Improvement After Constraint-Induced Movement Therapy: Recovery of Normal Motor Control or Task-Specific Compensation?
Improvement After Constraint-Induced Movement Therapy: Recovery of Normal Motor Control or Task-Specific Compensation?
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DOI：
10.1177/1545968312452631
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发表时间：
2013-02-01
影响因子：
4.2
通讯作者：
Krakauer, John W.
中科院分区：
文献类型：
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作者：
Kitago, Tomoko;Liang, Johnny;Krakauer, John W.
背景限制性运动疗法（CIMT）已被证明在增加慢性卒中患者患臂的功能使用方面有效。CIMT的发病机制尚不清楚。Objective.在一项概念验证研究中，证明使用运动学测量结合临床结局测量的可行性，以更好地了解接受CIMT的轻度至中度运动障碍慢性卒中患者的恢复机制。方法.共有10例慢性卒中患者参加了为期2周的改良CIMT方案。采用行动研究手臂测试（ARAT）、上肢Fugl-Meyer评分（FM-UE）和视觉引导手臂和手腕运动的运动学分析评估治疗反应。所有评估在治疗干预前进行两次，之后进行一次。结果与2次CIMT前治疗之间的变化相比，从第二次CIMT前治疗到CIMT后治疗的ARAT有临床意义的改善。相比之下，FM-UE和运动学测量结果没有显示出有意义的改善。结论.慢性卒中患者CIMT后患臂的功能改善似乎是通过代偿策略介导的，而不是减少损伤或恢复更正常的运动控制。我们建议，未来的大规模研究新的干预措施，神经康复跟踪性能使用运动学分析以及临床尺度。
Background. Constraint-induced movement therapy (CIMT) has proven effective in increasing functional use of the affected arm in patients with chronic stroke. The mechanism of CIMT is not well understood. Objective. To demonstrate, in a proof-of-concept study, the feasibility of using kinematic measures in conjunction with clinical outcome measures to better understand the mechanism of recovery in chronic stroke patients with mild to moderate motor impairments who undergo CIMT. Methods. A total of 10 patients with chronic stroke were enrolled in a modified CIMT protocol over 2 weeks. Treatment response was assessed with the Action Research Arm Test (ARAT), the Upper-Extremity Fugl-Meyer score (FM-UE), and kinematic analysis of visually guided arm and wrist movements. All assessments were performed twice before the therapeutic intervention and once afterward. Results. There was a clinically meaningful improvement in ARAT from the second pre-CIMT session to the post-CIMT session compared with the change between the 2 pre-CIMT sessions. In contrast, FM-UE and kinematic measures showed no meaningful improvements. Conclusions. Functional improvement in the affected arm after CIMT in patients with chronic stroke appears to be mediated through compensatory strategies rather than a decrease in impairment or return to more normal motor control. We suggest that future large-scale studies of new interventions for neurorehabilitation track performance using kinematic analyses as well as clinical scales.