Department of Physical Medicine and Rehabilitation, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
J Stroke Cerebrovasc Dis. 2012 Nov;21(8):767-75. doi: 10.1016/j.jstrokecerebrovasdis.2011.04.004. Epub 2011 May 18.
Constraint-induced movement therapy (CI therapy) is a rehabilitation treatment that is effective for improving upper extremity function in patients with stroke hemiparesis. In standard protocols, the burdens are great on the patient, therapist, and in terms of health care costs, preventing the wider application of CI therapy. To address this, we developed a protocol based on self-training and examined its effects.
Patients with chronic hemiparesis caused by a stroke (intracerebral hemorrhage or cerebral infarct) 180 days after disease onset were included in this study. We performed before and after comparisons after intervention. We assessed motor impairment in the shoulder, elbow, forearm, wrist, and hand with the Fugl-Meyer Assessment (FMA) and determined training tasks, taking into consideration the patient's primary complaint. We established direct supervision by the therapist and self-training to occupy 40% and 60% of the training period, respectively. With this protocol, training was conducted 5 hours per day for 10 consecutive weekdays. We assessed upper extremity function using the FMA, Wolf Motor Function Test (WMFT), and Motricity Index (MI) before and after intervention.
There were 40 subjects. Before and after intervention, scores for the FMA upper extremity items, WMFT functional ability scale, WMFT performance times, and MI showed significant improvements, from 49.35 ± 10.1 (mean ± SD) to 52.88 ± 8.0 points, 3.48 ± 0.65 to 3.72 ± 0.67 points, 14.37 ± 13.22 to 10.58 ± 11.97 seconds, and 75.0 ± 12.0 to 77.7 ± 12.0 points, respectively.
Our self-training-based CI therapy protocol is likely to be as effective for improving upper extremity function as the standard CI therapy. The method may contribute to the wider use of CI therapy.
强制性运动疗法（CI 疗法）是一种康复治疗方法，可有效改善脑卒中偏瘫患者的上肢功能。在标准方案中，患者、治疗师和医疗保健成本的负担都很大，这限制了 CI 疗法的广泛应用。为了解决这个问题，我们开发了一种基于自我训练的方案，并研究了其效果。
本研究纳入了发病后 180 天的慢性脑卒中偏瘫患者。我们在干预前后进行了比较。我们使用 Fugl-Meyer 评估（FMA）评估肩部、肘部、前臂、手腕和手部的运动障碍，并根据患者的主要抱怨确定训练任务。我们建立了治疗师的直接监督和自我训练，分别占训练期的 40%和 60%。按照该方案，每天训练 5 小时，连续 10 个工作日。我们在干预前后使用 FMA、Wolf 运动功能测试（WMFT）和运动指数（MI）评估上肢功能。
共有 40 名患者。干预前后，FMA 上肢项目、WMFT 功能能力量表、WMFT 运动时间和 MI 评分均显著提高，分别从 49.35±10.1（均数±标准差）提高至 52.88±8.0 分、3.48±0.65 提高至 3.72±0.67 分、14.37±13.22 提高至 10.58±11.97 秒、75.0±12.0 提高至 77.7±12.0 分。
我们的基于自我训练的 CI 疗法方案可能与标准 CI 疗法一样有效改善上肢功能。该方法可能有助于更广泛地应用 CI 疗法。
