Department of Physiotherapy, Ergonomics, Prosthetics and Orthotics and Basics of Physiotherapy, University School of Physical Education, Katowice, Poland.
Clin Rehabil. 2010 Sep;24(9):810-21. doi: 10.1177/0269215510367561. Epub 2010 Jun 11.
Are Butler's neuromobilizations combined with proprioceptive neuromuscular facilitation and traditional post-stroke therapy more effective in reducing affected upper extremity sensory deficits in late-stage stroke subjects than proprioceptive neuromuscular facilitation combined with traditional therapy or traditional therapy alone?
Pretest-posttest three-group randomized clinical experimental design.
A total of 96 late-stage stroke subjects were randomly assigned to three groups.
The therapeutic programme in the control group was based on traditional post-stroke methods. The second group (experimental 1) received in addition individual therapy based on the proprioceptive neuromuscular facilitation method. The third group (experimental 2) received a combination: traditional therapeutic programme plus individual proprioceptive neuromuscular facilitation exercises plus neuromobilization of the affected upper extremity. All groups received 18 training sessions lasting about 45 minutes each.
Assessment of the two-point discriminatory sense (distance between the tips of the compass when the subject indicated two-point sensation), stereognosia (identification up to 10 objects by touch) and thermaesthesia (using hot and cold cylinders on dermatomes C6-C8) were performed.
Analysis of change scores showed that two-point discriminatory sense for experimental group 2 was significantly better than that in the two other groups (P<0.001). Similar results were registered for thermaesthesia (experimental 2 versus experimental 1 P<0.01; experimental 2 versus control P<0.001). For stereognosia the only significant difference was found between experimental group 2 and the control group (P<0.05).
In our subjects, application of Butler's neuromobilizations combined with proprioceptive neuromuscular facilitation showed greater effectiveness in reducing sensory deficits than proprioceptive neuromuscular facilitation or traditional therapy alone.
与本体感觉神经肌肉促进法和传统卒中后治疗相结合的巴特勒神经松动术是否比本体感觉神经肌肉促进法与传统治疗相结合或单独传统治疗更能有效降低晚期卒中患者患侧上肢感觉缺失？
前后测三群组随机临床试验设计。
共有 96 名晚期卒中患者被随机分配到三组。
对照组的治疗方案基于传统的卒中后方法。第二组（实验组 1）除了接受个体基于本体感觉神经肌肉促进法的治疗外，还接受治疗。第三组（实验组 2）接受联合治疗：传统治疗方案加上个体本体感觉神经肌肉促进练习加上患侧上肢的神经松动术。所有组均接受 18 次持续约 45 分钟的训练。
对两点辨别觉（当患者表示两点感觉时，指南针尖端之间的距离）、实体觉（通过触摸识别最多 10 个物体）和温度觉（在 C6-C8 皮节上使用热和冷圆柱体）进行评估。
变化分数分析表明，实验组 2 的两点辨别觉明显优于其他两组（P<0.001）。温度觉也出现了类似的结果（实验组 2 与实验组 1 比较 P<0.01；实验组 2 与对照组比较 P<0.001）。对于实体觉，仅在实验组 2 与对照组之间发现了显著差异（P<0.05）。
在我们的研究对象中，与本体感觉神经肌肉促进法联合应用的巴特勒神经松动术在降低感觉缺失方面比本体感觉神经肌肉促进法或单独传统治疗更有效。
