Early Rehabilitation After Stroke: a Narrative Review.
Early Rehabilitation After Stroke: a Narrative Review.
复制标题
DOI：
10.1007/s11883-017-0686-6
复制
发表时间：
2017-11-07
影响因子：
5.8
通讯作者：
Feng W
中科院分区：
文献类型：
--
作者：
Coleman ER;Moudgal R;Lang K;Hyacinth HI;Awosika OO;Kissela BM;Feng W
尽管目前的康复策略，中风仍然是美国残疾的主要原因。中风后早期有一个增强神经可塑性的窗口，在此期间，大脑对损伤的动态反应增强，康复可能特别有效。本综述总结了这种塑料窗存在的证据，以及关于几种卒中领域特异性缺陷的早期康复策略的安全性和有效性的证据。总体而言，中风后前2周的康复试验很少。在非常早期的动员领域，一个大型和一个小型试验发现了中风后24小时内动员患者的潜在危害，只有一个小型试验发现了这样做的好处。对于上肢，在卒中后2周内开始强制性运动治疗似乎有益处。在急性期进行非侵入性脑刺激的证据仍然很少且不确定。对于失语症，证据是混合的，但强化的早期治疗可能对严重失语症患者有益。中风后早期开始的镜子治疗有望减轻忽视。中风后早期治疗吞咽困难的新方法似乎很有前途，但自发改善率高，使其效益难以衡量。卒中后开始康复的最佳时间仍未确定，尽管越来越多的证据表明，至少对于某些缺陷，在卒中的前2周内开始康复策略是有益的。在最初的24小时内开始强化治疗可能是有害的。
Despite current rehabilitative strategies, stroke remains a leading cause of disability in the USA. There is a window of enhanced neuroplasticity early after stroke, during which the brain’s dynamic response to injury is heightened and rehabilitation might be particularly effective. This review summarizes the evidence of the existence of this plastic window, and the evidence regarding safety and efficacy of early rehabilitative strategies for several stroke domain-specific deficits. Overall, trials of rehabilitation in the first 2 weeks after stroke are scarce. In the realm of very early mobilization, one large and one small trial found potential harm from mobilizing patients within the first 24 h after stroke, and only one small trial found benefit in doing so. For the upper extremity, constraint-induced movement therapy appears to have benefit when started within 2 weeks of stroke. Evidence for non-invasive brain stimulation in the acute period remains scant and inconclusive. For aphasia, the evidence is mixed, but intensive early therapy might be of benefit for patients with severe aphasia. Mirror therapy begun early after stroke shows promise for the alleviation of neglect. Novel approaches to treating dysphagia early after stroke appear promising, but the high rate of spontaneous improvement makes their benefit difficult to gauge. The optimal time to begin rehabilitation after a stroke remains unsettled, though the evidence is mounting that for at least some deficits, initiation of rehabilitative strategies within the first 2 weeks of stroke is beneficial. Commencing intensive therapy in the first 24 h may be harmful.
登录
查看更多内容
影响因子：
6.7
作者：
Bernhardt, Julie;Hayward, Kathryn S.;Cramer, Steven C.
通讯作者：
Cramer, Steven C.
影响因子：
11
作者：
de Jong-Hagelstein, M.;van de Sandt-Koenderman, W. M. E.;Visch-Brink, E. G.
通讯作者：
Visch-Brink, E. G.
影响因子：
168.9
作者：
Bernhardt, Julie;Langhorne, Peter;Donnan, Geoffrey
通讯作者：
Donnan, Geoffrey
DOI：
10.1016/j.jstrokecerebrovasdis.2011.03.010
发表时间：
2012-11-01
影响因子：
2.5
作者：
Alexander, Lisa D.;Pettersen, Jacqueline A.;Black, Sandra E.
通讯作者：
Black, Sandra E.
DOI：
10.1044/1092-4388(2012/11-0105
发表时间：
2012-10-01
影响因子：
2.6
作者：
Conklyn, Dwyer;Novak, Eric;Chemali, Kamal
通讯作者：
Chemali, Kamal