Impact of intensity of practice after stroke: Issues for consideration
Impact of intensity of practice after stroke: Issues for consideration
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DOI：
10.1080/09638280500534861
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发表时间：
2006-07-01
影响因子：
2.2
通讯作者：
Kwakkel, Gert
中科院分区：
文献类型：
--
作者：
Kwakkel, Gert
目的.目前的辩论文件解决了四个相关问题的影响，中风后的实践强度。首先，讨论了确定练习强度的最佳方法。其次，本文描述了中风康复中存在剂量反应关系的证据。第三，一个适当的病人选择一个有意义的密集实践的相关性进行了探讨。最后，本文提出了一个问题，即病人在提高他们的功能技能时实际上学到了什么。为此目的，我们对MEDLINE、CINAHL、科克伦对照试验中心、PEDro、DARE和PiCarta的文章以及相关出版物中的参考文献进行了检查。尽管有强有力的证据表明，早期强化运动治疗时间（表示为专门用于练习的时间）可能会促进功能恢复，但一方面，强化练习的益处与另一方面，在当前医疗保健系统中实施强化康复治疗计划的证据之间存在差异。应进一步强调更好地理解预后因素的时间依赖性，这些因素决定了卒中患者强化训练的有效性。此外，需要更好地理解脑卒中后功能任务补偿相关学习的神经生理学和生物力学机制。
Purpose. The present debate paper addresses four relevant issues related to the impact of intensity of practice after stroke. First, the best way to define intensity of practice is discussed. Second, the paper describes the evidence that exists for a dose-response relationship in stroke rehabilitation. Third, the relevance of an appropriate patient selection for a meaningful intensive practice is explored. Finally, the paper raises the question of what it is that patients actually learn when they improve their functional skills.Search strategy. For this purpose articles from MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, PEDro, DARE and PiCarta and references presented in relevant publications were examined.Discussion and conclusion. Although, there is strong evidence that early augmented exercise therapy time ( expressed as time dedicated to practice) may enhance functional recovery, there is a discrepancy between the evidence for the benefits of intensive practice, on the one hand, and, the implementation of intensive rehabilitation treatment programmes in the current healthcare system on the other. Further emphasis should be given on a better understanding of the time-dependency of prognostic factors that determine the effectiveness of intensive practice in patients with stroke. In addition, a better understanding is needed of the neurophysiological and biomechanical mechanisms that underlie compensation-related learning of functional tasks after stroke.