Rehabilitation of arm function after stroke. Literature review
Rehabilitation of arm function after stroke. Literature review
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DOI：
10.1016/j.rehab.2008.10.003
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发表时间：
2009-04-01
影响因子：
4.6
通讯作者：
Pelissier, J. Y.
中科院分区：
文献类型：
--
作者：
Oujamaa, L.;Relave, I.;Pelissier, J. Y.
导言。-在最近的文献中，我们可以找到许多关于中风患者上肢康复的文章。仍在评估中的新技术正在成为卒中后脑可塑性概念的实际应用。-本文献综述侧重于2004至2008年间英文版发表的对照随机研究、综述和荟萃分析。本研究在MEDLINE中进行，检索词为“上肢”、“中风”、“康复”。-我们审查了66项研究。其治疗策略主要有：激活患侧运动皮质，抑制对侧运动皮质，调节感觉传入。保留上肢远端的皮质代表可以防止习得的不使用现象。提出了感觉传入的调控方法：远端皮肤电刺激、健肢麻醉、镜面疗法、虚拟现实。加强康复护理意味着增加偏瘫肢体的康复总时数(本体感觉刺激和重复运动)。这种特定的康复是通过主动辅助模式下的机器人辅助治疗、神经肌肉电刺激和双边任务训练来促进的。在亚急性中风康复期间(6个月)，加强康复训练计划可显著改善手臂功能。视觉神经刺激和心理练习优化了重复手势对轻微运动障碍的效果。健手的对比性神经电刺激或麻醉均可通过减少跨痂抑制来提高偏瘫患者手的灵巧度。这一病理生理机制也可以解释强制诱导运动疗法(CL疗法)在环境环境中对慢性卒中患者的积极影响。-为了确保积极的功能结果，中风康复计划基于以任务为导向的重复训练。这篇文献综述表明，锻炼偏瘫的手和手腕在中风康复计划的所有阶段都是必不可少的。来自神经科学的新数据表明，自发性皮质脊髓兴奋性应该是优先考虑的。(C)2009年爱思唯尔·马森公司。版权所有。
Introduction. - In the recent literature we can find many articles dealing with upper extremity rehabilitation in stroke patients. New techniques, still under evaluation, are becoming the practical applications for the concept of post-stroke brain plasticity.Methods. - This literature review focuses on controlled randomized Studies, reviews and meta-analyses published in the English language from 2004 to 2008. The research was conducted in MEDLINE with the following keywords: "upper limb", "stroke", "rehabilitation".Results. - We reviewed 66 studies. The main therapeutic strategies are: activation of the ipsilesional motor cortex, inhibition of the contralesional motor cortex and modulation of the sensory afferents. Keeping a cortical representation of the upper limb distal extremity could prevent the learned non-use phenomenon. The modulation of sensory afferents is then proposed: distal cutaneous electrosimulation, anesthesia of the healthy limb, mirror therapy, virtual reality. Intensifying the rehabilitation care means increasing the total hours of rehabilitation dedicated to the paretic limb (proprioceptive stimulation and repetitive movements). This specific rehabilitation is facilitated by robot-aided therapy in the active-assisted mode, neuromuscular electrostimulation and bilateral task training. Intensifying the rehabilitation training program significantly improves the arm function outcome when performed during subacute stroke rehabilitation (< six months). Ipsilesional neurostimulation as well as mental practice optimize the effect of repetitive gestures for slight motor impairments. Contralesional neurosimulation or anesthesia of the healthy hand both improve the paretic hand's dexterity via a decrease of the transcallosal inhibition. This pathophysiological mechanism could also explain the positive impact of constraint-induced movement therapy (Cl therapy) in an environmental setting for chronic stroke patients.Conclusion. - To ensure a positive functional outcome, stroke rehabilitation programs are based on task-oriented repetitive training. This literature review shows that exercising the hemiparetic hand and wrist is essential in all stages of a stroke rehabilitation program. New data stemming from neurosciences suggest that ipsilesional corticospinal excitability should be a priority. (C) 2009 Elsevier Masson SAS. All rights reserved.