Department of Clinical and Motor Neuroscience, UCL Institute of Neurology, London, UK
The National Hospital for Neurology and Neurosurgery, London, UK.
J Neurol Neurosurg Psychiatry. 2019 May;90(5):498-506. doi: 10.1136/jnnp-2018-319954. Epub 2019 Feb 15.
Persistent difficulty in using the upper limb remains a major contributor to physical disability post-stroke. There is a nihilistic view about what clinically relevant changes are possible after the early post-stroke phase. The Queen Square Upper Limb Neurorehabilitation programme delivers high-quality, high-dose, high-intensity upper limb neurorehabilitation during a 3-week (90 hours) programme. Here, we report clinical changes made by the chronic stroke patients treated on the programme, factors that might predict responsiveness to therapy and the relationship between changes in impairment and activity.
Upper limb impairment and activity were assessed on admission, discharge, 6 weeks and 6 months after treatment, with modified upper limb Fugl-Meyer (FM-UL, max-54), Action Research Arm Test (ARAT, max-57) and Chedoke Arm and Hand Activity Inventory (CAHAI, max-91). Patient-reported outcome measures were recorded with the Arm Activity Measure (ArmA) parts A (0-32) and B (0-52), where lower scores are better.
224 patients (median time post-stroke 18 months) completed the 6-month programme. Median scores on admission were as follows: FM-UL = 26 (IQR 16-37), ARAT=18 (IQR 7-33), CAHAI=40 (28-55), ArmA-A=8 (IQR 4.5-12) and ArmA-B=38 (IQR 24-46). The median scores 6 months after the programme were as follows: FM-UL=37 (IQR 24-48), ARAT=27 (IQR 12-45), CAHAI=52 (IQR 35-77), ArmA-A=3 (IQR 1-6.5) and ArmA-B=19 (IQR 8.5-32). We found no predictors of treatment response beyond admission scores.
With intensive upper limb rehabilitation, chronic stroke patients can change by clinically important differences in measures of impairment and activity. Crucially, clinical gains continued during the 6-month follow-up period.
上肢活动困难仍是卒中后躯体残疾的主要原因。人们对卒中后早期阶段可能发生的临床相关变化持虚无主义观点。皇后广场上肢神经康复计划在 3 周（90 小时）的方案中提供高质量、高剂量、高强度的上肢神经康复。在此，我们报告接受该方案治疗的慢性卒中患者的临床变化，以及可能预测治疗反应性的因素，以及损伤和活动之间的变化关系。
在治疗前、出院时、治疗后 6 周和 6 个月时，采用改良上肢 Fugl-Meyer（FM-UL，最高 54）、上肢动作研究测试（ARAT，最高 57）和上肢和手活动量表（CAHAI，最高 91）评估上肢损伤和活动。使用上肢活动测量表（ArmA）的 A 部分（0-32）和 B 部分（0-52）记录患者报告的结果测量，分数越低越好。
224 名患者（卒中后中位时间 18 个月）完成了 6 个月的方案。入院时的中位数评分如下：FM-UL=26（IQR 16-37），ARAT=18（IQR 7-33），CAHAI=40（IQR 28-55），ArmA-A=8（IQR 4.5-12）和 ArmA-B=38（IQR 24-46）。方案结束后 6 个月的中位数评分如下：FM-UL=37（IQR 24-48），ARAT=27（IQR 12-45），CAHAI=52（IQR 35-77），ArmA-A=3（IQR 1-6.5）和 ArmA-B=19（IQR 8.5-32）。我们发现，除了入院评分外，没有治疗反应的预测因素。
通过强化上肢康复，慢性卒中患者在损伤和活动的测量中可以发生有临床意义的变化。至关重要的是，临床获益在 6 个月的随访期间持续存在。
