Rand Debbie, Weingarden Harold, Weiss Ronit, Yacoby Anat, Reif Shlomit, Malka Rachel, Shiller David Andrew, Zeilig Gabi
a Department of Occupational Therapy, Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.
b The Chaim Sheba Medical Center at Tel-HaShomer , Tel- HaShomer, Israel.
Disabil Rehabil. 2017 Jul;39(15):1541-1548. doi: 10.1080/09638288.2016.1239766. Epub 2016 Oct 28.
On-going practice and use of the weaker upper extremity (UE) are important for maintaining and improving function in individuals with chronic stroke. The effectiveness of two self-training programs for UE function and daily-use was compared.
In this pilot, single-blinded clinical trial, individuals with chronic stroke were randomized to video-games or traditional self-training (1-hour/day, 6-times/week, 5 weeks). Assessments were performed pre-intervention (an average of two assessments), post-intervention, and at 4-week follow-up. The primary outcome was the functional ability of the upper extremity [The Action Research Arm Test (ARAT)]. Secondary measures were the daily use of the upper extremity [Motor Activity Log (MAL)] and manual dexterity (Box and Block Test). Repeated measures ANOVA was used to test the effectiveness and estimate effect sizes.
Twenty-four of the 142 participants screened by phone were randomized to video-games [N = 13, mean (SD) age - 59.1 (10.5)] or traditional [N = 11, mean (SD) age - 64.9 (6.9)] self-training. Significant between-group differences were not detected. ARAT significantly improved by 13.9% and 9.6% following the video-games and traditional self-training programs (respectively), with a large effect size. MAL (quantity) also improved significantly between pre- intervention to follow-up with medium-large effect size.
UE functional improvement can be achieved by self-training at the chronic stage and, therefore, should be encouraged by clinicians. Implications for rehabilitation Video-games or traditional self-training programs can be used to practice repetitive UE movements without the supervision of a clinician Self-training of the UE is beneficial at the chronic stage post-stroke and, therefore, should be encouraged The type of self-training (video-games or traditional) should be suited to the client's abilities and preferences. The compliance of self-training using video-games during the follow-up period was higher than the traditional self-training. This is important since self-training programs for chronic stroke need to be long-term and sustainable.
持续练习并使用较弱的上肢对慢性卒中患者维持和改善功能很重要。比较了两种上肢功能和日常使用的自我训练方案的有效性。
在这项单盲临床试验中，慢性卒中患者被随机分为视频游戏组或传统自我训练组（每天1小时，每周6次，共5周）。在干预前（平均两次评估）、干预后和4周随访时进行评估。主要结局是上肢功能能力[动作研究臂测试（ARAT）]。次要指标是上肢的日常使用情况[运动活动日志（MAL）]和手部灵巧性（箱块测试）。采用重复测量方差分析来检验有效性并估计效应量。
通过电话筛选的142名参与者中有24名被随机分为视频游戏组[N = 13，平均（标准差）年龄 - 59.1（10.5）]或传统组[N = 11，平均（标准差）年龄 - 64.9（6.9）]自我训练。未检测到显著的组间差异。视频游戏和传统自我训练方案后，ARAT分别显著提高了13.9%和9.6%，效应量较大。MAL（数量）在干预前到随访期间也有显著改善，效应量为中到大。
慢性期通过自我训练可实现上肢功能改善，因此临床医生应予以鼓励。康复意义视频游戏或传统自我训练方案可用于在无临床医生监督的情况下练习重复性上肢动作。上肢自我训练在卒中慢性期有益，因此应予以鼓励。自我训练的类型（视频游戏或传统）应适合患者的能力和偏好。随访期间使用视频游戏进行自我训练的依从性高于传统自我训练。这很重要，因为慢性卒中的自我训练方案需要长期且可持续。
