Trinh Terry, Scheuer Sarah E, Thompson-Butel Angelica G, Shiner Christine T, McNulty Penelope A
a Neuroscience Research Australia , Sydney , Australia.
b School of Medical Sciences, Faculty of Medicine , University of New South Wales , Sydney , Australia.
Top Stroke Rehabil. 2016 Jun;23(3):208-16. doi: 10.1080/10749357.2016.1138672. Epub 2016 Mar 1.
Post-stroke cardiovascular fitness is typically half that of healthy age-matched people. Cardiovascular deconditioning is a risk factor for recurrent stroke that may be overlooked during routine rehabilitation. This study investigated the cardiovascular responses of two upper limb rehabilitation protocols.
Forty-six stroke patients completed a dose-matched program of Wii-based Movement Therapy (WMT) or modified Constraint-induced Movement Therapy (mCIMT). Heart rate and stepping were recorded during early (day 2)- and late (day 12-14)-therapy. Pre- and post-therapy motor assessments included the Wolf Motor Function Test and 6-min walk.
Upper limb motor function improved for both groups after therapy (WMT p = 0.003, mCIMT p = 0.04). Relative peak heart rate increased from early- to late-therapy WMT by 33% (p < 0.001) and heart rate recovery (HRR) time was 40% faster (p = 0.04). Peak heart rate was higher and HRR faster during mCIMT than WMT, but neither measure changed during mCIMT. Stepping increased by 88% during Wii-tennis (p < 0.001) and 21% during Wii-boxing (p = 0.045) while mCIMT activities were predominantly sedentary. Six-min walk distances increased by 8% (p = 0.001) and 4% (p = 0.02) for WMT and mCIMT, respectively.
Cardiovascular benefits were evident after WMT as both a cardiovascular challenge and improved cardiovascular fitness. The peak heart rate gradient across WMT activities suggests this therapy can be further individualized to address cardiovascular needs. The mCIMT data suggest a cardiovascular stress response.
This is the first study to demonstrate a cardiovascular benefit during specifically targeted upper limb rehabilitation. Thus, WMT not only improves upper limb motor function but also improves cardiovascular fitness.
中风后心血管健康水平通常仅为年龄匹配的健康人群的一半。心血管功能失调是复发性中风的一个风险因素，在常规康复过程中可能被忽视。本研究调查了两种上肢康复方案的心血管反应。
46名中风患者完成了剂量匹配的基于Wii的运动疗法（WMT）或改良的强制性运动疗法（mCIMT）方案。在治疗早期（第2天）和晚期（第12 - 14天）记录心率和步幅。治疗前后的运动评估包括Wolf运动功能测试和6分钟步行测试。
两组治疗后上肢运动功能均有改善（WMT，p = 0.003；mCIMT，p = 0.04）。从治疗早期到晚期，WMT组的相对峰值心率增加了33%（p < 0.001），心率恢复（HRR）时间快了40%（p = 0.04）。mCIMT期间的峰值心率高于WMT，HRR也更快，但mCIMT期间这两项指标均无变化。在Wii网球运动中步幅增加了88%（p < 0.001），在Wii拳击运动中增加了21%（p = 0.045），而mCIMT活动主要是静态的。WMT和mCIMT的6分钟步行距离分别增加了8%（p = 0.001）和4%（p = 0.02）。
WMT作为一种心血管挑战和改善心血管健康的方法，其心血管益处是明显的。WMT活动中的峰值心率梯度表明该疗法可以进一步个体化以满足心血管需求。mCIMT数据表明存在心血管应激反应。
这是第一项证明在针对性上肢康复过程中心血管有益效果的研究。因此，WMT不仅能改善上肢运动功能，还能提高心血管健康水平。
