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一种用于亚急性中风后恢复上肢运动的神经认知方法:一项随机对照试验研究

A neurocognitive approach for recovering upper extremity movement following subacute stroke: a randomized controlled pilot study.

作者信息

Sallés Laia, Martín-Casas Patricia, Gironès Xavier, Durà María José, Lafuente José Vicente, Perfetti Carlo

机构信息

Faculty of Health Sciences at Manresa, University of Vic-Central University of Catalonia, Spain.

Departamento de Medicina Física y Rehabilitación, Hidrología Médica, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Spain.

出版信息

J Phys Ther Sci. 2017 Apr;29(4):665-672. doi: 10.1589/jpts.29.665. Epub 2017 Apr 20.

Abstract

[Purpose] This study aims to describe a protocol based on neurocognitive therapeutic exercises and determine its feasibility and usefulness for upper extremity functionality when compared with a conventional protocol. [Subjects and Methods] Eight subacute stroke patients were randomly assigned to a conventional (control group) or neurocognitive (experimental group) treatment protocol. Both lasted 30 minutes, 3 times a week for 10 weeks and assessments were blinded. Outcome measures included: Motor Evaluation Scale for Upper Extremity in Stroke Patients, Motricity Index, Revised Nottingham Sensory Assessment and Kinesthetic and Visual Imagery Questionnaire. Descriptive measures and nonparametric statistical tests were used for analysis. [Results] The results indicate a more favorable clinical progression in the neurocognitive group regarding upper extremity functional capacity with achievement of the minimal detectable change. The functionality results are related with improvements on muscle strength and sensory discrimination (tactile and kinesthetic). [Conclusion] Despite not showing significant group differences between pre and post-treatment, the neurocognitive approach could be a safe and useful strategy for recovering upper extremity movement following stroke, especially regarding affected hands, with better and longer lasting results. Although this work shows this protocol's feasibility with the panel of scales proposed, larger studies are required to demonstrate its effectiveness.

摘要

[目的] 本研究旨在描述一种基于神经认知治疗练习的方案,并确定与传统方案相比,其对上肢功能的可行性和有效性。[对象与方法] 8例亚急性脑卒中患者被随机分配至传统治疗组(对照组)或神经认知治疗组(试验组)。两种治疗均持续30分钟,每周3次,共10周,评估采用盲法。结局指标包括:脑卒中患者上肢运动评估量表、运动指数、修订版诺丁汉感觉评估以及动觉和视觉意象问卷。采用描述性指标和非参数统计检验进行分析。[结果] 结果表明,神经认知组在上肢功能能力方面临床进展更优,达到了最小可检测变化。功能结果与肌肉力量和感觉辨别(触觉和动觉)的改善有关。[结论] 尽管治疗前后两组间未显示出显著差异,但神经认知方法可能是脑卒中后恢复上肢运动的一种安全有效的策略,尤其是对于患手,效果更佳且持续时间更长。虽然本研究表明该方案在所提出的量表组中具有可行性,但仍需要更大规模的研究来证明其有效性。

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