Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers University, The State University of New Jersey, 65 Bergen Street, Newark, NJ, 07107, USA.
Movement Neuroscience Laboratory, Department of Physical Therapy, Bouve College of Health Sciences, Movement and Rehabilitation Science, Northeastern University, 308C Robinson Hall - 360 Huntington Avenue, Boston, MA, 02115, USA.
J Neuroeng Rehabil. 2019 Jul 17;16(1):92. doi: 10.1186/s12984-019-0563-3.
There is conflict regarding the benefits of greater amounts of intensive upper limb rehabilitation in the early period post-stroke. This study was conducted to test the feasibility of providing intensive therapy during the early period post-stroke and to develop a randomized control trial that is currently in process. Specifically, the study investigated whether an additional 8 h of specialized, intensive (200-300 separate hand or arm movements per hour) virtual reality (VR)/robotic based upper limb training introduced within 1-month post-stroke resulted in greater improvement in impairment and behavior, and distinct changes in cortical reorganization measured via Transcranial Magnetic Stimulation (TMS), compared to that of a control group.
Seven subjects received 8-1 h sessions of upper limb VR/robotic training in addition to their inpatient therapy (PT, OT, ST). Six subjects only received their inpatient therapy. All were tested on measures of impairment [Upper Extremity Fugl-Meyer Assessment (UEFMA), Wrist AROM, Maximum Pinch Force], behavior [Wolf Motor Function Test (WMFT)], and also received TMS mapping until 6 months post training. ANOVAs were conducted to measure differences between groups across time for all outcome measures. Associations between changes in ipsilesional cortical maps during the early period of enhanced neuroplasticity and long-term changes in upper limb impairment and behavior measures were evaluated.
The VR/robotic group made significantly greater improvements on UEFMA and Wrist AROM scores compared to the usual care group. There was also less variability in the association between changes in the First Dorsal Interosseus (FDI) muscle map area and WMFT and Maximum Force change scores for the VR/robotic group.
An additional 8 h of intensive VR/robotic based upper limb training initiated within the first month post-stroke may promote greater gains in impairment compared to usual care alone. Importantly, the data presented demonstrated the feasibility of conducting this intervention and multiple outcome measures (impairment, behavioral, neurophysiological) in the early period post-stroke.
在脑卒中后早期，增加高强度上肢康复治疗的益处存在争议。本研究旨在测试在脑卒中后早期提供强化治疗的可行性，并开展一项正在进行的随机对照试验。具体而言，该研究调查了在脑卒中后 1 个月内引入额外 8 小时的专门的、高强度（每小时 200-300 次手部或手臂单独运动）虚拟现实（VR）/机器人辅助上肢训练是否会导致损伤和行为方面的更大改善，以及通过经颅磁刺激（TMS）测量的皮质重组的明显变化，与对照组相比。
7 名受试者在接受常规治疗（PT、OT、ST）的基础上，额外接受 8-1 小时的上肢 VR/机器人训练。6 名受试者仅接受常规治疗。所有受试者均接受损伤评估[上肢 Fugl-Meyer 评估（UEFMA）、腕部 AROM、最大捏力]、行为评估[Wolf 运动功能测试（WMFT）]，并在训练后 6 个月进行 TMS 映射。进行方差分析以测量所有结果测量指标在两组之间的随时间变化差异。评估增强神经可塑性早期阶段同侧皮质图的变化与上肢损伤和行为测量的长期变化之间的关系。
VR/机器人组在 UEFMA 和腕部 AROM 评分上的改善明显大于常规护理组。VR/机器人组在第一背侧骨间肌（FDI）肌肉图面积与 WMFT 和最大力变化评分之间的变化之间的关联的变异性也较小。
在脑卒中后第一个月内额外增加 8 小时的强化 VR/机器人辅助上肢训练可能会比单独常规护理获得更大的损伤改善。重要的是，所呈现的数据证明了在脑卒中后早期进行这种干预和多个结果测量（损伤、行为、神经生理学）的可行性。
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