Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy.
Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy.
J Healthc Eng. 2018 Mar 14;2018:4208492. doi: 10.1155/2018/4208492. eCollection 2018.
Acquired brain injuries (ABIs) can lead to a wide range of impairments, including weakness or paralysis on one side of the body known as hemiplegia. In hemiplegic patients, the rehabilitation of the upper limb skills is crucial, because the recovery has an immediate impact on patient quality of life. For this reason, several treatments were developed to flank physical therapy (PT) and improve functional recovery of the upper limbs. Among them, Constraint-Induced Movement Therapy (CIMT) and robot-aided therapy have shown interesting potentialities in the rehabilitation of the hemiplegic upper limb. Nevertheless, there is a lack of quantitative evaluations of effectiveness in a standard clinical setting, especially in children, as well as a lack of direct comparative studies between these therapeutic techniques. In this study, a group of 18 children and adolescents with hemiplegia was enrolled and underwent intensive rehabilitation treatment including PT and CIMT or Armeo®Spring therapy. The effects of the treatments were assessed using clinical functional scales and upper limb kinematic analysis during horizontal and vertical motor tasks. Results showed CIMT to be the most effective in terms of improved functional scales, while PT seemed to be the most significant in terms of kinematic variations. Specifically, PT resulted to have positive influence on distal movements while CIMT conveyed more changes in the proximal kinematics. Armeo treatment delivered improvements mainly in the vertical motor task, showing trends of progresses of the movement efficiency and reduction of compensatory movements of the shoulder with respect to other treatments. Therefore, every treatment gave advantages in a specific and different upper limb district. Therefore, results of this preliminary study may be of help to define the best rehabilitation treatment for each patient, depending on the goal, and may thus support clinical decision.
获得性脑损伤（ABI）可导致广泛的损伤，包括身体一侧的无力或瘫痪，称为偏瘫。在偏瘫患者中，上肢技能的康复至关重要，因为恢复会直接影响患者的生活质量。因此，开发了几种治疗方法来辅助物理治疗（PT）并改善上肢的功能恢复。其中，强制性运动疗法（CIMT）和机器人辅助治疗在偏瘫上肢的康复中显示出了有趣的潜力。然而，在标准临床环境中，尤其是在儿童中，缺乏对有效性的定量评估，以及这些治疗技术之间缺乏直接比较研究。在这项研究中，招募了 18 名偏瘫的儿童和青少年，并对他们进行了强化康复治疗，包括 PT 和 CIMT 或 Armeo®Spring 治疗。使用临床功能量表和上肢运动任务期间的运动学分析评估了治疗的效果。结果表明，在改善功能量表方面，CIMT 最有效，而在运动学变化方面，PT 似乎最显著。具体而言，PT 对远端运动有积极影响，而 CIMT 对近端运动学有更多变化。Armeo 治疗主要在垂直运动任务中带来了改善，显示出运动效率提高和与其他治疗相比肩部代偿运动减少的趋势。因此，每种治疗方法在特定的和不同的上肢区域都有优势。因此，这项初步研究的结果可能有助于根据目标为每个患者确定最佳的康复治疗方法，并为临床决策提供支持。
