Bütefisch C, Hummelsheim H, Denzler P, Mauritz K H
Klinik BERLIN, Department of Neurological Rehabilitation, Free University of Berlin, Germany.
J Neurol Sci. 1995 May;130(1):59-68. doi: 10.1016/0022-510x(95)00003-k.
The effect of a standardized training on movements of the affected hand has been studied in 27 hemiparetic patients using a multiple baseline approach across individuals. The training consisted of repetitive hand and finger flexions and extensions against various loads and was carried out twice daily during 15-min periods. Grip strength (p < 0.006), peak force of isometric hand extensions (p < 0.05), peak acceleration (p < 0.05) of isotonic hand extensions as well as contraction velocities as indicators of motor performance significantly improved during the training period. In contrast to the standardized training of hand and finger movements, therapeutic strategies following the Bobath concept aim at reducing enhanced muscle tone without reinforcing the activity in centrally paretic distal muscle groups directly. Patients undergoing this treatment approach alone did not experience a significant improvement in the motor capacity of the hand. Therefore, the results of the present study emphasize the importance of frequent movement repetition for the motor rehabilitation of the centrally paretic hand and challenge conventional physiotherapeutic strategies that focus on spasticity reduction instead of early initiation of active movements.
采用个体间多基线方法，对27例偏瘫患者进行了标准化训练对患侧手部运动影响的研究。训练包括针对不同负荷进行重复性的手部和手指屈伸，每天进行两次，每次15分钟。握力（p < 0.006）、等长手部伸展的峰值力（p < 0.05）、等张手部伸展的峰值加速度（p < 0.05）以及作为运动表现指标的收缩速度在训练期间均有显著改善。与手部和手指运动的标准化训练不同，遵循Bobath概念的治疗策略旨在降低增强的肌张力，而不是直接增强中枢性瘫痪远端肌肉群的活动。仅接受这种治疗方法的患者手部运动能力并未得到显著改善。因此，本研究结果强调了频繁重复运动对中枢性瘫痪手部运动康复的重要性，并对专注于降低痉挛而非早期启动主动运动的传统物理治疗策略提出了挑战。
