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中风后康复中的肢体间耦合:一项初步随机对照试验。

Interlimb coupling in poststroke rehabilitation: a pilot randomized controlled trial.

作者信息

Arya Kamal Narayan, Pandian Shanta, Sharma Abhishek, Kumar Vikas, Kashyap Varun Kumar

机构信息

Department of Occupational Therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India.

Department of Community Medicine, Jamia Hamdard, New Delhi, India.

出版信息

Top Stroke Rehabil. 2020 May;27(4):272-289. doi: 10.1080/10749357.2019.1682368. Epub 2019 Nov 9.

DOI:10.1080/10749357.2019.1682368
PMID:31707972
Abstract

: The interlimb coupling, coordination between the limbs, gets hampered in post-stroke hemiparesis. Most of the poststroke motor regimes primarily focus on the more affected limb.: To develop an interlimb coupling protocol and assess its feasibility and effect on motor recovery, gait and disability among post-stroke subjects.: A pilot randomized controlled, doubled blinded trial: A rehabilitation institute: 50 post-stroke (> 6 months) hemiparetic subjects (Brunnstrom recovery stage ≥ 3) were randomly divided into experimental (n=26) and control (n=24) groups. The 8-week experimental intervention (3 sessions of 1 hour each, per week) comprised activities demanding coordinated, alternate, and rhythmic use of the affected as well as the less-affected limbs. The outcome measures were feasibility of activities, Fugl-Meyer assessment (FMA), Rivermead visual gait assessment (RVGA), Functional ambulation category (FAC) and modified Rankin scale (mRS).: The experimental protocol was found to be feasible by the participants. Post intervention, the experimental group exhibited highly significant difference for FMA (mean difference = 7.12, 95% CI = 5.71 - 8.53, p < 0.001), RVGA reduction (mean difference = - 6.32, 95% CI = 7.51 - 5.13, p < 0.001), and median FAC enhancement (p < 0.001) in comparison to the controls. However, the median mRS level of experimental group did not change significantly (p = 0.056) when compared with the controls.: The interlimb coupling training, a feasible program may enhance recovery of the upper and lower limbs and gait in stroke. Further definitive randomized trials are warranted to validate the present findings.

摘要

肢体间的耦合,即肢体之间的协调性,在中风后偏瘫中会受到损害。大多数中风后的运动疗法主要集中在受影响更严重的肢体上。

为了制定一种肢体间耦合方案,并评估其可行性以及对中风后受试者运动恢复、步态和残疾状况的影响。

一项试点随机对照双盲试验

一家康复机构:50名中风后(超过6个月)偏瘫受试者(Brunnstrom恢复阶段≥3)被随机分为实验组(n = 26)和对照组(n = 24)。为期8周的实验性干预(每周3次,每次1小时)包括要求受影响和受影响较小的肢体进行协调、交替和有节奏使用的活动。结果测量指标包括活动的可行性、Fugl-Meyer评估(FMA)、Rivermead视觉步态评估(RVGA)、功能性步行分类(FAC)和改良Rankin量表(mRS)。

参与者认为实验方案是可行的。干预后,与对照组相比,实验组在FMA方面表现出高度显著差异(平均差异 = 7.12,95%置信区间 = 5.71 - 8.53,p < 0.001),RVGA降低(平均差异 = - 6.32,95%置信区间 = 7.51 - 5.13,p < 0.001),以及FAC中位数提高(p < 0.001)。然而,与对照组相比,实验组的mRS中位数水平没有显著变化(p = 0.056)。

肢体间耦合训练是一个可行的方案,可能会促进中风患者上下肢的恢复和步态改善。有必要进行进一步的确定性随机试验来验证目前的研究结果。

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