Rungseethanakul Somchanok, Tretriluxana Jarugool, Piriyaprasarth Pagamas, Pakaprot Narawut, Jitaree Khanitha, Tretriluxana Suradej, Danoff Jerome V
Motor Control and Neural Plasticity Laboratory, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand.
Faculty of Medicine Siriraj Hospital, Mahidol University, Wang Lang, Thailand.
Top Stroke Rehabil. 2022 May;29(4):241-254. doi: 10.1080/10749357.2021.1926136. Epub 2021 Jul 28.
Task-oriented training with upper extremity (UE) skilled movements has been established as a method to regain function post stroke. Although improved UE function has been shown after this type of therapy, there is minimal evidence that brain plasticity is associated with this training. The accelerated skill acquisition program (ASAP) is an example of an approach for promoting UE function using targeting movements.
To investigate the effects of a single 2-hour session of ASAP in individuals with stroke on measures of brain plasticity as represented by corticospinal excitability (CE) and determine associations with reach-to-grasp (RTG) performance.
Eighteen post-acute stroke patients were randomized to two groups. Experimental group (n = 9) underwent ASAP for 2 hours, while the control group (n = 9) received dose equivalent usual and customary care. Both groups were evaluated for CE and RTG performance prior to the session and then four times after training: immediately, 1 day, 6 days, and 12 days.
Significant alterations in CE were found in the peak-to-peak of Motor Evoked Potential amplitude of elbow and wrist extensor muscles in the lesioned hemisphere. The experimental group also demonstrated improved execution (shortened total movement time, TMT), feed-forward mechanism (deceleration time, DT) and planning (lengthened relative time to maximum hand aperture, RTApmax) compared to the control group.
Alterations in brain plasticity occur concurrently with improvements in RTG performance in post-acute stroke patients with mild impairment after a single 2-hour session of task-oriented training and persist for at least 12 days.
上肢（UE）技能运动的任务导向训练已被确立为中风后恢复功能的一种方法。尽管这种类型的治疗后上肢功能有所改善，但几乎没有证据表明脑可塑性与这种训练有关。加速技能习得计划（ASAP）是一种使用目标导向运动促进上肢功能的方法示例。
研究单次2小时的ASAP训练对中风患者脑可塑性指标（以皮质脊髓兴奋性（CE）表示）的影响，并确定其与抓握动作（RTG）表现的相关性。
18名急性中风后患者被随机分为两组。实验组（n = 9）接受2小时的ASAP训练，而对照组（n = 9）接受等效剂量的常规护理。两组在训练前均评估CE和RTG表现，训练后立即、1天、6天和12天各评估一次。
在患侧半球的肘和腕伸肌运动诱发电位峰峰值的CE中发现了显著变化。与对照组相比，实验组在执行（缩短总运动时间，TMT）、前馈机制（减速时间，DT）和计划（延长相对最大手开度时间，RTApmax）方面也有改善。
在单次2小时的任务导向训练后，轻度受损的急性中风后患者的脑可塑性变化与RTG表现的改善同时发生，并持续至少12天。
