The Effects of Constraint-Induced Therapy on Kinematic Outcomes and Compensatory Movement Patterns: An Exploratory Study
The Effects of Constraint-Induced Therapy on Kinematic Outcomes and Compensatory Movement Patterns: An Exploratory Study
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DOI：
10.1016/j.apmr.2008.09.574
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发表时间：
2009-04-01
影响因子：
4.3
通讯作者：
Thaut, Michael
中科院分区：
文献类型：
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作者：
Massie, Crystal;Malcolm, Matthew P.;Thaut, Michael
马西，马肯，葛林，等。约束诱导治疗对运动结果和代偿运动模式的影响：一项探索性研究。中华医学杂志（英文版）；2009;39(5):571- 579。目的：了解脑卒中幸存者完成约束诱导治疗（CIT）后运动学变量和代偿运动模式的变化。设计：前后，案例系列。单位：临床康复研究实验室。参与者：男性（n=7）和女性（n=3），在研究开始前至少9个月发生单侧中风，伴有中度、稳定的运动缺陷。干预：参与者完成连续10个工作日的CIT，每天6小时，包括培训师监督的、基于功能的活动，使用大量练习。主要观察指标：运动学指标包括运动时间、平均速度、运动轨迹稳定性、肩关节外展和节段贡献。功能测量包括Wolf运动功能测试（WMFT）的表现时间和功能能力得分以及运动活动日志（MAL）的“如何”得分。所有措施均在CIT干预2周前后实施。结果：运动时间、平均速度和运动轨迹稳定性在CIT后显著改善，参与者在CIT后使用更多的肩部屈曲来达到目标，但也表现出增加的代偿性肩部外展。功能评分也有显著提高，包括WMFT表现时间和功能能力以及MAL评分。躯干运动和肘部伸展量没有变化。结论：CIT改善了偏瘫手臂的运动能力，这反映在功能结果和一些运动学指标上。本研究结果表明，虽然CIT后偏瘫臂的功能能力和某些运动策略有所改善，但参与者可能无法克服对常见代偿运动模式的依赖。基于这些发现，本研究表明CIT可能鼓励受试者通过代偿和/或协同主导的运动产生运动，而不是促进运动控制的正常化。这一结果强调了进一步发展CIT作为一种改善功能能力和更规范的运动策略的干预措施的必要性。
Massie C, Malcolm MP, Greene D, Thaut M. The effects of constraint-induced therapy on kinematic outcomes and compensatory movement patterns: an exploratory study. Arch Phys Med Rehabil 2009;90:571-9.Objective: To determine changes in kinematic variables and compensatory movement patterns Of Survivors of stroke completing constraint-induced therapy (CIT).Design: Pre-post, case series.Setting: Clinical rehabilitation research laboratory.Participants: Men (n=7) and women (n=3) with unilateral stroke occurring at least 9 months prior to study entry with moderate, stable motor deficits.Intervention: Participants completed 10 consecutive weekdays of CIT for 6 hours a day comprised of trainer-supervised, functionally based activities using massed practice.Main Outcome Measures: Kinematic measures included movement time, average velocity, trajectory stability, shoulder abduction, and segmental contribution. Functional measures included Wolf Motor Function Test (WMFT) performance time and functional ability scores and Motor Activity Log (MAL) "how-well" scores. All measures were administered before and after the 2-week CIT intervention.Results: Movement time, average velocity, and trajectory stability significantly improved after CIT. Participants used more shoulder flexion to reach after CIT, but also demonstrated increased compensatory shoulder abduction. Functional scores also significantly improved, including WMFT performance time and functional ability and MAL scores. There was no change in trunk movement or amount of elbow extension.Conclusions: CIT improved motor capacities in the hemiparetic arm as reflected in the functional outcomes and in some kinematic measures. Participants' reliance on common compensatory movements was not beneficially affected by CIT. The results of this study demonstrate that while functional capacity and some movement strategies in the hemiparetic arm improve after CIT, participants may not overcome their reliance on common compensatory movement patterns. Based on these findings, this study suggests that CIT may encourage subjects to generate movement through compensatory and/or synergy-dominated movement rather than promote the normalization of motor control. This outcome highlights the need to develop CIT further as an intervention that improves functional capacity and more normative movement strategies.