Ehrensberger Monika, Simpson Daniel, Broderick Patrick, Monaghan Kenneth
a Health Science & Physiology Laboratory , School of Science, Institute of Technology , Sligo , Ireland.
Top Stroke Rehabil. 2016 Apr;23(2):126-35. doi: 10.1080/10749357.2015.1112062. Epub 2016 Feb 24.
Since its discovery in 1894 cross-education of strength - a bilateral adaptation after unilateral training - has been shown to be effective in the rehabilitation after one-sided orthopedic injuries. Limited knowledge exists on its application within the rehabilitation after stroke. This review examined the evidence regarding the implication of cross-education in the rehabilitation of the post-stroke hemiplegic patient and its role in motor function recovery.
Electronic databases were searched by two independent assessors. Studies were included if they described interventions which examined the phenomenon of cross-education of strength from the less-affected to the more-affected side in stroke survivors. Study quality was assessed using the PEDro scale and the Cochrane risk of bias assessment tool.
Only two controlled trials met the eligibility criteria. The results of both studies show a clear trend towards cross-educational strength transfer in post-stroke hemiplegic patients with 31.4% and 45.5% strength increase in the untrained, more-affected dorsiflexor muscle. Results also suggest a possible translation of strength gains towards functional task improvements and motor recovery.
Based on best evidence synthesis guidelines the combination of the results included in this review suggest at least a moderate level of evidence for the application of cross-education of strength in stroke rehabilitation. Following this review it is recommended that additional high quality randomized controlled trials are conducted to further support the findings.
自1894年发现力量的交叉训练——单侧训练后的双侧适应性变化——以来，已证明其在单侧骨科损伤后的康复中有效。关于其在中风后康复中的应用，相关知识有限。本综述研究了关于交叉训练在中风后偏瘫患者康复中的意义及其在运动功能恢复中的作用的证据。
由两名独立评估人员检索电子数据库。如果研究描述了对中风幸存者中力量从受影响较小一侧向受影响较大一侧的交叉训练现象进行研究的干预措施，则纳入该研究。使用PEDro量表和Cochrane偏倚风险评估工具评估研究质量。
只有两项对照试验符合纳入标准。两项研究的结果均显示，中风后偏瘫患者存在明显的力量交叉训练转移趋势，未训练的、受影响较大的背屈肌力量分别增加了31.4%和45.5%。结果还表明，力量的增加可能转化为功能任务的改善和运动恢复。
根据最佳证据综合指南，本综述纳入的结果组合表明，至少有中等程度的证据支持在中风康复中应用力量交叉训练。基于本综述，建议开展更多高质量的随机对照试验以进一步支持这些发现。
