Dos Anjos Sarah, Bowman Mary, Morris David
Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
Brain Sci. 2025 Jan 17;15(1):87. doi: 10.3390/brainsci15010087.
BACKGROUND/AIM: Currently, there are limited evidence-based protocols for improving upper extremity (UE) motor function after stroke. The Keys protocol, a distributed form of constraint-induced movement therapy (CIMT), delivers CIMT components in fewer hours per day over an extended period, fitting outpatient rehabilitation schedules and third-party payor models. This pilot study aimed to assess the effectiveness of the Keys protocol in enhancing UE capacity and performance poststroke.
Ten adults with chronic stroke (>6 months) participated in an 8-week intervention. The protocol included 22 supervised training sessions (1.5 h each): 4 days/week for 4 weeks, 2 days/week for weeks 5-6, and 1 day/week for weeks 7-8. Participants wore a restraint mitt on the less-affected UE during waking hours and used an adapted transfer package. Outcome measures included the Motor Activity Log (MAL), Wolf Motor Function Test (WMFT), Stroke Impact Scale (SIS), and Zung Depression Scale, assessed pre-treatment, mid-treatment (4 weeks), and posttreatment.
Significant improvements were observed in SIS Strength, ADLs/IADLs, Mobility, and Hand Function domains, exceeding MCID thresholds. Memory and Communication domains improved significantly at the 3-month follow-up. WMFT performance times improved, with fewer incomplete tasks. MAL scores for Amount of Use and Quality of Movement increased across all time points. Depressive symptoms significantly decreased posttreatment.
The Keys protocol effectively improves UE use, motor function, mood, and quality of life, with the greatest gains observed mid-intervention. These findings support its feasibility and potential for outpatient stroke rehabilitation (ClinicalTrials.gov Registration: NCT05311384).
背景/目的：目前，关于改善中风后上肢运动功能的循证方案有限。Keys方案是一种分布式的强制性使用运动疗法（CIMT），在较长时间内每天提供较少时长的CIMT组件，适合门诊康复计划和第三方支付模式。这项初步研究旨在评估Keys方案在增强中风后上肢能力和表现方面的有效性。
10名患有慢性中风（>6个月）的成年人参与了为期8周的干预。该方案包括22次有监督的训练课程（每次1.5小时）：第1至4周每周4天，第5至6周每周2天，第7至8周每周1天。参与者在清醒时间佩戴患侧上肢的约束手套，并使用改良的转移工具。结果测量包括运动活动日志（MAL）、沃尔夫运动功能测试（WMFT）、中风影响量表（SIS）和zung抑郁量表，在治疗前、治疗中期（4周）和治疗后进行评估。
在SIS的力量、日常生活活动/工具性日常生活活动、活动能力和手功能领域观察到显著改善，超过了最小临床重要差异阈值。在3个月的随访中，记忆和沟通领域有显著改善。WMFT的表现时间有所改善，未完成任务减少。MAL的使用量和运动质量得分在所有时间点均有所增加。治疗后抑郁症状显著减轻。
Keys方案有效改善了上肢使用、运动功能、情绪和生活质量，在干预中期取得了最大的改善。这些发现支持了其在门诊中风康复中的可行性和潜力（ClinicalTrials.gov注册号：NCT05311384）。
