De Bruyn Nele, Saenen Leen, Thijs Liselot, Van Gils Annick, Ceulemans Eva, Essers Bea, Lafosse Christophe, Michielsen Marc, Beyens Hilde, Schillebeeckx Fabienne, Alaerts Kaat, Verheyden Geert
Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium.
RevArte-Rehabilitation Hospital Antwerp, Antwerp, Belgium.
Front Neurol. 2020 Dec 4;11:597666. doi: 10.3389/fneur.2020.597666. eCollection 2020.
Somatosensory function plays an important role in motor learning. More than half of the stroke patients have somatosensory impairments in the upper limb, which could hamper recovery. Is sensorimotor upper limb (UL) therapy of more benefit for motor and somatosensory outcome than motor therapy? Randomized assessor- blinded multicenter controlled trial with block randomization stratified for neglect, severity of motor impairment, and type of stroke. 40 first-ever stroke patients with UL sensorimotor impairments admitted to the rehabilitation center. Both groups received 16 h of additional therapy over 4 weeks consisting of sensorimotor ( = 22) or motor ( = 18) UL therapy. Action Research Arm test (ARAT) as primary outcome, and other motor and somatosensory measures were assessed at baseline, post-intervention and after 4 weeks follow-up. No significant between-group differences were found for change scores in ARAT or any somatosensory measure between the three time points. For UL impairment (Fugl-Meyer assessment), a significant greater improvement was found for the motor group compared to the sensorimotor group from baseline to post-intervention [mean (SD) improvement 14.65 (2.19) vs. 5.99 (2.06); = 0.01] and from baseline to follow-up [17.38 (2.37) vs. 6.75 (2.29); = 0.003]. UL motor therapy may improve motor impairment more than UL sensorimotor therapy in patients with sensorimotor impairments in the early rehabilitation phase post stroke. For these patients, integrated sensorimotor therapy may not improve somatosensory function and may be less effective for motor recovery. www.ClinicalTrials.gov, identifier NCT03236376.
体感功能在运动学习中起着重要作用。超过半数的中风患者上肢存在体感障碍，这可能会妨碍恢复。与单纯运动疗法相比，感觉运动上肢（UL）疗法对运动和体感结果是否更有益？采用随机、评估者盲法、多中心对照试验，按忽视情况、运动障碍严重程度和中风类型进行分层区组随机化。40例首次发生中风且上肢存在感觉运动障碍的患者入住康复中心。两组均在4周内接受16小时的额外治疗，治疗内容包括感觉运动（n = 22）或运动（n = 18）上肢疗法。以动作研究臂测试（ARAT）作为主要结局指标，并在基线、干预后和4周随访时评估其他运动和体感指标。在三个时间点，ARAT的变化分数或任何体感指标在组间均未发现显著差异。对于上肢功能障碍（Fugl-Meyer评估），从基线到干预后，运动组的改善明显大于感觉运动组[平均（标准差）改善14.65（2.19）对5.99（2.06）；P = 0.01]，从基线到随访时也是如此[17.38（2.37）对6.75（2.29）；P = 0.003]。在中风后早期康复阶段，上肢存在感觉运动障碍的患者中，上肢运动疗法可能比上肢感觉运动疗法更能改善运动功能障碍。对于这些患者，综合感觉运动疗法可能无法改善体感功能，对运动恢复的效果可能也较差。ClinicalTrials.gov网站，标识符NCT03236376。
