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改良步态和平衡功能在慢性脑卒中患者中的作用:一项随机对照临床试验。

Improvement of gait and balance function in chronic post-stroke patients induced by : a randomized controlled clinical trial.

机构信息

Neurology/Neuroscience program, Federal University, UNIFESP, São Paulo, Brazil.

Adult Physiotherapy Department at Associação de Assistência à Criança com Deficiência, São Paulo, Brazil.

出版信息

Brain Inj. 2024 Jun 6;38(7):559-568. doi: 10.1080/02699052.2024.2328808. Epub 2024 Mar 12.

Abstract

OBJECTIVE

To evaluate the effects of Lower Extremity - Constraint Induced Movement Therapy on gait function and balance in chronic hemiparetic patients.

METHODS

Randomized, controlled, single-blinded study. We recruited chronic post stroke patients and allocated them to Lower Extremity - Constraint Induced Movement Tharapy (LE-CIMT) or Control Group. The LE-CIMT group received this protocol 2.5 hour/day for 15 followed days, including: 1) intensive supervised training, 2) use of shaping as a strategy for motor training, and 3) application of a transfer package. The control group received conventional physiotherapy for 2.5 hours/day for 15 followed days. Outcomes were assessed at baseline, after the interventions, and after 6 months, through 6-minute walk test and Mini-Balance Evaluation Systems Test; 10-meter walk test, Timed Up and Go, 3-D gait analysis, and Lower Extremity - Motor Activity Log.

RESULTS

LE-CIMT was superior on the Assistance and confidence subscale of Lower Extremity - Motor Activity Log, Mini-BESTest and 6-minute walk test. The effect size for all outcomes was small when comparing both groups. LE-CIMT showed clinically significant differences in daily activities, balance, and gait capacity, with no clinically significant difference for spatiotemporal parameters.

CONCLUSION

The LE-CIMT protocol had positive outcomes on balance, performance, and confidence perception.

摘要

目的

评估下肢限制诱导运动疗法对慢性偏瘫患者步态功能和平衡的影响。

方法

随机、对照、单盲研究。我们招募了慢性脑卒中后患者,并将其分配到下肢限制诱导运动疗法(LE-CIMT)组或对照组。LE-CIMT 组接受此方案,每天 2.5 小时,持续 15 天,包括:1)强化监督训练,2)使用塑造作为运动训练策略,3)应用转移方案。对照组每天接受常规物理治疗 2.5 小时,持续 15 天。在基线、干预后和 6 个月时通过 6 分钟步行测试和 Mini-Balance Evaluation Systems Test、10 米步行测试、计时起立行走测试、3D 步态分析和下肢运动活动日志评估结果。

结果

LE-CIMT 在下肢运动活动日志的辅助和信心子量表、Mini-BESTest 和 6 分钟步行测试方面表现更佳。与对照组相比,所有结果的效应量均较小。LE-CIMT 在日常活动、平衡和步态能力方面显示出有临床意义的差异,但在时空参数方面没有临床意义的差异。

结论

LE-CIMT 方案对平衡、表现和信心感知有积极影响。

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