Community-Based Exercise for Upper Limb Paresis: A Controlled Trial With Telerehabilitation
Community-Based Exercise for Upper Limb Paresis: A Controlled Trial With Telerehabilitation
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DOI：
10.1177/1545968314521003
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发表时间：
2014-09-01
影响因子：
4.2
通讯作者：
Weinrich, Michael
中科院分区：
文献类型：
--
作者：
Benvenuti, Francesco;Stuart, Mary;Weinrich, Michael
背景尽管进行了最好的常规康复治疗，手臂麻痹仍然是卒中后的主要损伤。密集运动计划的随机对照试验表明，慢性卒中患者的手臂功能得到改善。然而，所取得的收益相对于患者和治疗师时间的大量投资而言相对温和。objective.评估慢性卒中患者上肢轻瘫社区锻炼计划的安全性、可接受性、依从性和有效性，以及通过社区分布的信息亭进行远程康复监测的效果。方法.纵向队列与地理对照组。实验组接受了基于卡尔和谢泼德"运动学习计划"的家庭锻炼计划所需的设备，并被指示每周至少在信息亭练习两次，每周至少在家练习3天。对照组给予常规护理。结果与对照组相比，实验组的患者表现出手臂功能的显着增益，通过Wolf运动功能测试，9孔钉测试，运动指数，和诺丁汉日常生活扩展活动问卷测量。该干预措施获得了很高的满意度，没有产生不良事件。只有30%的受试者经常光顾售货亭。这一组的结果与那些只在家里练习的人没有显著差异。结论.家庭和社区为基础的手臂轻瘫运动是安全和有效的。远程康复干预措施需要进一步加强，以提高有效性。中风后最佳上肢运动处方仍有待建立。
Background. Arm paresis remains a major impairment after stroke despite the best conventional rehabilitation. Randomized, controlled trials of intensive exercise programs have demonstrated improvements in arm function for patients with chronic stroke. However, the gains achieved have been relatively modest for the large investments in patient and therapist time. Objective. To evaluate the safety, acceptance, adherence, and effectiveness of a community-based exercise program for upper limb paresis in patients with chronic stroke and the effects of telerehabilitation monitoring in kiosks distributed through the community. Methods. Longitudinal cohort with geographic control group. The experimental group received devices needed for a home exercise program based on the Carr and Shepherd "Motor Learning Program" and were instructed to practice the exercises at least twice a week at the kiosk and at least 3 more days a week at home. The control group received usual care. Results. Compared with the control group, patients in the experimental group demonstrated significant gains in arm function as measured by the Wolf Motor Function Test, 9-Hole Peg Test, Motricity Index, and Nottingham Extended Activities of Daily Living Questionnaire. The intervention received high satisfaction ratings and produced no adverse events. Only 30% of the subjects attended kiosks regularly. Outcomes for this group did not differ significantly from those who only practiced at home. Conclusions. Home-and community-based exercise for arm paresis is safe and effective. Telerehabilitation interventions will need additional enhancements to improve effectiveness. The optimal upper extremity exercise prescription poststroke remains to be established.