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机器人辅助治疗与强制性运动疗法对中风后运动恢复的影响:一项随机临床试验的结果

Robot-Assisted Therapy and Constraint-Induced Movement Therapy for Motor Recovery in Stroke: Results From a Randomized Clinical Trial.

作者信息

Terranova Thais Tavares, Simis Marcel, Santos Artur César Aquino, Alfieri Fábio Marcon, Imamura Marta, Fregni Felipe, Battistella Linamara Rizzo

机构信息

Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.

Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States.

出版信息

Front Neurorobot. 2021 Jul 21;15:684019. doi: 10.3389/fnbot.2021.684019. eCollection 2021.

Abstract

Stroke is one of the leading causes of adult disability, and up to 80% of stroke survivors undergo upper extremity motor dysfunction. Constraint-Induced Movement Therapy (CIMT) and Robot-Assisted Therapy (RT) are used for upper limb stroke rehabilitation. Although CIMT and RT are different techniques, both are beneficial; however, their results must be compared. The objective is to establish the difference between RT and CIMT after a rehabilitation program for chronic stroke patients. This is a randomized clinical trial, registered at ClinicalTrials.gov (ID number NCT02700061), in which patients with stroke received sessions of RT or CIMT protocol, combined with a conventional rehabilitation program for 12 weeks. The primary outcome was measured by Wolf Motor Function Test (WMFT) and Fugl-Meyer Assessment-Upper Limb (FMA-UL). Activities of daily living were also assessed. Fifty one patients with mild to moderate upper limb impairment were enrolled in this trial, 25 women and 26 men, mean age of 60,02 years old (SD 14,48), with 6 to 36 months after stroke onset. Function significantly improved regardless of the treatment group. However, no statistical difference was found between both groups as -values of the median change of function measured by WMFT and FMA were 0.293 and 0.187, respectively. This study showed that Robotic Therapy (RT) was not different from Constraint-Induced Movement Therapy (CIMT) regardless of the analyzed variables. There was an overall upper limb function, motor recovery, functionality, and activities of daily living improvement regardless of the interventions. At last, the combination of both techniques should be considered in future studies.

摘要

中风是成人残疾的主要原因之一,高达80%的中风幸存者存在上肢运动功能障碍。强制性运动疗法(CIMT)和机器人辅助疗法(RT)用于上肢中风康复。尽管CIMT和RT是不同的技术,但两者都有益处;然而,必须对它们的效果进行比较。目的是确定慢性中风患者康复计划后RT和CIMT之间的差异。这是一项在ClinicalTrials.gov注册的随机临床试验(注册号NCT02700061),中风患者接受RT或CIMT方案治疗,并结合传统康复计划,为期12周。主要结局通过Wolf运动功能测试(WMFT)和Fugl-Meyer上肢评估(FMA-UL)进行测量。还评估了日常生活活动能力。51例轻度至中度上肢功能障碍患者纳入本试验,25例女性和26例男性,平均年龄60.02岁(标准差14.48),中风发病后6至36个月。无论治疗组如何,功能均有显著改善。然而,两组之间未发现统计学差异,因为WMFT和FMA测量的功能中位数变化的P值分别为0.293和0.187。本研究表明,无论分析的变量如何,机器人疗法(RT)与强制性运动疗法(CIMT)并无差异。无论采用何种干预措施,上肢功能、运动恢复、功能能力和日常生活活动能力均有整体改善。最后,未来研究应考虑两种技术的联合应用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9e02/8335542/6bc2b4d44d1e/fnbot-15-684019-g0001.jpg

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