Platz Thomas, Lotze Martin
BDH-Klinik Greifswald, Centre for Neurorehabilitation, Intensive and Ventilation Care, Spinal Cord Injury Unit, University of Greifswald, Greifswald, Germany.
Functional Imaging Unit, Center for Diagnostic Radiology, University of Greifswald, Greifswald, Germany.
Front Neurol. 2018 Dec 11;9:1082. doi: 10.3389/fneur.2018.01082. eCollection 2018.
Arm Ability Training (AAT) has been specifically designed to promote manual dexterity recovery for stroke patients who have mild to moderate arm paresis. The motor control problems that these patients suffer from relate to a lack of efficiency in terms of the sensorimotor integration needed for dexterity. Various sensorimotor arm and hand abilities such as speed of selective movements, the capacity to make precise goal-directed arm movements, coordinated visually guided movements, steadiness, and finger dexterity all contribute to our "dexterity" in daily life. All these abilities are deficient in stroke patients who have mild to moderate paresis causing focal disability. The AAT explicitly and repetitively trains all these sensorimotor abilities at the individual's performance limit with eight different tasks; it further implements various task difficulty levels and integrates augmented feedback in the form of intermittent knowledge of results. The evidence from two randomized controlled trials indicates the clinical effectiveness of the AAT with regard to the promotion of "dexterity" recovery and the reduction of focal disability in stroke patients with mild to moderate arm paresis. In addition, the effects have been shown to be superior to time-equivalent "best conventional therapy." Further, studies in healthy subjects showed that the AAT induced substantial sensorimotor learning. The observed learning dynamics indicate that different underlying sensorimotor arm and hand abilities are trained. Capacities strengthened by the training can, in part, be used by both arms. Non-invasive brain stimulation experiments and functional magnetic resonance imaging data documented that at an early stage in the training cortical sensorimotor network areas are involved in learning induced by the AAT, yet differentially for the tasks trained. With prolonged training over 2 to 3 weeks, subcortical structures seem to take over. While behavioral similarities in training responses have been observed in healthy volunteers and patients, training-induced functional re-organization in survivors of a subcortical stroke uniquely involved the ipsilesional premotor cortex as an adaptive recruitment of this secondary motor area. Thus, training-induced plasticity in healthy and brain-damaged subjects are not necessarily the same.
手臂能力训练（AAT）是专门为促进轻度至中度手臂麻痹的中风患者恢复手部灵活性而设计的。这些患者所面临的运动控制问题与灵活性所需的感觉运动整合效率低下有关。各种感觉运动手臂和手部能力，如选择性运动速度、进行精确目标导向手臂运动的能力、协调视觉引导运动的能力、稳定性和手指灵活性，都有助于我们在日常生活中的“灵活性”。所有这些能力在轻度至中度麻痹导致局灶性残疾的中风患者中都存在缺陷。AAT通过八项不同任务，在个体的表现极限水平上明确且重复地训练所有这些感觉运动能力；它还设置了各种任务难度级别，并以间歇性结果知识的形式整合增强反馈。两项随机对照试验的证据表明，AAT在促进“灵活性”恢复以及减少轻度至中度手臂麻痹的中风患者局灶性残疾方面具有临床有效性。此外，研究表明其效果优于时间等效的“最佳传统疗法”。此外，对健康受试者的研究表明，AAT能诱导显著的感觉运动学习。观察到的学习动态表明，不同的潜在感觉运动手臂和手部能力得到了训练。训练增强的能力部分可被双臂使用。非侵入性脑刺激实验和功能磁共振成像数据表明，在训练早期，皮质感觉运动网络区域参与了AAT诱导的学习，但因训练任务不同而有所差异。经过2至3周的长期训练后，似乎是皮层下结构发挥了作用。虽然在健康志愿者和患者中观察到了训练反应的行为相似性，但在皮质下中风幸存者中，训练诱导的功能重组独特地涉及同侧运动前皮质，这是对该二级运动区域的适应性招募。因此，健康受试者和脑损伤受试者中训练诱导的可塑性不一定相同。
