Marquardt Michael K, Cohen Anna-Lisa, Gollwitzer Peter M, Gilbert Sam J, Dettmers Christian
Department of Psychology, University of Konstanz, Konstanz, Germany.
Department of Psychology, Yeshiva University, New York, USA.
Restor Neurol Neurosci. 2017;35(5):537-545. doi: 10.3233/RNN-170748.
After stroke, the learned non-use of a paretic arm is a major obstacle to the improvement of hand function.
We examined whether patients with a central paresis could profit from applying the self-regulation strategy of making if-then plans that specify situational triggers to using the paretic arm.
Seventeen stroke patients with a mild to moderate hand paresis were asked to perform a Simon task which is commonly used to study the enhanced executive control needed when there is a mismatch between stimulus (e.g., color) and response (e.g., location) features. We examined whether patients with hemiparesis would be able to reduce the Simon effect (i.e., responding slower to mismatched as compared to matched stimulus and response features) by creating new stimulus-response associations via if-then plans.
A significant Simon effect was observed in both the affected and the non-affected arm for control trials. However, there was no longer a significant Simon effect for the critical trials prepared by forming if-then plans. This led to a significant stimulus×compatibility interaction effect for the affected arm and a marginally significant interaction effect for the non-affected arm. Making if-then plans was effective for eliminating or at least reducing the Simon effect for the affected and the non-affected arm, respectively.
This observation opens a potential new route to improving stroke rehabilitation. If-then plans may qualify as a viable strategy to overcome the learned non-use of the affected arm. Further research is now required to develop and test therapeutic measures based on this proof-of-principle.
中风后，习得性废用患侧手臂是手部功能改善的主要障碍。
我们研究了中枢性麻痹患者是否能从应用自我调节策略制定“如果……那么……”计划中获益，该计划明确了使用患侧手臂的情境触发因素。
17名轻度至中度手部麻痹的中风患者被要求执行一项西蒙任务，该任务通常用于研究当刺激（如颜色）和反应（如位置）特征不匹配时所需增强的执行控制。我们研究了偏瘫患者是否能够通过“如果……那么……”计划创建新的刺激 - 反应关联来减少西蒙效应（即与匹配的刺激和反应特征相比，对不匹配的反应更慢）。
在对照试验中，患侧和非患侧手臂均观察到显著的西蒙效应。然而，对于通过制定“如果……那么……”计划准备的关键试验，不再有显著的西蒙效应。这导致患侧手臂出现显著的刺激×相容性交互效应，非患侧手臂出现边缘显著的交互效应。制定“如果……那么……”计划分别有效地消除或至少减少了患侧和非患侧手臂的西蒙效应。
这一观察结果为改善中风康复开辟了一条潜在的新途径。“如果……那么……”计划可能成为克服患侧手臂习得性废用的可行策略。现在需要进一步的研究来开发和测试基于这一原理验证的治疗措施。
