Brain Rehabilitation R&D Center (151A), Malcolm Randall VA Medical Center, 1601 SW Archer Rd, Gainesville, FL 32608, USA.
J Neuroeng Rehabil. 2013 Jan 21;10:1. doi: 10.1186/1743-0003-10-1.
Repetitive task practice is argued to drive neural plasticity following stroke. However, current evidence reveals that hemiparetic weakness impairs the capacity to perform, and practice, movements appropriately. Here we investigated how power training (i.e., high-intensity, dynamic resistance training) affects recovery of upper-extremity motor function post-stroke. We hypothesized that power training, as a component of upper-extremity rehabilitation, would promote greater functional gains than functional task practice without deleterious consequences.
Nineteen chronic hemiparetic individuals were studied using a crossover design. All participants received both functional task practice (FTP) and HYBRID (combined FTP and power training) in random order. Blinded evaluations performed at baseline, following each intervention block and 6-months post-intervention included: Wolf Motor Function Test (WMFT-FAS, Primary Outcome), upper-extremity Fugl-Meyer Motor Assessment, Ashworth Scale, and Functional Independence Measure. Neuromechanical function was evaluated using isometric and dynamic joint torques and concurrent agonist EMG. Biceps stretch reflex responses were evaluated using passive elbow stretches ranging from 60 to 180º/s and determining: EMG onset position threshold, burst duration, burst intensity and passive torque at each speed.
Improvements in WMFT-FAS were significantly greater following HYBRID vs. FTP (p = .049), regardless of treatment order. These functional improvements were retained 6-months post-intervention (p = .03).
A greater proportion of participants achieved minimally important differences (MID) following HYBRID vs. FTP (p = .03). MIDs were retained 6-months post-intervention. Ashworth scores were unchanged (p > .05). Increased maximal isometric joint torque, agonist EMG and peak power were significantly greater following HYBRID vs. FTP (p < .05) and effects were retained 6-months post-intervention (p's < .05). EMG position threshold and burst duration were significantly reduced at fast speeds (≥120º/s) (p's < 0.05) and passive torque was reduced post-washout (p < .05) following HYBRID.
Functional and neuromechanical gains were greater following HYBRID vs. FPT. Improved stretch reflex modulation and increased neuromuscular activation indicate potent neural adaptations. Importantly, no deleterious consequences, including exacerbation of spasticity or musculoskeletal complaints, were associated with HYBRID. These results contribute to an evolving body of contemporary evidence regarding the efficacy of high-intensity training in neurorehabilitation and the physiological mechanisms that mediate neural recovery.
有观点认为重复性任务练习有助于中风后的神经可塑性。然而，现有证据表明，偏瘫后肢体无力会影响运动的执行和练习。在此，我们研究了力量训练（高强度、动态阻力训练）如何影响中风后上肢运动功能的恢复。我们假设，作为上肢康复的一部分，力量训练将比单纯的功能性任务练习带来更大的功能增益，而不会产生有害的后果。
19 名慢性偏瘫患者采用交叉设计进行研究。所有参与者均随机接受功能性任务练习（FTP）和 HYBRID（FTP 与力量训练相结合）。在基线、每个干预阶段后以及干预后 6 个月进行盲法评估，包括 Wolf 运动功能测试（WMFT-FAS，主要结局）、上肢 Fugl-Meyer 运动评估、Ashworth 量表和功能独立性测量。使用等长和动态关节扭矩以及同时的运动肌肌电图评估神经力学功能。使用被动肘伸展从 60 到 180°/s 评估二头肌牵张反射反应，并确定：在每个速度下，肌电图起始位置阈值、爆发持续时间、爆发强度和被动扭矩。
与 FTP 相比，HYBRID 后 WMFT-FAS 的改善显著更大（p=0.049），且与治疗顺序无关。这些功能改善在干预后 6 个月时仍保留（p=0.03）。
与 FTP 相比，HYBRID 后有更大比例的参与者达到了最小临床重要差异（MID）（p=0.03）。MID 在干预后 6 个月时仍保留。Ashworth 评分无变化（p>0.05）。与 FTP 相比，HYBRID 后最大等长关节扭矩、运动肌肌电图和峰值功率显著增加（p<0.05），且在干预后 6 个月时仍保留（p's<0.05）。快速（≥120°/s）时肌电图起始位置阈值和爆发持续时间显著降低（p<0.05），HYBRID 后被动扭矩在冲洗后降低（p<0.05）。
与 FTP 相比，HYBRID 后功能和神经力学增益更大。牵张反射调节改善和运动肌激活增加表明存在强大的神经适应。重要的是，HYBRID 与痉挛加重或肌肉骨骼投诉等有害后果无关。这些结果为高强度训练在神经康复中的疗效以及介导神经恢复的生理机制的不断发展的当代证据做出了贡献。
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