中风幸存者边做边说：中风后手功能继续康复的治疗框架的发展。
Stroke survivors talk while doing: development of a therapeutic framework for continued rehabilitation of hand function post stroke.
机构信息
Southside Hospital - North Shore Long Island Jewish, 301 East Main Street, Bay Shore, NY 11706, USA.
出版信息
J Hand Ther. 2013 Apr-Jun;26(2):124-30; quiz 131. doi: 10.1016/j.jht.2012.08.002. Epub 2012 Oct 13.
STUDY DESIGN
Qualitative study to identify themes and explore mechanisms underlying recovery of hand function post stroke for individuals discharged from rehabilitation services.
PURPOSE OF THE STUDY
Post-stroke hemiparesis frequently results in persistent hand dysfunction; the mechanisms of functional recovery are however poorly understood. We assessed the perspectives of community-dwelling individuals with chronic stroke on their hand function limitations and recovery to explore the feasibility of developing a theoretical framework for understanding the process of continued post-stroke recovery.
METHODS
Eight subjects with chronic post-stroke hemiparesis were interviewed and videotaped while they performed a battery of 20 upper limb tasks. Qualitative analysis consisted of two investigators independently reviewing the videotapes and reading the transcribed conversations, identifying significant issues and then comparing their observations to determine common themes and develop emerging concepts.
RESULTS
Four core themes pertaining to impairment and recovery of task-specific ability emerged: 1) spasticity can be overcome actively through task-specific attempts to use the affected arm and hand; 2) use of the affected arm can be facilitated by adopting positions that reduce the effect of gravity on the arm or enable gravity to act as a natural assist in the movement; 3) task-specific skill can be attained by repeatedly attempting specific component movements of tasks in the context of a variety of different tasks; and 4) frustration impedes task performance but a mental state of 'detached focus' can improve the motivation to use the affected arm.
CONCLUSIONS
These themes suggest a therapeutic framework for continued upper limb rehabilitation in patients' own environment to maximize functional recovery in individuals long after their stroke, and generate hypotheses which may lead to the development of new therapeutic protocols.
LEVEL OF EVIDENCE
NA.
研究设计
定性研究，旨在确定从康复服务出院的中风个体手部功能恢复的主题和探索机制。
研究目的
中风后偏瘫常导致手部持续功能障碍；然而，其功能恢复的机制尚不清楚。我们评估了社区居住的慢性中风个体对手部功能限制和恢复的看法，以探索为理解中风后持续恢复过程制定理论框架的可行性。
方法
对 8 名慢性中风偏瘫患者进行访谈和录像，同时进行 20 项上肢任务的测试。定性分析由两名研究人员独立审查录像带和阅读转录的对话，确定重要问题，然后比较他们的观察结果，以确定共同主题和发展新兴概念。
结果
出现了与特定任务能力的损伤和恢复相关的四个核心主题：1）通过主动尝试使用受影响的手臂和手进行特定任务的活动，可以克服痉挛；2）通过采用减少手臂重力影响或使重力成为运动自然辅助的姿势，可以促进受影响手臂的使用；3）可以通过在各种不同任务的背景下重复尝试特定任务的特定组件运动来获得特定任务的技能；4）挫折会阻碍任务表现，但“超然专注”的心理状态可以提高使用受影响手臂的动力。
结论
这些主题为在患者自己的环境中继续进行上肢康复治疗提供了一个治疗框架，以最大限度地提高中风后个体的功能恢复，并提出了可能导致新治疗方案发展的假设。
证据水平
无。
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