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管理体感障碍的当前临床实践和中风康复中的技术应用。

Current clinical practice in managing somatosensory impairments and the use of technology in stroke rehabilitation.

机构信息

Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore.

Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.

出版信息

PLoS One. 2022 Aug 11;17(8):e0270693. doi: 10.1371/journal.pone.0270693. eCollection 2022.

Abstract

Stroke-induced somatosensory impairments seem to be clinically overlooked, despite their prevalence and influence on motor recovery post-stroke. Interest in technology has been gaining traction over the past few decades as a promising method to facilitate stroke rehabilitation. This questionnaire-based cross-sectional study aimed to identify current clinical practice and perspectives on the management of somatosensory impairments post-stroke and the use of technology in assessing outcome measures and providing intervention. Participants were 132 physiotherapists and occupational therapists currently working with stroke patients in public hospitals and rehabilitation centres in Singapore. It was found that the majority (64.4%) of the therapists spent no more than half of the time per week on somatosensory interventions. Functional or task-specific training was the primary form of intervention applied to retrain somatosensory functions in stroke survivors. Standardised assessments (43.2%) were used less frequently than non-standardised assessments (97.7%) in clinical practice, with the sensory subscale of the Fugl-Meyer Assessment being the most popular outcome measure, followed by the Nottingham Sensory Assessment. While the adoption of technology for assessment was relatively scarce, most therapists (87.1%) reported that they have integrated technology into intervention. There was a common agreement that proprioception is an essential component in stroke rehabilitation, and that robotic technology combined with conventional therapy is effective in enhancing stroke rehabilitation, particularly for retraining proprioception. Most therapists identified price, technology usability, and lack of available space as some of the biggest barriers to integrating robotic technology in stroke rehabilitation. Standardised assessments and interventions targeting somatosensory functions should be more clearly delineated in clinical guidelines. Although therapists were positive about technology-based rehabilitation, obstacles that make technology integration challenging ought to be addressed.

摘要

脑卒中引起的感觉障碍在临床上似乎被忽视了,尽管它们很普遍,而且会对脑卒中后的运动康复产生影响。过去几十年来,人们对技术的兴趣与日俱增,将其作为促进脑卒中康复的一种有前途的方法。这项基于问卷的横断面研究旨在确定目前脑卒中后感觉障碍管理的临床实践和观点,以及技术在评估结果和提供干预措施方面的应用。参与者是 132 名物理治疗师和职业治疗师,他们目前在新加坡的公立医院和康复中心与脑卒中患者一起工作。研究发现,大多数(64.4%)治疗师每周用于感觉障碍干预的时间不超过一半。功能性或任务特定的训练是应用于脑卒中幸存者感觉功能再训练的主要干预形式。标准化评估(43.2%)在临床实践中比非标准化评估(97.7%)使用得更少,其中 Fugl-Meyer 评估的感觉分量表是最受欢迎的结果测量方法,其次是诺丁汉感觉评估。虽然评估中采用技术的情况相对较少,但大多数治疗师(87.1%)报告说他们已经将技术整合到干预中。大多数治疗师一致认为,本体感觉是脑卒中康复的一个重要组成部分,机器人技术与常规疗法相结合可以有效地增强脑卒中康复,特别是对本体感觉的再训练。大多数治疗师认为,价格、技术可用性和缺乏可用空间是将机器人技术整合到脑卒中康复中的一些最大障碍。临床指南中应更明确地规定针对感觉功能的标准化评估和干预措施。尽管治疗师对基于技术的康复持积极态度,但应该解决使技术集成具有挑战性的障碍。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b6e8/9371309/4d1a728ec612/pone.0270693.g001.jpg

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