Kate Madhurika, Kumar K Vijaya, Nayak Akshatha, Shirali Arun
Department of Physiotherapy, Suryadatta Institute of Health Sciences, Pune, Maharashtra, India.
Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
J Neurosci Rural Pract. 2024 Apr-Jun;15(2):238-244. doi: 10.25259/JNRP_416_2023. Epub 2023 Dec 1.
Globally, stroke is known to be one of the major health problems, resulting in disability among an aging population. Rehabilitation is a process of re-learning of skills, lost due to brain injury. Many factors influence motor learning post neurological insult and practice is one of the key factors which influence relearning or reacquisition of lost motor skills. Practice can be varied concerning order (blocked or random), scheduling (massed or distributed), or whole and part practice. The study observed the effect of variations in practice schedules on motor and functional recovery.
Thirty-two acute stroke subjects were recruited and equally divided into two groups (16 in massed and 16 in distributed). Both groups received an accelerated skill acquisition program (ASAP) for six sessions a week for 2 weeks. Pre- and post-outcome measures included stroke rehabilitation assessment of movement (STREAM) for motor recovery, modified Barthel index (MBI) for functional recovery, and brain-derived neurotrophic factor (BDNF) for neuroplasticity.
The median scores of participants in the massed practice group before the intervention, of STREAM total, MBI, and BDNF were 23.5, 19, and 0.65, respectively, whereas post values of STREAM total, MBI, and BDNF were 40.5, 60.5, and 0.75, respectively. The median scores of the distributed practice group of the pre-STREAM total, MBI, and BDNF were 23.5, 6.5, and 0.70, respectively, whereas the post-STREAM total, MBI, and BDNF were 41, 45.5, and 0.80, respectively. -value was reported to be <0.05 while comparing pre- and post-values of STREAM, MBI, and BDNF within both intervention groups. The median change scores of STREAM, MBI, and BDNF reported ≥ 0.05 when compared between the groups.
Both the groups had significant recovery post-intervention designed based on ASAP, about impairment mitigation, pursuing skilled movement leading to significant functional gains. Appropriate timing along with optimal dosage became an active ingredient in functional recovery in acute stroke subjects. The distributed practice might have added effect of spacing, resulting in easier learning and accuracy of skills. The study reveals that distributed practice can be part of regular clinical practice to enhance functional recovery in acute stroke rehabilitation.
在全球范围内，中风是主要的健康问题之一，会导致老年人群体出现残疾。康复是一个重新学习因脑损伤而丧失技能的过程。许多因素会影响神经损伤后的运动学习，而练习是影响重新学习或重新获得丧失的运动技能的关键因素之一。练习在顺序（集中或随机）、安排（集中或分散）或整体与部分练习方面可以有所不同。本研究观察了练习安排的变化对运动和功能恢复的影响。
招募了32名急性中风患者，并将他们平均分为两组（集中练习组16人，分散练习组16人）。两组患者均接受了加速技能习得计划（ASAP），每周进行6次训练，共2周。干预前后的评估指标包括用于评估运动恢复的中风康复运动评估（STREAM）、用于评估功能恢复的改良巴氏指数（MBI）以及用于评估神经可塑性的脑源性神经营养因子（BDNF）。
集中练习组参与者干预前STREAM总分、MBI和BDNF的中位数分别为23.5、19和0.65，而干预后STREAM总分、MBI和BDNF的数值分别为40.5、60.5和0.75。分散练习组干预前STREAM总分、MBI和BDNF的中位数分别为23.5、6.5和0.70，而干预后STREAM总分、MBI和BDNF分别为41、45.5和0.80。在比较两个干预组内STREAM、MBI和BDNF的干预前后数值时，p值<0.05。两组之间STREAM、MBI和BDNF的中位数变化得分比较时p≥0.05。
两组在基于ASAP设计的干预后均有显著恢复，在减轻损伤方面，通过追求熟练运动实现了显著的功能改善。合适的时机与最佳剂量成为急性中风患者功能恢复的有效因素。分散练习可能具有间隔的附加效果，从而使学习更容易且技能更准确。该研究表明，分散练习可以作为常规临床实践的一部分，以促进急性中风康复中的功能恢复。
