Hunter Susan M, Johansen-Berg Heidi, Ward Nick, Kennedy Niamh C, Chandler Elizabeth, Weir Christopher John, Rothwell John, Wing Alan M, Grey Michael J, Barton Garry, Leavey Nick Malachy, Havis Claire, Lemon Roger N, Burridge Jane, Dymond Amy, Pomeroy Valerie M
School of Health and Rehabilitation, Institute for Applied Clinical Sciences, Keele University, Keele, United Kingdom.
Wellcome Centre for Integrative Neuroimaging, Functional MRI of the Brain (FMRIB), University of Oxford, Nuffield Department of Clinical neurosciences, John Radcliffe Hospital, Oxford, United Kingdom.
Front Neurol. 2018 Jan 25;8:733. doi: 10.3389/fneur.2017.00733. eCollection 2017.
Variation in physiological deficits underlying upper limb paresis after stroke could influence how people recover and to which physical therapy they best respond.
To determine whether functional strength training (FST) improves upper limb recovery more than movement performance therapy (MPT). To identify: (a) neural correlates of response and (b) whether pre-intervention neural characteristics predict response.
Explanatory investigations within a randomised, controlled, observer-blind, and multicentre trial. Randomisation was computer-generated and concealed by an independent facility until baseline measures were completed. Primary time point was outcome, after the 6-week intervention phase. Follow-up was at 6 months after stroke.
With some voluntary muscle contraction in the paretic upper limb, not full dexterity, when recruited up to 60 days after an anterior cerebral circulation territory stroke.
Conventional physical therapy (CPT) plus either MPT or FST for up to 90 min-a-day, 5 days-a-week for 6 weeks. FST was "hands-off" progressive resistive exercise cemented into functional task training. MPT was "hands-on" sensory/facilitation techniques for smooth and accurate movement.
The primary efficacy measure was the Action Research Arm Test (ARAT). Neural measures: fractional anisotropy (FA) corpus callosum midline; asymmetry of corticospinal tracts FA; and resting motor threshold (RMT) of motor-evoked potentials.
Covariance models tested ARAT change from baseline. At outcome: correlation coefficients assessed relationship between change in ARAT and neural measures; an interaction term assessed whether baseline neural characteristics predicted response.
288 Participants had: mean age of 72.2 (SD 12.5) years and mean ARAT 25.5 (18.2). For 240 participants with ARAT at baseline and outcome the mean change was 9.70 (11.72) for FST + CPT and 7.90 (9.18) for MPT + CPT, which did not differ statistically ( = 0.298). Correlations between ARAT change scores and baseline neural values were between 0.199, = 0.320 for MPT + CPT RMT ( = 27) and -0.147, = 0.385 for asymmetry of corticospinal tracts FA ( = 37). Interaction effects between neural values and ARAT change between baseline and outcome were not statistically significant.
There was no significant difference in upper limb improvement between FST and MPT. Baseline neural measures did not correlate with upper limb recovery or predict therapy response.
Current Controlled Trials: ISRCT 19090862, http://www.controlled-trials.com.
中风后上肢麻痹潜在的生理缺陷差异可能会影响人们的恢复情况以及他们对哪种物理治疗反应最佳。
确定功能强度训练（FST）是否比运动表现疗法（MPT）更能改善上肢恢复。识别：（a）反应的神经相关性；（b）干预前的神经特征是否能预测反应。
在一项随机、对照、观察者盲法和多中心试验中进行解释性研究。随机分组由计算机生成，并由独立机构保密，直到完成基线测量。主要时间点是6周干预阶段后的结果。随访在中风后6个月进行。
在前脑循环区域中风后60天内招募，患侧上肢有一些自主肌肉收缩，但未达到完全灵活。
常规物理治疗（CPT）加上MPT或FST，每天最多90分钟，每周5天，共6周。FST是融入功能任务训练的“放手”渐进性抗阻运动。MPT是用于实现平稳准确运动的“手把手”感觉/促进技术。
主要疗效指标是动作研究上肢测试（ARAT）。神经测量指标：胼胝体中线的分数各向异性（FA）；皮质脊髓束FA的不对称性；以及运动诱发电位的静息运动阈值（RMT）。
协方差模型测试ARAT相对于基线的变化。在结果方面：相关系数评估ARAT变化与神经测量指标之间的关系；一个交互项评估基线神经特征是否能预测反应。
288名参与者：平均年龄72.2（标准差12.5）岁，平均ARAT为25.5（18.2）。对于240名在基线和结果时均有ARAT数据的参与者，FST + CPT组的平均变化为9.70（11.72），MPT + CPT组为7.90（9.18），两者无统计学差异（P = 0.298）。ARAT变化分数与基线神经值之间的相关性在0.199之间，MPT + CPT组RMT的P = 0.320（n = 27），皮质脊髓束FA不对称性的P = 0.385（n = 37）时为-0.147。基线神经值与ARAT在基线和结果之间的变化之间的交互作用无统计学意义。
FST和MPT在上肢改善方面无显著差异。基线神经测量指标与上肢恢复无关，也不能预测治疗反应。
当前受控试验：ISRCT 19090862，http://www.controlled-trials.com 。
