Kiper Pawel, Baba Alfonc, Agostini Michela, Turolla Andrea
Laboratory of Kinematics and Robotics, IRCCS San Camillo Hospital Foundation, via Alberoni 70, Venice, 30126 Italy.
Department of Neuroscience, University of Sheffield, Glossop Road, Sheffield, S10 2JF UK.
Arch Physiother. 2015 Aug 3;5:6. doi: 10.1186/s40945-015-0007-8. eCollection 2015.
The central nervous system (CNS) has plastic properties allowing its adaptation through development. These properties are still maintained in the adult age and potentially activated in case of brain lesion. In the present study authors hypothesized that a significant recovery of voluntary muscle contraction in post stroke patients experiencing severe upper limb paresis can be obtained, when proprioceptive based stimulations are provided. Proprioceptive based training (PBT) is based on performing concurrent movements with both unaffected and affected arm, with the aim to foster motor recovery through some mutual connections of interhemispheric and transcallosal pathways. The aim of this pre-post pilot study was to evaluate the feasibility of PBT on recovery of voluntary muscle contraction in subacute phase after stroke.
The treatment lasted 1 h daily, 5 days per week for 3 weeks. The PBT consisted of multidirectional exercises executed synchronously with unaffected limb and verbal feedback. The Medical Research Council scale (MRC), Dynamometer, Fugl-Meyer Upper Extremity scale (F-M UE), Functional Independence Measure scale (FIM) and modified Ashworth scale were administered at the beginning and at the end of training. Statistical significance was set at < 0.05.
Six patients with severe paresis of the upper limb within 6 months after stroke were enrolled in the study (5 ischemic and 1 hemorrhagic stroke, 3 men and 3 women, mean age 65.7 ± 8.7 years, mean distance from stroke 4.1 ± 1.5 months) and all of them well tolerated the training. The clinical changes of voluntary muscle contraction after PBT were statistically significant at the MRC scale overall ( = 0.028), and dynamometer assessment overall ( = 0.028). Each patient improved muscle contraction of one or more muscles and in 4 out of 6 patients voluntary active movement emerged after therapy. The functional outcomes (i.e. F-M UE and FIM) did not show significant change within group.
The findings of this preliminary research revealed that PBT may be a feasible intervention to improve the motricity of upper limb in stroke survivors.
中枢神经系统（CNS）具有可塑性，使其能够在发育过程中进行适应性变化。这些特性在成年期仍然保持，并且在脑损伤时可能被激活。在本研究中，作者假设，对于患有严重上肢麻痹的中风后患者，当提供基于本体感觉的刺激时，可以显著恢复其自主肌肉收缩功能。基于本体感觉的训练（PBT）是基于同时使用未受影响和受影响的手臂进行运动，旨在通过一些半球间和胼胝体通路的相互连接促进运动恢复。这项前后对照的初步研究的目的是评估PBT对中风亚急性期自主肌肉收缩恢复的可行性。
治疗持续3周，每天1小时，每周5天。PBT包括与未受影响的肢体同步进行的多方向运动练习和言语反馈。在训练开始和结束时使用医学研究委员会量表（MRC）、握力计、Fugl-Meyer上肢量表（F-M UE）、功能独立性测量量表（FIM）和改良Ashworth量表进行评估。设定统计学显著性水平为<0.05。
6例中风后6个月内出现严重上肢麻痹的患者纳入本研究（5例缺血性中风和1例出血性中风，3例男性和3例女性，平均年龄65.7±8.7岁，距中风平均时间4.1±1.5个月），所有患者均能很好地耐受训练。PBT后自主肌肉收缩的临床变化在MRC量表总体上具有统计学显著性（=0.028），握力计评估总体上也具有统计学显著性（=0.028）。每位患者改善了一块或多块肌肉的收缩，6例患者中有4例在治疗后出现了自主主动运动。功能结局（即F-M UE和FIM）在组内未显示出显著变化。
这项初步研究的结果表明，PBT可能是一种可行的干预措施，可改善中风幸存者上肢的运动能力。
