Dobkin Bruce H
Geffen School of Medicine at the University of California Los Angeles, Reed Neurologic Research Center, Los Angeles, California, USA.
Curr Opin Neurol. 2016 Dec;29(6):693-699. doi: 10.1097/WCO.0000000000000380.
Rehabilitation trials and postacute care to lessen impairments and disability after stroke, spinal cord injury, and traumatic brain injury almost never include training to promote long-term self-management of skills practice, strengthening and fitness. Without behavioral training to develop self-efficacy, clinical trials, and home-based therapy may fail to show robust results.
Behavioral theories about self-management and self-efficacy for physical activity have been successfully incorporated into interventions for chronic diseases, but rarely for neurologic rehabilitation. The elements of behavioral training include education about the effects of practice and exercise that are relevant to the person, goal setting, identification of possible barriers, problem solving, feedback about performance, tailored instruction, decision making, and ongoing personal or social support. Mobile health and telerehabilitation technologies offer new ways to remotely enable such training by monitoring activity from wearable wireless sensors and instrumented exercise devices to allow real-world feedback, goal setting, and instruction.
Motivation, sense of responsibility, and confidence to practice and exercise in the home can be trained to increase adherence to skills practice and exercise both during and after formal rehabilitation. To optimize motor learning and improve long-term outcomes, self-management training should be an explicit component of rehabilitation care and clinical trials.
旨在减轻中风、脊髓损伤和创伤性脑损伤后功能障碍和残疾的康复试验及急性后期护理，几乎从未包括促进技能练习、强化训练和健身的长期自我管理训练。若缺乏培养自我效能感的行为训练，临床试验和家庭治疗可能无法取得显著效果。
关于身体活动自我管理和自我效能感的行为理论已成功纳入慢性病干预措施，但在神经康复领域却很少应用。行为训练的要素包括：针对个人的练习和运动效果教育、目标设定、识别可能的障碍、解决问题、表现反馈、个性化指导、决策制定以及持续的个人或社会支持。移动健康和远程康复技术提供了新途径，通过可穿戴无线传感器和器械化运动设备监测活动，实现远程训练，从而提供现实世界的反馈、目标设定和指导。
可以通过训练增强在家中练习和锻炼的动机、责任感和信心，以提高在正式康复期间及之后对技能练习和锻炼的依从性。为优化运动学习并改善长期效果，自我管理训练应成为康复护理和临床试验的明确组成部分。
