Feedback and cognition in arm motor skill reacquisition after stroke
Feedback and cognition in arm motor skill reacquisition after stroke
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DOI：
10.1161/01.str.0000217417.89347.63
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发表时间：
2006-05-01
期刊：
影响因子：
8.3
通讯作者：
Levin, MF
中科院分区：
文献类型：
--
作者：
Cirstea, CM;Ptito, A;Levin, MF
背景与目的：脑卒中康复中一个争论不休的话题是运动恢复的最佳训练方式。首先，我们分析了在两种反馈条件下（结果知识[KR]；表现知识[KP]）重复动作练习对达到性再习得的影响。其次，我们评估了认知障碍对运动再学习能力的影响。方法：1998 - 2003年在蒙特利尔地区康复中心对37例慢性偏瘫患者进行随机对照临床试验。患者随机分为3组：(1)KR （n = 14）每天练习75次，每周5天，连续2周，动作精度KR为20%；(2) KP （n = 14）与KR在相同的任务和时间表上训练，但对关节运动的KP有所下降；(3)对照组（C, n = 9）练习非到达性任务。在练习前后（立即，1个月）评估物理（运动损伤，功能）和运动学（运动时间，精度，分割，可变性）变量。认知功能（记忆、注意力、心理灵活性、计划）也被评估。结果：KR（精度）和KP（时间、变异性）的运动增益超过了C，这取决于记忆和心理灵活性的缺陷。在KP中，受损更严重的患者获得了最多的临床收益（bbbb2xc），这与记忆和计划能力有关。结论：在重复运动练习中使用KP可以获得更好的运动效果。脑卒中严重程度和认知障碍是脑卒中后选择运动康复干预措施的重要因素。
Background and Purpose-A debated subject in stroke rehabilitation relates to the best type of training approach for motor recovery. First, we analyzed the effects of repetitive movement practice in 2 feedback conditions ( knowledge of results [KR]; knowledge of performance, [KP]) on reacquisition of reaching. Second, we evaluated the impact of cognitive impairment on motor relearning ability.Methods-A randomized controlled clinical trial was conducted in Montreal-area rehabilitation centers between 1998 and 2003 with 37 patients with chronic hemiparesis. Patients were randomly assigned to 3 groups: (1) KR (n = 14) practiced a reaching task involving 75 repetitions per day, 5 days per week for 2 weeks, with 20% KR about movement precision; (2) KP (n = 14) trained on the same task and schedule as KR but with faded KP about joint motions; and (3) control (C; n = 9) practiced a nonreaching task. Physical (motor impairment, function) and kinematic (movement time, precision, segmentation, variability) variables were assessed before and after (immediately, 1 month) practice. Cognitive functions (memory, attention, mental flexibility, planning) were also evaluated.Results-Kinematic gains in KR (precision) and KP (time, variability) exceeded those in C and depended on memory and mental flexibility deficits. In KP, more severely impaired patients made the most clinical gains (> 2XC), which were related to memory and planning abilities.Conclusions-Use of KP during repetitive movement practice resulted in better motor outcomes. Stroke severity together with cognitive impairments are important factors for choosing motor rehabilitation interventions after stroke.