卒中后的运动康复：欧洲卒中组织（ESO）基于共识的定义和指导框架。
Motor rehabilitation after stroke: European Stroke Organisation (ESO) consensus-based definition and guiding framework.
机构信息
Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA.
出版信息
Eur Stroke J. 2023 Dec;8(4):880-894. doi: 10.1177/23969873231191304. Epub 2023 Aug 7.
PURPOSE
To propose a consensus-based definition and framework for motor rehabilitation after stroke.
METHODS
An expert European working group reviewed the literature, attaining internal consensus after external feedback.
FINDINGS
Motor rehabilitation is defined as a process that engages people with stroke to benefit their motor function, activity capacity and performance in daily life. It is necessary for people with residual motor disability whose goal is to enhance their functioning, independence and participation. Motor rehabilitation operates through learning- and use-dependent mechanisms. The trajectory of motor recovery varies across patients and stages of recovery. Early behavioral restitution of motor function depends on spontaneous biological mechanisms. Further improvements in activities of daily living are achieved by compensations. Motor rehabilitation is guided by regular assessment of motor function and activity using consensus-based measures, including patient-reported outcomes. Results are discussed with the patient and their carers to set personal goals. During motor rehabilitation patients learn to optimize and adapt their motor, sensory and cognitive functioning through appropriately dosed repetitive, goal-oriented, progressive, task- and context-specific training. Motor rehabilitation supports people with stroke to maximize health, well-being and quality of life. The framework describes the International Classification of Functioning, Disability and Health in the context of stroke, describes neurobiological mechanisms of behavioral restitution and compensation, and summarizes recommendations for clinical assessment, prediction tools, and motor interventions with strong recommendations from clinical practice guidelines (2016-2022).
CONCLUSIONS
This definition and framework may guide clinical educators, inform clinicians on current recommendations and guidelines, and identify gaps in the evidence base.
目的
提出一种基于共识的脑卒中后运动康复定义和框架。
方法
一个欧洲专家工作组审查了文献，并在外部反馈后达成了内部共识。
发现
运动康复被定义为一个使卒中患者受益于其运动功能、活动能力和日常生活表现的过程。它适用于有残余运动障碍的患者，其目标是增强其功能、独立性和参与度。运动康复通过学习和使用依赖的机制运作。患者的运动康复轨迹因个体差异和康复阶段而异。早期运动功能的行为恢复依赖于自发的生物学机制。进一步提高日常生活活动能力则需要通过代偿来实现。运动康复通过基于共识的测量方法，包括患者报告的结果，定期评估运动功能和活动，以指导康复进程。结果与患者及其照顾者进行讨论，以制定个性化目标。在运动康复过程中，患者通过适当剂量的重复、有针对性、渐进、任务和情境特定的训练，学会优化和适应其运动、感觉和认知功能。运动康复支持卒中患者最大限度地提高健康、幸福感和生活质量。该框架描述了国际功能、残疾和健康分类在卒中背景下的应用，描述了行为恢复和代偿的神经生物学机制，并总结了临床评估、预测工具和运动干预的建议，其中包括来自临床实践指南（2016-2022 年）的强烈推荐。
结论
本定义和框架可以为临床教育者提供指导，为临床医生提供当前推荐和指南的信息，并确定证据基础中的空白。
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