Chen Liping, Xiong Siqing, Liu Yi, Lin Meiqing, Zhu Lu, Zhong Renjia, Zhao Jiuhan, Liu Wenjing, Wang Jirui, Shang Xiuli
Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China; Department of Neurology, The Ji'an Central People's Hospital, Ji'an City, Jiangxi Province, China.
Department of Urinary Surgery, The Ji'an Central People's Hospital, Ji'an City, Jiangxi Province, China.
J Stroke Cerebrovasc Dis. 2019 Mar;28(3):655-664. doi: 10.1016/j.jstrokecerebrovasdis.2018.11.011. Epub 2018 Nov 28.
Apathy is a multidimensional syndrome referring to a primary lack of motivation, frequent in survivors of stroke. And prior studies have demonstrated the negative effect of apathy on recovery from stroke.
A randomized controlled study of acute stroke patients. Four hundred and eighty-eight patients without evidence of apathy or depression at the initial visit were consecutively recruited, 258 males and 230 female. Patients were block randomized into 2 groups. Group A (n = 245) and Group B (n = 243) had physiotherapy according to Motor Relearning Program and Bobath in the first 4 weeks, respectively. The supplemental treatment did not differ in the 2 groups. Patients were assessed with Apathy Evaluation Scale-Clinical, National Institutes of Health Stroke Scale scores, Barthel Index scores, Mini-Mental State Examination scores, Hamilton Depression Scale scores, and Hamilton Anxiety Scale scores upon admission. At 1-, 3-, 6-, 9-, and 12-month follow-up after stroke, patients were assessed for diagnosis and severity of apathy using the Apathy Evaluation Scale-Clinical.
Baseline characteristics of the subjects are age mean 65.1 (standard deviations, SD 10.9); 47.1% female; Apathy Evaluation Scale-Clinical mean 24.9 (SD 4.7); National Institutes of Health Stroke Scale mean 3.9 (SD 3.8); Barthel Index mean 87.9 (SD 8.7); Mini-Mental State Examination mean 23.3 (SD 4.5); Hamilton Depression Scale mean 17.5 (SD 6.6); and Hamilton Anxiety Scale mean 14.4 (SD 6.2). Participants in both groups had similar levels of apathy symptoms at study admission (Motor Relearning Program, mean = 24.78, SD = 4.62; Bobath, mean = 25.07, SD = 4.75). The Apathy Evaluation Scale scores of participants in both groups demonstrated to decline gradually from month 1 to month 12. Motor Learning Program participants had significantly less apathy severity compared with Bobath participants with respect to each time point. Participants given Bobath approach were 1.629 times more likely to develop poststroke apathy than patients given Motor Relearning Program over 12 months.
Physiotherapy treatment in acute stroke rehabilitation using Motor Relearning program was significantly more effective in preventing of new onset of apathy following stroke compared with Bobath approach.
冷漠是一种多维度综合征，指的是原发性动机缺乏，在中风幸存者中很常见。先前的研究已经证明冷漠对中风恢复有负面影响。
一项针对急性中风患者的随机对照研究。连续招募了488例初诊时无冷漠或抑郁证据的患者，其中男性258例，女性230例。患者被整群随机分为两组。A组（n = 245）和B组（n = 243）在最初4周分别根据运动再学习方案和Bobath法进行物理治疗。两组的补充治疗无差异。入院时使用临床冷漠评估量表、美国国立卫生研究院卒中量表评分、巴氏指数评分、简易精神状态检查表评分、汉密尔顿抑郁量表评分和汉密尔顿焦虑量表评分对患者进行评估。在中风后1个月、3个月、6个月、9个月和12个月的随访中，使用临床冷漠评估量表对患者的冷漠诊断和严重程度进行评估。
受试者的基线特征为年龄平均65.1岁（标准差，SD 10.9）；女性占47.1%；临床冷漠评估量表平均24.9分（SD 4.7）；美国国立卫生研究院卒中量表平均3.9分（SD 3.8）；巴氏指数平均87.9分（SD 8.7）；简易精神状态检查表平均23.3分（SD 4.5）；汉密尔顿抑郁量表平均17.5分（SD 6.6）；汉密尔顿焦虑量表平均14.4分（SD 6.2）。两组参与者在研究入院时的冷漠症状水平相似（运动再学习方案组，平均 = 24.78，SD = 4.62；Bobath法组，平均 = 25.07，SD = 4.75）。两组参与者的冷漠评估量表评分从第1个月到第12个月均呈逐渐下降趋势。在每个时间点，运动再学习方案组的参与者冷漠严重程度明显低于Bobath法组的参与者。在12个月的时间里，采用Bobath法的参与者发生中风后冷漠的可能性是采用运动再学习方案患者的1.629倍。
与Bobath法相比，在急性中风康复中使用运动再学习方案进行物理治疗在预防中风后新发性冷漠方面明显更有效。
