Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands.
Clin Rehabil. 2011 Jun;25(6):487-500. doi: 10.1177/0269215510391285. Epub 2011 Mar 14.
Post-stroke fatigue is a common and debilitating complaint, which has only recently received attention in clinical rehabilitation. Until now, no evidence-based treatments have been available for the condition. Therefore, a new treatment was designed to reduce post-stroke fatigue complaints: Cognitive and Graded Activity Training (COGRAT).
Following the premise that post-stroke fatigue is primarily caused by brain damage, the treatment aims to prevent fatigue and to manage existing fatigue symptoms. The purpose of the added graded activity programme is to reduce fatigue by changing cognitions and enhancing physical fitness.
COGRAT consists of a cognitive treatment and graded activity programme in small groups over 12 weeks. In the cognitive treatment, patients receive education on post-stroke fatigue and register their activities and fatigue to gain insight into their daily agenda and fatigability. Patients are then taught several compensation strategies. Cognitive behavioural therapy is used to diminish anxiety, facilitate behavioural change and manage fatigue symptoms. The graded activity programme consists of walking on a treadmill, strength training and home work assignments. Maximum heart rate and strength are increased from 40% at the beginning of the training to a maximum of 70%.
COGRAT is currently being evaluated in outpatients with severe post-stroke fatigue in a multicentre randomized controlled trial. Preliminary data suggest both positive short- and long-term effects. Adaptations for other neurological patient groups suffering from fatigue are suggested.
中风后疲劳是一种常见且使人虚弱的症状，直到最近才在临床康复中受到关注。迄今为止，这种疾病还没有有效的治疗方法。因此，设计了一种新的治疗方法来减轻中风后疲劳的抱怨：认知和分级活动训练（COGRAT）。
基于中风后疲劳主要是由大脑损伤引起的前提，该治疗旨在预防疲劳和管理现有的疲劳症状。附加的分级活动计划的目的是通过改变认知和增强身体适应性来减轻疲劳。
COGRAT 包括认知治疗和 12 周内的小组分级活动计划。在认知治疗中，患者接受关于中风后疲劳的教育，并记录他们的活动和疲劳情况，以了解他们的日常日程安排和疲劳程度。然后，患者会学习几种补偿策略。认知行为疗法用于减轻焦虑、促进行为改变和管理疲劳症状。分级活动计划包括在跑步机上行走、力量训练和家庭作业。从训练开始时的最大心率和力量的 40%逐渐增加到 70%的最大值。
COGRAT 目前正在一项多中心随机对照试验中对患有严重中风后疲劳的门诊患者进行评估。初步数据表明短期和长期效果均为阳性。建议为患有疲劳的其他神经科患者群体进行适应性调整。
