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1.
目的 通过功能性近红外光谱技术(functional near-infrared spectroscopy,fNIRS)对比卒中患者执行单侧上肢训练任务与双侧上肢训练任务时近红外脑功能成像中氧合血红蛋白的浓度变化以及脑区的激活情况。   相似文献   

2.
Bilateral arm training has emerged as an approach that leads to positive outcomes in addressing upper extremity paresis after stroke. However, studies have not demonstrated improvements in all patients using current outcome measures. Furthermore, the rationale for using this type of training has been incompletely explained. The purpose of this article was to first review the theoretical justifications for the use of bilateral arm training by examining motor control and neural mechanisms underlying arm function and neural recovery, and second, to discuss examples of clinical studies using a variety of bilateral training strategies to identify who may benefit most from this approach. We argue that bilateral arm training is a necessary adjunct to unilateral training because bilateral re-training is important and best served through bilateral not unilateral training, and also, that bilateral training may help unilateral skill recovery through alternative putative mechanisms. Our review of the empirical evidence suggests that individuals at all levels of severity can benefit in some manner from bilateral training, but that not all approaches are effective for all severity levels. In addition to requesting more randomized controlled trials and studies of neurophysiological mechanisms we conclude the following: 1) Bilateral training can improve unilateral paretic limb functions of the upper extremity after stroke, however, specific training approaches need to be matched to baseline characteristics of the patients; 2) Given the importance of bilateral activities in daily life, there is a need to recognize, train and assess the important contribution of supportive role functions of the paretic arm used on its own and as part of complementary bilateral functional skills; 3) An assessment of bilateral and unilateral functioning which includes bilateral task analysis, as well as, evaluations of interlimb coordination should be included in all studies that include bilateral training; 4) Studies with thoughtful sequencing or combining of bilateral approaches or sequencing of bilateral and unilateral approaches are needed to assess if there are improved outcomes in paretic and bilateral limb function.  相似文献   

3.
Identifying effective rehabilitation interventions founded on sound theoretical and neurophysiological bases should decrease the prevalence of motor disabilities and chronic hemiparesis. This article addresses two theoretically sound behavioral interventions: (a) active neuromuscular stimulation on the impaired upper extremity and (b) coupled bilateral coordination training (i.e., mirrored movements on the less impaired limb combined with active stimulation on the impaired limb). The series of stroke motor recovery experiments currently reviewed clearly indicate that sensorimotor integration theory and bimanual coordination theory are viable candidates for directing behavioral rehabilitation approaches. Indeed, the reported evidence clearly supports activity dependent neural plasticity for progress toward stroke motor recovery.  相似文献   

4.
Chronic upper extremity hemiparesis following stroke is a significant impairment that can limit a person's independence in all aspects of ADL, IADL, and functional mobility. Although recovery of functional independence may be more efficient using traditional compensatory techniques, these therapeutic methods often do not encourage integration of the hemiparetic arm and hand. In contrast, the task-oriented approach to motor recovery of poststroke hemiparesis emphasizes integration of the impaired limb into all functional tasks via skill-based training. Cortical changes have been documented following skill-based training of the upper limb in the healthy animal model. Additionally, the combination of subthreshold cortical stimulation combined with skill-based forelimb training in the induced-stroke rat model has demonstrated better outcomes than training alone. Preliminary research with human stroke survivors using task-oriented training and subthreshold cortical stimulation has shown promising results. The purpose of this article is to introduce an upper limb training protocol that was used in a national multisite trial that compares cortical stimulation in conjunction with taskoriented training to training alone.  相似文献   

5.
《Neurological research》2013,35(5):504-510
Abstract

Objective: Cerebral stroke is a major cause for long-term disability in the elderly and it is often manifested in hemiparesis of the upper extremity. Constraint-induced movement therapy (CIMT), an intensive 2 week rehabilitation program, improves affected upper limb motor abilities in subjects with stroke. Intensive training has also been suggested to modify neural function. We wanted to find out if there are changes in cortical excitability in subjects with chronic stroke after CIMT.

Methods: Participants were 13 subjects with stroke who fulfilled the entry criteria for the CIMT program. The motor function of the affected arm and hand was assessed using a structured motor behavior test (WMFT). The cortical excitability changes were assessed in regard to involuntary and voluntary motor control, former with transcranial magnetic stimulation (TMS) and latter with movement-related cortical potentials (MRCP).

Results: The motor abilities of the affected arm improved after 2 week rehabilitation (total time in WMFT shortened 36%). The motor-evoked potential (MEP) amplitudes were unchanged following the stimulation of the non-affected hemisphere; however, the MEP amplitudes of lateral stimulation locations increased significantly in the affected side after the intervention. The power spectra of MRCPs revealed reduced peak frequency over the supplementary motor area when the affected hand was moved. However, no changes occurred when the healthy hand was moved.

