于技能的训练，将受损肢体整合到所有功能任务中。在健康动物模型中，对上肢进行基于技能的训练后，已记录到皮质变化。此外，在诱导性中风大鼠模型中，阈下皮质刺激与基于技能的前肢训练相结合，已证明比单独训练有更好的效果。对人类中风幸存者进行的以任务为导向的训练和阈下皮质刺激的初步研究已显示出有前景的结果。本文的目的是介绍一种上肢训练方案，该方案用于一项全国多中心试验，该试验将皮质刺激与任务导向训练相结合与单独训练进行比较。
