Department of Psychology, University of Alabama, Birmingham, CPM 712, 1530 3rd Ave, S, Birmingham, AL 35294, USA.
Stroke. 2013 May;44(5):1383-8. doi: 10.1161/STROKEAHA.111.000559. Epub 2013 Mar 21.
Constraint-induced movement therapy is a set of treatments for rehabilitating motor function after central nervous system damage. We assessed the roles of its 2 main components.
A 2 × 2 factorial components analysis with random assignment was conducted. The 2 factors were type of training and presence/absence of a set of techniques to facilitate transfer of therapeutic gains from the laboratory to the life situation (Transfer Package; TP). Participants (N=40) were outpatients ≥ 1-year after stroke with hemiparesis. The different treatments, which in each case targeted the more affected arm, lasted 3.5 hours/d for 10 weekdays. Spontaneous use of the more affected arm in daily life and maximum motor capacity of that arm in the laboratory were assessed with the Motor Activity Log and the Wolf Motor Function Test, respectively.
Use of the TP, regardless of the type of training received, resulted in Motor Activity Log gains that were 2.4 times as large as the gains in its absence (P<0.01). These clinical results parallel previously reported effects of the TP on neuroplastic change. Both the TP and training by shaping enhanced gains on the Wolf Motor Function Test (P<0.05). The Motor Activity Log gains were retained without loss 1 year after treatment. An additional substudy (N=10) showed that a single component of the TP, weekly telephone contact with participants for 1 month after treatment, doubled Motor Activity Log scores at 6-month follow-up.
The TP is a method for enhancing both spontaneous use of a more affected arm after chronic stroke and its maximum motor capacity. Shaping enhances the latter.
约束诱导运动疗法是一套用于治疗中枢神经系统损伤后运动功能的治疗方法。我们评估了其 2 个主要组成部分的作用。
采用 2×2 析因设计的随机分组方法。2 个因素是训练类型和是否存在一套促进治疗效果从实验室转移到生活情境的技术（转移包；TP）。参与者（N=40）为中风后 1 年以上且有偏瘫的门诊患者。针对病情较重的手臂，每种治疗方案都持续 10 个工作日，每天 3.5 小时。使用运动活动日志评估日常生活中病情较重手臂的自发使用情况，使用 Wolf 运动功能测试评估该手臂的最大运动能力。
无论接受何种类型的训练，使用 TP 都会使运动活动日志的收益增加 2.4 倍（P<0.01），而不使用 TP 则不会增加（P<0.01）。这些临床结果与之前报道的 TP 对神经可塑性变化的影响相平行。TP 和塑形训练都能提高 Wolf 运动功能测试的收益（P<0.05）。治疗后 1 年，运动活动日志的收益仍保持不变。一项额外的子研究（N=10）表明，TP 的一个单一组成部分，即治疗后 1 个月每周与参与者进行一次电话联系，可使治疗后 6 个月的运动活动日志得分增加 1 倍。
TP 是一种提高慢性中风后病情较重手臂的自发使用和最大运动能力的方法。塑形训练可增强后者。
