Smedes Fred, Giacometti da Silva Leandro
Department of Physical Therapy, Saxion, University of Applied Sciences, Enschede, The Netherlands; Practice for Physical Therapy: "ten Berge", Losser, The Netherlands.
Department of Physiotherapy, Universidade Luterana do Brasil, Canoas, Brazil; Private Practice (clinic): Luthier - Innovation and Rehabilitation, Porte Alegre, Brazil.
J Bodyw Mov Ther. 2019 Jul;23(3):622-627. doi: 10.1016/j.jbmt.2018.05.003. Epub 2018 May 31.
Over sixteen million people suffer a stroke each year. Stroke is characterized by a one-sided paresis. Upper extremity and hand function are most limited. The current view on "neuro rehabilitation" advocates a constrained induced movement therapy (CIMT) setting. This case report seeks to illustrate the clinical reasoning and the feasibility of applying an alternative approach in patients who are not accepted or not suitable for the constrained induced movement therapy.
A male patient, 68 years of age, developed impairments in his right arm and hand, such as loss of range of motion and strength besides spasticity after a stroke. This resulted in a loss of dexterity in his affected right side and in "disuse" of that arm and hand.
A therapy was designed based upon the Proprioceptive Neuromuscular Facilitation-concept (PNF-concept) and consisting of PNF pattern exercises in a functional task setting with specified PNF-principles of facilitations and PNF-techniques for motor re-learning activities, over a period of six weeks. This resulted in clinical important improvements of wrist extension, grip strength, spasticity, dexterity and patient satisfaction with specific tasks.
The provided comprehensive therapy mimics CIMT and robotics. The approach addresses possibly motor learning effects, cortical reorganization and structural impairments. Proprioceptive Neuromuscular Facilitation (PNF) - diagonal movement patterns have been described as: "having beneficial effects in cortical adaptations and cortical organization resulting in motor learning effects". In cases where CIMT is difficult to apply, a specified PNF-based therapy has shown to be a feasible alternative.
每年有超过1600万人遭受中风。中风的特征是单侧轻瘫。上肢和手部功能受限最为明显。当前对“神经康复”的观点提倡在强制性诱导运动疗法（CIMT）环境下进行治疗。本病例报告旨在说明临床推理以及在不适合或不接受强制性诱导运动疗法的患者中应用另一种方法的可行性。
一名68岁男性患者，中风后右臂和右手出现功能障碍，如运动范围和力量丧失以及痉挛。这导致其患侧右侧灵活性丧失，该手臂和手部出现“废用”。
基于本体感觉神经肌肉促进概念（PNF概念）设计了一种治疗方法，包括在功能任务环境中进行PNF模式练习，并采用特定的PNF促进原则和用于运动再学习活动的PNF技术，为期六周。这导致手腕伸展、握力、痉挛、灵活性以及患者对特定任务的满意度在临床上有了重要改善。
所提供的综合治疗模仿了CIMT和机器人技术。该方法解决了可能的运动学习效应、皮质重组和结构损伤问题。本体感觉神经肌肉促进（PNF）——对角线运动模式已被描述为：“对皮质适应和皮质组织有有益影响，从而产生运动学习效应”。在难以应用CIMT的情况下，特定的基于PNF的治疗已被证明是一种可行的替代方法。
