Wolf Steven L, Newton Heather, Maddy Douglas, Blanton Sarah, Zhang Qin, Winstein Carolee J, Morris David M, Light Kathye
Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA 30322, USA.
Restor Neurol Neurosci. 2007;25(5-6):549-62.
To examine the relationship between change scores on the log mean Wolf Motor Function Test (lmWMFT) and the intensity of supervised Constraint Induced Movement Therapy (CIMT) in participants with subacute and chronic stroke.
A retrospective analysis of data from 169 EXCITE participants who received CIMT either immediately after randomization or one year later was undertaken. During waking hours, participants wore a restraining mitt on the less affected extremity. The lmWMFT was administered before and after the two week treatment block.
Significant relationships were seen between the intensity of training and functional score in the immediate, lower functional group for whom more training in adaptive task practice resulted in poorer outcomes (p=0.01) and in the immediate, higher functioning group for whom more training in repetitive task practice resulted in poorer outcomes (p=0.02). Female participants in the immediate group showed less progress in lmWMFT scores with greater amounts of total training (p=0.01). Functional level, gender, and concordance did not modify any other relationship. Both higher functioning participants who trained within the normal ratio (N=50) and who were exposed to more than the prescribed adaptive task practice (N=11) experienced a significant improvement in the lmWMFT score (p=0.03 and p=0.02, respectively) compared to those higher functioning participants who experienced excessive repetitive task practice.
Applying CIMT to a large sample of participants with stroke resulted in directionally inappropriate but significant relationships between intensity and lmWMFT scores in the immediate but not the delayed group. Our data also suggest that functional improvements observed in the EXCITE Trial might be attributable to training components other than the designated ratio of training approaches (adaptive and repetitive task practice).
探讨亚急性和慢性卒中患者在对数平均沃尔夫运动功能测试（lmWMFT）中的变化分数与强化约束诱导运动疗法（CIMT）强度之间的关系。
对169名EXCITE研究参与者的数据进行回顾性分析，这些参与者在随机分组后立即或一年后接受了CIMT治疗。在清醒时间里，参与者在受影响较小的肢体上佩戴限制手套。在为期两周的治疗阶段前后分别进行lmWMFT测试。
在即时治疗的、功能较低的组中，适应性任务练习训练量越大，结果越差（p = 0.01）；在即时治疗的、功能较高的组中，重复性任务练习训练量越大，结果越差（p = 0.02），训练强度与功能评分之间存在显著关系。即时治疗组中的女性参与者在lmWMFT评分上随着总训练量的增加进展较小（p = 0.01）。功能水平、性别和一致性并未改变任何其他关系。与经历过多重复性任务练习的高功能参与者相比，按照正常比例训练的高功能参与者（N = 50）以及接受了超过规定的适应性任务练习的高功能参与者（N = 11）在lmWMFT评分上均有显著改善（分别为p = 0.03和p = 0.02）。
对大量卒中患者应用CIMT，在即时治疗组而非延迟治疗组中，训练强度与lmWMFT评分之间呈现出方向不当但显著的关系。我们的数据还表明，EXCITE试验中观察到的功能改善可能归因于训练方法指定比例（适应性和重复性任务练习）之外的训练组成部分。
