Modified Constraint-Induced Therapy Combined With Mental Practice Thinking Through Better Motor Outcomes
Modified Constraint-Induced Therapy Combined With Mental Practice Thinking Through Better Motor Outcomes
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DOI：
10.1161/strokeaha.108.528760
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发表时间：
2009-02-01
期刊：
影响因子：
8.3
通讯作者：
Khoury, Jane C.
中科院分区：
文献类型：
--
作者：
Page, Stephen J.;Levine, Peter;Khoury, Jane C.
背景和目的改良的强制诱导疗法(MCIT)是一种门诊疗法，鼓励对受影响的手臂进行重复的、特定任务的练习。MCIT在卒中后各阶段均显示出疗效。鉴于其与其他治疗方案相结合的有效性，目前的研究检验了心理练习与MCIT相结合时的有效性，而MCIT仅使用随机、对照的方法。方法：10例慢性卒中患者(男性7例，平均年龄61.4±-3.02岁；年龄48~79岁；平均卒中起病时间28.5个月；13~42个月)，表现出稳定的、受影响的手臂运动障碍，接受MCIT治疗，包括：(1)结构性治疗，强调受影响的手臂在10周内每周3天进行功能活动；(2)较少受影响的手臂束缚，每周5天，持续5小时。这两种成分都是在10周内服用的。随机分配到MCIT+心理练习实验条件的受试者也在治疗后直接接受30分钟的心理练习。这些心理练习需要每天对在MCIT临床会议期间练习的日常生活活动进行认知排练。结果-在任何人口统计变量或运动尺度上，组之间没有发现预先存在的差异。所有受试者在受影响的手臂损伤和功能限制方面都有明显的减少。然而，MCIT+心理训练组的两项运动测量在干预后的变化明显更大：动作研究性手臂测试，仅MCIT组的+15.4分与+8.4分的变化(P
Background and Purpose-Modified constraint-induced therapy (mCIT) is an outpatient therapy encouraging repetitive, task-specific practice with the affected arm. mCIT has shown efficacy in all stages poststroke. Given its efficacy when combined with other therapy regimens, the current study examined the efficacy of mental practice when combined with mCIT versus mCIT only using randomized, controlled methods. Method-Ten patients with chronic stroke (7 males; mean age, 61.4 +/- 3.02 years; age range, 48 to 79 years; mean time since stroke, 28.5 months; range, 13 to 42 months) exhibiting stable, affected arm motor deficits were administered mCIT, consisting of: (1) structured therapy emphasizing affected arm use in functional activities 3 days/week for 10 weeks; and (2) less affected arm restraint 5 days/week for 5 hours. Both of these components were administered during a 10-week period. Subjects randomly assigned to the mCIT+mental practice experimental condition also received 30-minute mental practice sessions provided directly after therapy sessions. These mental practice sessions required daily cognitive rehearsal of the activities of daily living practiced during mCIT clinical sessions. Results-No pre-existing differences were found between groups on any demographic variable or movement scale. All subjects exhibited marked reductions in affected arm impairment and functional limitation. However, subjects in the mCIT+mental practice group exhibited significantly larger changes on both movement measures after intervention: Action Research Arm Test, +15.4-point change versus +8.4-point change for mCIT only subjects (P