Improvement of arm movement patterns and endpoint control depends on type of feedback during practice in stroke survivors
Improvement of arm movement patterns and endpoint control depends on type of feedback during practice in stroke survivors
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DOI：
10.1177/1545968306298414
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发表时间：
2007-09-01
影响因子：
4.2
通讯作者：
Levin, M. E.
中科院分区：
文献类型：
--
作者：
Cirstea, A. C.;Levin, M. E.
背景。中风康复的一个主要挑战是恢复手臂运动功能。治疗引起的手臂功能改善可能通过恢复病前运动模式（恢复）或制定补偿性运动策略来实现。然而，尚不清楚通过结合不同形式的反馈、关注运动结果或特定的手臂运动模式是否可以增强练习的学习效益。 目标。确定通过提供结果知识（KR）反馈（关注运动结果）或表现知识（KP）反馈（在重复练习指向运动期间关注手臂运动模式）来操纵注意力焦点是否可能导致手臂运动恢复。方法。 28 名慢性中风幸存者被随机分配到 2 组，分别练习 10 次、75 个指向动作。在练习过程中，各组要么获得有关运动精度的 20% KR，要么获得有关手臂关节运动的褪色 KP（平均 26.6%）。非残疾对照组 (n = 5) 使用 KR.Results 练习相同的任务。运动模式仅在 KP 中恢复，关节范围的即时和长期增加、早期运动阶段更好的关节间协调以及增益的泛化证明了这一点。临床损伤和功能的改善与代偿（躯干旋转）的减少和运动中期关节间协调的恢复有关。结论。在中风幸存者中，当学习者的注意力集中在运动本身（KP）时，与注意力集中在运动结果（KR）时相比，运动改善反映了恢复情况。
Background. A major challenge in stroke rehabilitation is restoration of arm motor function. Therapy-induced improvements in arm function may occur via restoration of premorbid movement patterns (recovery) or development of compensatory movement strategies. However, it is unclear whether the learning benefits of practice might be enhanced by incorporating different forms of feedback, focusing on movement outcomes or on specific arm movement patterns.Objective. To determine if manipulation of attentional focus by providing either knowledge of results (KR) feedback, focusing on movement outcomes, or knowledge of performance (KP) feedback, focusing on arm movement patterns during repetitive practice of a pointing movement, may lead to arm motor recovery.Methods. Twenty-eight chronic stroke survivors were randomly assigned to 2 groups that practiced 10 sessions of 75 pointing movements. During practice, groups received either 20% KR about movement precision or faded (26.6% average) KP about arm joint movements. A nondisabled control group (n = 5) practiced the same task with KR.Results. Motor patterns recovered only in KP, as evidenced by immediate and long-term increases in joint range, better interjoint coordination in early movement phases, and generalization of gains. Improvements in clinical impairment and function were related to decreases in compensation (trunk rotation) and recovery of interjoint coordination in mid-movement phases.Conclusions. In stroke survivors, when the learners' attention was directed to the movements themselves (KP), motor improvements reflect recovery compared to when attention was directed toward movement outcomes (KR).