Poststroke motor dysfunction and spasticity - Novel pharmacological and physical treatment strategies
Poststroke motor dysfunction and spasticity - Novel pharmacological and physical treatment strategies
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DOI：
10.2165/00023210-200317150-00004
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发表时间：
2003-01-01
期刊：
影响因子：
6
通讯作者：
Werner, C
中科院分区：
文献类型：
--
作者：
Hesse, S;Werner, C
中风后，大约90%的患者会经历持续的神经运动缺陷，导致残疾和残疾。运动康复的药物和物理治疗策略都可以考虑。在药物治疗方面，当加入物理治疗方案时，可能促进运动恢复的药物包括兴奋剂苯丙胺和哌醋酸甲酯，以及左旋多巴和氟西汀。A型肉毒杆菌毒素在几个安慰剂对照试验中被证明是有效的，并且耐受性良好，用于治疗局灶性上肢和下肢痉挛，尽管还没有证明它可以改善运动功能。局部注射A型肉毒杆菌毒素会抑制乙酰胆碱释放到突触间隙，导致与痉挛畸形相关的肌肉可逆性瘫痪。其他药物，如苯二氮类药物、抗癫痫药物和抗精神病药物，可能会对运动功能产生有害影响，如果可能的话，应该避免使用。在物理策略方面，现代的运动学习概念倾向于一种特定于任务的重复方法，这种方法可以诱导与患者日常生活相关的技能获得。基于习得性不使用概念的CON张力诱导运动疗法、肌电触发的腕部肌肉电刺激、机器人辅助的运动康复以增加治疗强度以及双边练习以促进瘫痪肢体的运动都是上肢康复的例子。带部分体重支持的跑步机训练丰富了腿部康复；自动步态康复可以减轻治疗师所需的繁重工作；以及节奏听觉刺激，应用单独调整的音乐来提高步行速度和对称性。
Following stroke, approximately 90% of patients experience persistent neurological motor deficits that lead to disability and handicap. Both pharmacological and physical treatment strategies for motor rehabilitation may be considered. In terms of pharmacological treatment, drugs that may potentially promote motor recovery when added to a regimen of,physical therapy include the stimulants amphetamine and methylphenidate, as well as levodopa and fluoxetine. Botulinum toxin A has proven effective and well tolerated in several placebo-controlled trials for the treatment of focal upper and lower limb spasticity, although it has not been shown to improve motor function. The focal injection of botulinum toxin A inhibits the release of acetylcholine into the synaptic cleft, resulting in a reversible paresis of the muscles relevant for the spastic deformity. Other drugs, such as benzodiazepines, antiepileptic drugs and antipsychotics, may have detrimental effects on motor function and should be avoided, if possible. With respect to physical strategies, modern concepts of motor learning favour a task-specific repetitive approach that induces skill-acquisition relevant to the patient's daily life. Con strained-induced movement therapy based on the concept of learned non-use, electromyography-triggered electrical stimulation of the wrist muscles, robot-assisted motor rehabilitation to increase therapy intensity and bilateral practice to facilitate the movement of the paretic extremity are examples in upper limb rehabilitation. Lower limb rehabilitation has been enriched by treadmill training with partial bodyweight support, enabling the practice of up to 1000 steps per session; automated gait rehabilitation to relieve the strenuous effort required of the therapist; and rhythmic auditory stimulation, applying individually adjusted music to improve walking speed and symmetry.