McCombe Waller Sandy, Whitall Jill, Jenkins Toye, Magder Laurence S, Hanley Daniel F, Goldberg Andrew, Luft Andreas R
School of Medicine, Department of Physical Therapy and Rehabilitation Science, University of Maryland, 100 Penn Street, Baltimore, MD, 21201, USA.
Department of Epidemiology and Public Health, University of Maryland, 660 W. Redwood Street, Baltimore, MD, 21201, USA.
BMC Neurol. 2014 Dec 14;14:236. doi: 10.1186/s12883-014-0236-6.
Recovering useful hand function after stroke is a major scientific challenge for patients with limited motor recovery. We hypothesized that sequential training beginning with proximal bilateral followed by unilateral task oriented training is superior to time-matched unilateral training alone. Proximal bilateral training could optimally prepare the motor system to respond to the more challenging task-oriented training.
Twenty-six participants with moderate severity hemiparesis Intervention: PARTICIPANTS received either 6-weeks of bilateral proximal training followed sequentially by 6-weeks unilateral task-oriented training (COMBO) or 12-weeks of unilateral task-oriented training alone (SAEBO). A subset of 8 COMB0 and 9 SAEBO participants underwent three functional magnetic resonance imaging (fMRI) scans of hand and elbow movement every 6 weeks.
Fugl-Meyer Upper extremity scale, Modified Wolf Motor Function Test, University of Maryland Arm Questionnaire for Stroke, Motor cortex activation (fMRI).
The COMBO group demonstrated significantly greater gains between baseline and 12-weeks over all outcome measures (p = .018 based on a MANOVA test) and specifically in the Modified Wolf Motor Function test (time). Both groups demonstrated within-group gains on the Fugl-Meyer Upper Extremity test (impairment) and University of Maryland Arm Questionnaire for Stroke (functional use). fMRI subset analyses showed motor cortex (primary and premotor) activation during hand movement was significantly increased by sequential combination training but not by task-oriented training alone.
Sequentially combining a proximal bilateral before a unilateral task-oriented training may be an effective way to facilitate gains in arm and hand function in those with moderate to severe paresis post-stroke compared to unilateral task oriented training alone.
对于运动恢复有限的中风患者而言，恢复有用的手部功能是一项重大科学挑战。我们假设，从近端双侧训练开始，随后进行单侧任务导向训练的序贯训练优于仅进行时间匹配的单侧训练。近端双侧训练可最佳地使运动系统做好准备，以应对更具挑战性的任务导向训练。
26名中度偏瘫参与者
参与者接受为期6周的双侧近端训练，随后依次进行为期6周的单侧任务导向训练（联合训练组），或仅接受为期12周的单侧任务导向训练（SAEBO组）。联合训练组的8名参与者和SAEBO组的9名参与者每6周接受三次关于手部和肘部运动的功能磁共振成像（fMRI）扫描。
Fugl-Meyer上肢量表、改良Wolf运动功能测试、马里兰大学中风手臂问卷、运动皮层激活（fMRI）。
联合训练组在所有结局指标上，从基线到12周的改善均显著更大（基于多变量方差分析测试，p = 0.018），特别是在改良Wolf运动功能测试（时间方面）。两组在Fugl-Meyer上肢测试（损伤）和马里兰大学中风手臂问卷（功能使用）方面均显示出组内改善。fMRI亚组分析显示，序贯联合训练可显著增加手部运动期间运动皮层（初级和运动前区）的激活，而仅进行任务导向训练则无此效果。
与仅进行单侧任务导向训练相比，在单侧任务导向训练前序贯结合近端双侧训练可能是促进中风后中度至重度麻痹患者手臂和手部功能改善的有效方法。
