Moss Rehabilitation Research Institute, Elkins Park, PA, USA.
UCLA and California Rehabilitation Institute, Los Angeles, CA, USA.
Neurorehabil Neural Repair. 2023 Feb-Mar;37(2-3):131-141. doi: 10.1177/15459683231159660. Epub 2023 Mar 6.
Enhanced neural plasticity early after stroke suggests the potential to improve outcomes with intensive rehabilitation therapy. Most patients do not get such therapy, however, due to limited access, changing rehabilitation therapy settings, low therapy doses, and poor compliance.
To examine the feasibility, safety, and potential efficacy of an established telerehabilitation (TR) program after stroke initiated during admission to an inpatient rehabilitation facility (IRF) and completed in the patient's home.
Participants with hemiparetic stroke admitted to an IRF received daily TR targeting arm motor function in addition to usual care. Treatment consisted of 36, 70-minute sessions (half supervised by a licensed therapist via videoconference), over a 6-week period, that included functional games, exercise videos, education, and daily assessments.
Sixteen participants of 19 allocated completed the intervention (age 61.3 ± 9.4 years; 6 female; baseline Upper Extremity Fugl-Meyer [UEFM] score 35.9 ± 6.4 points, mean ± SD; NIHSS score 4 (3.75, 5.25), median, IQR; intervention commenced 28.3 ± 13.0 days post-stroke). Compliance was 100%, retention 84%, and patient satisfaction 93%; 2 patients developed COVID-19 and continued TR. Post-intervention UEFM improvement was 18.1 ± 10.9 points ( < .0001); Box and Blocks, 22.4 ± 9.8 blocks ( = .0001). Digital motor assessments, acquired daily in the home, were concordant with these gains. The dose of rehabilitation therapy received as usual care during this 6-week interval was 33.9 ± 20.3 hours; adding TR more than doubled this to 73.6 ± 21.8 hours ( < .0001). Patients enrolled in Philadelphia could be treated remotely by therapists in Los Angeles.
These results support feasibility, safety, and potential efficacy of providing intense TR therapy early after stroke.
clinicaltrials.gov; NCT04657770.
中风后早期增强的神经可塑性表明，通过强化康复治疗有可能改善预后。然而，由于可及性有限、康复治疗环境的变化、治疗剂量低以及依从性差，大多数患者无法获得这种治疗。
研究在中风患者入住住院康复机构（IRF）期间开始并在患者家中完成的既定远程康复（TR）计划的可行性、安全性和潜在疗效。
入住 IRF 的偏瘫中风患者接受每日 TR 治疗，以靶向手臂运动功能，同时接受常规护理。治疗包括 6 周内 36 次 70 分钟的疗程（由经过许可的治疗师通过视频会议进行一半监督），包括功能游戏、运动视频、教育和日常评估。
19 名分配患者中有 16 名完成了干预（年龄 61.3±9.4 岁；6 名女性；基线上肢 Fugl-Meyer [UEFM] 评分 35.9±6.4 分，平均值±标准差；NIHSS 评分 4（3.75，5.25），中位数，IQR；干预开始于中风后 28.3±13.0 天）。依从性为 100%，保留率为 84%，患者满意度为 93%；2 名患者感染了 COVID-19，但仍继续进行 TR。干预后 UEFM 改善了 18.1±10.9 分（ < .0001）；Box and Blocks 增加了 22.4±9.8 个（ = .0001）。在家中每天采集的数字运动评估结果与这些改善结果一致。在这 6 周的时间内，作为常规护理接受的康复治疗剂量为 33.9±20.3 小时；而加入 TR 则将其增加了一倍多，达到 73.6±21.8 小时（ < .0001）。费城的患者可以由洛杉矶的治疗师进行远程治疗。
这些结果支持在中风后早期提供强化 TR 治疗的可行性、安全性和潜在疗效。
clinicaltrials.gov；NCT04657770。
