兩種復健方式聯合使用有助於腦中風病人的復健

用有力的肢體來加速無力肢體的復健

  2002-6-17—聯合的腦中風復健的方法有助於慢性輕偏癱的復健,這項研究發表在6月的《Stroke》雜誌上—美國心臟協會的期刊。當用電刺激恢復運動肌功能時,使用完好的肢體幫助訓練受影響的肢體,效果高於單獨使用傳統的物理療法 。

  「這項研究顯示了兩種運動肌復健方法聯合使用效果好於單獨使用一種方法—刺激療法和雙側運動療法聯合高於單獨使用刺激療法。」第一作者來自Gainesville的佛羅里達州大學James H. Cauraugh博士在新聞發表會上說。「但是刺激療法好於只坐著想運動四肢好。兩種方法聯合能夠幫助病人增加他們可運動的肌肉的數量。」

  在這項研究中,從輕到重由於腦中風癱瘓的25例病人被隨機分成三組進行復健實驗:第一組用刺激療法和雙側運動療法聯合激發產生肌電圖(EMG)(n=10),第二組用刺激訓練單側運動療法激發產生肌電圖(n=10),第三組用傳統的物理療法治療(n=5)。這些病人平均年齡64歲,腦中風後平均39個月。所有的病人每兩週內接受6小時的治療。

  相對另外兩組,接受神經肌肉刺激療法和雙側運動療法協同治療組在肌電圖中顯示的運動的反應時間和可運動的區域數量有了更明顯的增多及持續的肌肉收縮能力明顯增強。接受用刺激訓練單側運動療法組在可運動的區域數量和運動反應時間中值好於對照組。第一組的運動反應時間是57ms(標準差25.9),第二組是63ms(標準差25.8),對照組為95ms(標準差26)。

  這項研究中這些腦中風後手腕和手指的活動能力顯著下降的慢性輕偏癱病人經過聯合治療以後可運動肌的數量明顯增多,表明了雙側運動療法能夠使腦形成新的神經傳導通路,使病人恢復功能,而電刺激能夠幫助恢復腦中風後的神經連接。

  「雖然這種療法使你不能恢復以前的生活,但是你有兩隻能動的胳膊是再好不過的事情。」Cauraugh說,「這項療法加速運動肌的復健,以致能使這些病人更加地獨立,甚至使他們能做的運動而感覺良好。」

Two Limbs Best for Stroke Rehab

Using Strong Limb Improves Recovery in Weak Limb

By Laurie Barclay, MD
WebMD Medical News

Reviewed by Gary D. Vogin, MD

June 17, 2002 -- A two-pronged approach to stroke rehabilitation improves recovery from chronic hemiparesis, as described in the June issue of Stroke: Journal of the American Heart Association. Using the unaffected limb to assist training of the affected limb while electrically stimulating the weak limb restores motor function better than conventional physical therapy alone.

"This study shows that two motor-recovery protocols are better than one -- that stimulation and bilateral movements are better than only stimulation," lead author James H. Cauraugh, PhD, from the University of Florida in Gainesville, says in a news release. "But stimulation is better than just sitting there and trying to move the arm yourself. A combination of protocols helps people increase their motor repertoire."

In this study, 25 patients with chronic, mild-to-moderate upper extremity paralysis from a stroke were randomly assigned to one of three rehabilitation treatments: electromyogram (EMG)-triggered stimulation coupled with bilateral movement (n=10), EMG-triggered stimulation with unilateral movement (n=10), or conventional physical therapy (n=5). Mean age was 64, and mean duration of time elapsed following stroke was 39 months. All subjects received 6 hours of their assigned treatment during a 2-week period.

Compared with the other two groups, the group receiving EMG-triggered neuromuscular stimulation and bilateral coordination training had significant improvements in the number of blocks moved in a functional task, reaction times before initiating movements, and sustained muscle contraction capability. Patients receiving unilateral movement training with stimulation did better than the controls in the number of blocks moved and in median reaction time, which was 57 (SD 25.9) ms in the bilateral movement/stimulation group, 63 (SD 25.8) ms in the unilateral movement/stimulation group, and 95 (SD 26) ms in the controls.

"The two protocols improved motor performance after just 6 hours of training," Cauraugh says. "Chances are that by extending the period of time, additional improvements would be found."

Chronic hemiparesis decreased considerably in the wrist and fingers as stroke patients expanded their motor repertoire, suggesting that bilateral action allows the brain to recruit new neural pathways to help restore function, and that electrical stimulation helps restore neural connections lost following stroke.

"You can't regain a previous life because of this protocol, but you can be significantly better off than if your arm is just hanging at your side," Cauraugh says. "[This protocol] expedites motor recovery so these people can be more independent, and they feel good about the movements they can do."

© 2002 WebMD Inc. All rights reserved.

    
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