Discussion: We show changes in cortical electrical excitability while performing both involuntary and voluntary movements after 2 weeks of CIMT in subjects with chronic stroke. These changes may be seen as a sign of neural reorganization instigated by the intervention.  相似文献   

6.
Investigators have demonstrated that a variety of intensive movement training protocols for persistent upper limb paralysis in patients with chronic stroke (6 months or more after stroke) improve motor outcome. This randomized controlled study determined in patients with upper limb motor impairment after chronic stroke whether movement therapy delivered by a robot or by a therapist using an intensive training protocol was superior. Robotic training (n = 11) and an intensive movement protocol (n = 10) improved the impairment measures of motor outcome significantly and comparably; there were no significant changes in disability measures. Motor gains were maintained at the 3-month evaluation after training. These data contribute to the growing awareness that persistent impairments in those with chronic stroke may not reflect exhausted capacity for improvement. These new protocols, rendered by either therapist or robot, can be standardized, tested, and replicated, and potentially will contribute to rational activity-based programs.  相似文献   

7.
OBJECTIVE: To determine how stroke lesion side and ipsilateral motor pathways influence motor performance in bimanual tasks. METHODS: Stroke subjects and age-matched controls participated in two data collection sessions: (1) motor behavior was examined during a movement task performed in unimanual, bimanual symmetric, and bimanual asymmetric conditions and (2) transcranial magnetic stimulation was used to examine the excitability of ipsilateral and contralateral motor pathways during isometric unilateral and bilateral muscle activation. RESULTS: Subjects with left hemiparesis and controls demonstrated a performance differential between symmetric and asymmetric motor tasks compared to subjects with right hemiparesis. Contralateral motor pathway excitability decreased and ipsilateral pathway excitability increased during bilateral compared to unilateral activation in control subjects and in the non-affected arm of stroke subjects. Responses in the affected arm were similar to controls in subjects with left hemiparesis but not right. CONCLUSIONS: Changes in motor pathway excitability during bilateral activation may promote more stable performance of symmetric movements. In individuals with hemiparesis, the side of lesion influences neural and behavioral aspects of bimanual tasks. Those with injuries to the right hemisphere exhibit coupling that is more similar to age-matched controls. SIGNIFICANCE: The efficacy of bilateral training interventions may be different between people with lesions in the left and right hemispheres.  相似文献   

8.
ObjectivesAlthough healthy individuals have less force production capacity during bilateral muscle contractions compared to unilateral efforts, emerging evidence suggests that certain aspects of paretic upper limb task performance after stroke may be enhanced by moving bilaterally instead of unilaterally. We investigated whether the bilateral movement condition affects grip force differently on the paretic side of people with post-stroke hemiparesis, compared to their non-paretic side and both sides of healthy young adults.MethodsWithin a single session, we compared: (1) maximal grip force during unilateral vs. bilateral contractions on each side, and (2) force contributed by each side during a 30% submaximal bilateral contraction.ResultsHealthy controls produced less grip force in the bilateral condition, regardless of side (?2.4% difference), and similar findings were observed on the non-paretic side of people with hemiparesis (?4.5% difference). On the paretic side, however, maximal grip force was increased by the bilateral condition in most participants (+11.3% difference, on average). During submaximal bilateral contractions in each group, the two sides each contributed the same percentage of unilateral maximal force.ConclusionsThe bilateral condition facilitates paretic limb grip force at maximal, but not submaximal levels.SignificanceIn some people with post-stroke hemiparesis, the paretic limb may benefit from bilateral training with high force requirements.  相似文献   

9.
Background Intensive motor training with low-frequency repetitive transcranial magnetic stimulation (rTMS) has efficacy as a therapeutic method for motor dysfunction of the affected upper limb in patients with mild to moderate stroke. However, it is not clear whether this combination therapy has the same effect in chronic post-stroke patients with severe upper limb motor impairment.

Objectives The aim of this study was to test the treatment effects of intensive motor training with low-frequency rTMS in chronic post-stroke patients with severe upper limb motor impairment.

Methods A convenience sample of 26 chronic post-stroke patients with severe upper limb motor impairment participated in this study with the non-randomized, non-controlled clinical trial. All subjects were hospitalized to receive intensive motor training with low-frequency rTMS. During 2 weeks in which Sundays were excluded, a total of 24 sessions (2 sessions per day) of the intervention were conducted. The Fugl–Meyer Assessment (FMA) and Wolf Motor Function Test (WMFT) were used to assess motor impairment and function of the affected upper limb, respectively, before and after intervention. Paired t-test was used to analyze the effects of the intervention.

Results The FMA total score and WMFT log performance time significantly improved from before to after intervention (FMA: 12.6–18.0; WMFT: 3.6–3.3, p < 0.001).

Conclusions The present results suggest that intensive motor training with low-frequency rTMS could improve motor impairment in chronic post-stroke patients with severe upper limb motor impairment and contribute to the expansion of the application range of this combination therapy.  相似文献   

10.
Somatosensory stimulation enhances aspects of motor function in patients with chronic, predominantly subcortical infarcts. We investigated the effects of somatosensory stimulation on motor function in stroke patients with predominantly cortical involvement in the middle cerebral artery territory in a double-blind, pseudorandomized crossover trial. Motor performance was evaluated with the Jebsen-Taylor test before, after 2-hour somatosensory stimulation, and after subsequent motor training (n = 11). In one experimental session, patients were submitted to median nerve stimulation (MNS) and in the other session, to control stimulation (CS). The order of the sessions was counterbalanced across patients. Improvement in performance in the Jebsen-Taylor test after somatosensory stimulation and after motor training was significantly greater in the MNS session than in the CS session. Additionally, patients who received MNS in the second session maintained the beneficial effects of training 30 days later. A single MNS session improves hand motor function in patients with chronic cortico-subcortical strokes and appears to favor consolidation of training effects. Somatosensory stimulation may be an adjuvant tool for stroke rehabilitation in patients with cortical lesions. Received in revised form: 2 August 2006  相似文献   

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