反向跑步机训练与A型肉毒毒素疗法联合应用对慢性卒中患者步态和平衡的影响：一项前瞻性、单盲、随机对照试验
Combined effects of backward treadmill training and botulinum toxin type A therapy on gait and balance in patients with chronic stroke: A pilot, single-blind, randomized controlled trial.
作者信息
Munari Daniele, Serina Anna, Disarò Jacopo, Modenese Angela, Filippetti Mirko, Gandolfi Marialuisa, Smania Nicola, Picelli Alessandro
机构信息
Department of Neurosciences, Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy.
Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy.
出版信息
NeuroRehabilitation. 2020;46(4):519-528. doi: 10.3233/NRE-203067.
BACKGROUND
Backward walking is recommended to improve the components of physiological gait in neurological disease. Botulinum toxin type A is an effective safe first line-treatment for post-stroke spasticity.
OBJECTIVE
To compare the effects of backward treadmill training (BTT) versus standard forward treadmill training (FTT) on motor impairment in patients with chronic stroke receiving botulinum toxin type A therapy.
METHODS
Eighteen chronic stroke patients were randomly assigned to receive BTT (n = 7) or FTT (n = 11) as adjunct to botulinum toxin type A therapy. A total of twelve 40-minute sessions (3 sessions/week for 4 weeks) of either BTT or FTT were conducted. A blinded assessor evaluated the patients before and after treatment. The primary outcome was the 10-meter Walking Test (10 MWT). Secondary outcomes were the modified Ashworth Scale, gait analysis, and stabilometric assessment.
RESULTS
Between-group comparison showed a significant change on the 10 MWT (P = 0.008) and on stabilometric assessment [length of centre of pressure CoP (P = 0.001) and sway area (P = 0.002) eyes open and length of CoP (P = 0.021) and sway area (P = 0.008) eyes closed] after treatment.
CONCLUSIONS
Greater improvement in gait and balance was noted after BTT than after FTT as an adjunct to botulinum toxin therapy in patients with chronic stroke.
背景
建议倒走以改善神经疾病患者的生理步态组成部分。A型肉毒毒素是治疗中风后痉挛的一种有效且安全的一线治疗方法。
目的
比较倒走跑步机训练（BTT）与标准正走跑步机训练（FTT）对接受A型肉毒毒素治疗的慢性中风患者运动功能障碍的影响。
方法
18名慢性中风患者被随机分配接受BTT（n = 7）或FTT（n = 11）作为A型肉毒毒素治疗的辅助治疗。总共进行12次40分钟的训练（每周3次，共4周），训练方式为BTT或FTT。由一名盲法评估者在治疗前后对患者进行评估。主要结局指标是10米步行测试（10MWT）。次要结局指标包括改良Ashworth量表、步态分析和静态平衡评估。
结果
组间比较显示，治疗后10MWT（P = 0.008）以及静态平衡评估[睁眼时压力中心（CoP）长度（P = 0.001）和摆动面积（P = 0.002），闭眼时CoP长度（P = 0.021）和摆动面积（P = 0.008）]有显著变化。
结论
在慢性中风患者中，作为A型肉毒毒素治疗的辅助手段，BTT后步态和平衡的改善比FTT后更明显。
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