C.L. Pollock, PT, MSc, Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
Phys Ther. 2014 Apr;94(4):562-70. doi: 10.2522/ptj.20130046. Epub 2013 Dec 20.
Stepping reactions are important for walking balance and community-level mobility. Stepping reactions of people with stroke are characterized by slow reaction times, poor coordination of motor responses, and low amplitude of movements, which may contribute to their decreased ability to recover their balance when challenged. An important aspect of rehabilitation of mobility after stroke is optimizing the motor learning associated with retraining effective stepping reactions. The Challenge Point Framework (CPF) is a model that can be used to promote motor learning through manipulation of conditions of practice to modify task difficulty, that is, the interaction of the skill of the learner and the difficulty of the task to be learned. This case series illustrates how the retraining of multidirectional stepping reactions may be informed by the CPF to improve balance function in people with stroke.
Four people (53-68 years of age) with chronic stroke (>1 year) and mild to moderate motor recovery received 4 weeks of multidirectional stepping reaction retraining. Important tenets of motor learning were optimized for each person during retraining in accordance with the CPF.
Participants demonstrated improved community-level walking balance, as determined with the Community Balance and Mobility Scale. These improvements were evident 1 year later. Aspects of balance-related self-efficacy and movement kinematics also showed improvements during the course of the intervention.
The application of CPF motor learning principles in the retraining of stepping reactions to improve community-level walking balance in people with chronic stroke appears to be promising. The CPF provides a plausible theoretical framework for the progression of functional task training in neurorehabilitation.
跨步反应对于步行平衡和社区水平的移动能力很重要。脑卒中患者的跨步反应特征是反应时间慢、运动反应协调性差、动作幅度小，这可能导致他们在受到挑战时平衡恢复能力下降。脑卒中后移动能力康复的一个重要方面是优化与重新训练有效跨步反应相关的运动学习。挑战点框架（CPF）是一种可用于通过操作练习条件来促进运动学习的模型，从而改变任务难度，即学习者的技能和要学习的任务的难度之间的相互作用。本病例系列说明了如何根据 CPF 重新训练多方向跨步反应，以改善脑卒中患者的平衡功能。
4 名（53-68 岁）慢性脑卒中（>1 年）和轻度至中度运动恢复的患者接受了 4 周的多方向跨步反应再训练。根据 CPF，在重新训练过程中为每个人优化了运动学习的重要原则。
参与者在社区平衡和移动量表上表现出改善的社区水平步行平衡。这些改善在 1 年后仍然存在。平衡相关自我效能感和运动运动学的各个方面也在干预过程中有所改善。
CPF 运动学习原则在重新训练跨步反应以改善慢性脑卒中患者社区水平步行平衡方面的应用似乎很有前景。CPF 为神经康复中功能性任务训练的进展提供了一个合理的理论框架。
