Watanabe T K, O'Dell M W, Togliatti T J
Department of Physical Medicine and Rehabilitation, University of Cincinnati College of Medicine and Drake Center, Inc., OH, USA.
Arch Phys Med Rehabil. 1998 Jun;79(6):709-14. doi: 10.1016/s0003-9993(98)90049-1.
Conversion disorder is a psychological disturbance that produces subconscious alterations in sensorimotor function. Hysterical hemiparesis is a relatively rare, and difficult to diagnose, form of conversion disorder presenting as unilateral motor weakness with or without sensory deficits. We report four patients who required inpatient rehabilitation for hysterical hemiparesis, a diagnosis for which there is little information regarding rehabilitation management. In all cases, an extensive acute care evaluation including multiple imaging studies failed to identify a new neurologic lesion. All patients had rapid functional improvement using functional and behavioral therapies and extensive psychosocial support (mean length of stay of 11 days; mean Functional Independence Measure [FIM] gain of 22; mean discharge FIM of 112), consistent with other published reports of rehabilitation of conversion disorder. Evaluation of these cases reveals consistencies regarding presentation, psychosocial history, and rehabilitation course that can aid clinicians in making the diagnosis. Rehabilitation strategies for hysterical hemiparesis are reviewed.
转换障碍是一种心理障碍，会导致感觉运动功能出现潜意识改变。癔症性偏瘫是转换障碍中一种相对罕见且难以诊断的形式，表现为单侧运动无力，可伴有或不伴有感觉缺陷。我们报告了4例因癔症性偏瘫需要住院康复治疗的患者，对于这种诊断，关于康复管理的信息很少。在所有病例中，包括多项影像学检查在内的广泛急性护理评估均未发现新的神经病变。所有患者通过功能和行为疗法以及广泛的心理社会支持均实现了快速功能改善（平均住院时间为11天；功能独立性测量量表[FIM]平均提高22分；出院时FIM平均为112分），这与其他已发表的转换障碍康复报告一致。对这些病例的评估揭示了在表现、心理社会病史和康复过程方面的一致性，有助于临床医生进行诊断。本文对癔症性偏瘫的康复策略进行了综述。
