Maenza Candice, Wagstaff David A, Varghese Rini, Winstein Carolee, Good David C, Sainburg Robert L
Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA, United States.
Department of Kinesiology, Pennsylvania State University, State College, PA, United States.
Front Hum Neurosci. 2021 Mar 12;15:645714. doi: 10.3389/fnhum.2021.645714. eCollection 2021.
The ipsilesional arm of stroke patients often has functionally limiting deficits in motor control and dexterity that depend on the side of the brain that is lesioned and that increase with the severity of paretic arm impairment. However, remediation of the ipsilesional arm has yet to be integrated into the usual standard of care for upper limb rehabilitation in stroke, largely due to a lack of translational research examining the effects of ipsilesional-arm intervention. We now ask whether ipsilesional-arm training, tailored to the hemisphere-specific nature of ipsilesional-arm motor deficits in participants with moderate to severe contralesional paresis, improves ipsilesional arm performance and generalizes to improve functional independence. We assessed the effects of this intervention on ipsilesional arm unilateral performance [Jebsen-Taylor Hand Function Test (JHFT)], ipsilesional grip strength, contralesional arm impairment level [Fugl-Meyer Assessment (FM)], and functional independence [Functional independence measure (FIM)] ( = 13). Intervention occurred over a 3 week period for 1.5 h/session, three times each week. All sessions included virtual reality tasks that targeted the specific motor control deficits associated with either left or right hemisphere damage, followed by graded dexterity training in real-world tasks. We also exposed participants to 3 weeks of sham training to control for the non-specific effects of therapy visits and interactions. We conducted five test-sessions: two pre-tests and three post-tests. Our results indicate substantial improvements in the less-impaired arm performance, without detriment to the paretic arm that transferred to improved functional independence in all three posttests, indicating durability of training effects for at least 3 weeks. We provide evidence for establishing the basis of a rehabilitation approach that includes evaluation and remediation of the ipsilesional arm in moderately to severely impaired stroke survivors. This study was originally a crossover design; however, we were unable to complete the second arm of the study due to the COVID-19 pandemic. We report the results from the first arm of the planned design as a longitudinal study.
中风患者的患侧上肢在运动控制和灵活性方面往往存在功能受限的缺陷，这些缺陷取决于受损的脑半球，并且随着患侧上肢麻痹程度的加重而增加。然而，患侧上肢的康复治疗尚未纳入中风上肢康复的常规标准护理中，这主要是由于缺乏关于患侧上肢干预效果的转化研究。我们现在要问，针对中度至重度对侧麻痹参与者患侧上肢运动缺陷的半球特异性特点进行的患侧上肢训练，是否能改善患侧上肢的表现，并推广至改善功能独立性。我们评估了这种干预对患侧上肢单侧表现[杰布森-泰勒手功能测试（JHFT）]、患侧握力、对侧上肢损伤程度[Fugl-Meyer评估（FM）]以及功能独立性[功能独立性测量（FIM）]的影响（n = 13）。干预为期3周，每次1.5小时，每周三次。所有疗程都包括针对与左半球或右半球损伤相关的特定运动控制缺陷的虚拟现实任务，随后是现实任务中的分级灵活性训练。我们还让参与者接受了3周的假训练，以控制治疗就诊和互动的非特异性影响。我们进行了五次测试疗程：两次预测试和三次后测试。我们的结果表明，受损较轻的上肢表现有显著改善，且对麻痹上肢无害，这在所有三次后测试中都转化为功能独立性的提高，表明训练效果至少持续3周。我们为建立一种康复方法提供了证据，该方法包括对中度至重度受损中风幸存者患侧上肢的评估和康复治疗。这项研究原本是交叉设计；然而，由于新冠疫情，我们无法完成研究的第二部分。我们将计划设计中第一部分的结果作为纵向研究报告。
