Journal of Taiwan Occupational Therapy Research and Practice
半年刊,正常發行
目的:侷限誘發療法與雙側動作訓練已證實有助於中風病患之上肢動作功能及動作控制,本文從兩者之腦重組機制來探究其治療機轉,以提供對治療引起之腦塑性更深入瞭解。綜論概要:文獻顯示侷限誘發療法有助於輕度至中度動作受損之中風病患的功能恢復;功能性腦影像學研究指出此種療法可讓腦部活化改變,且讓兩側大腦半球之興奮性回復平衡。對於患側手動作極度受損之中風病患,研究卻顯示雙側動作訓練效益優於侷限誘發療法,不但同時活化兩腦相似的神經網絡,還徵召健側腦至患側手之同側神經路徑,以促進患側手之動作控制。結論:本文藉由對照侷限誘發療法與雙側動作訓練之腦重組機制,提供臨床工作者對於中風患者治療方案之選擇依據。未來研究可進一步針對可能影響兩者治療效益之因子進行探究。
Objective: Constraint-induced therapy (CIT) and bilateral training have shown beneficial effects in improving motor function and control of upper extremity (UE) for patients with stroke. This review intends to underscore the treatment mechanisms of CIT and bilateral trainings from the perspective of brain plasticity and reorganization. Summary of Reviews: CIT consists of restricted use of the unaffected UE, intensive training of the affected UE, and is usually applied to stroke patients with mild-to-moderate motor impairments. The CIT studies using the functional neuroimaging techniques have shown that the CIT induced changes in activity in ipsileional sensorimotor cortex, contralesional motor cortex, and perilesional cortex, and facilitate restoration of the normal balance of excitability of the two hemispheres. In contrast, patients with severe motor impairment are more appropriate to be treated by the bilateral training than by the CIT because existing neural networks and connections in patients with lower motor function are not sufficient for activation of the recovered limb. The bilateral symmetrical movements could activate similar neural networks in both hemispheres, reinforce the coupling effects between the two limbs, and promote the involvement of ipsileional projections to restoration of function in affected UE. Conclusions: This review summarized and compared the brain reorganizations after CIT and bilateral training for understanding the neural basis of treatment-induced plasticity, and to promote the optimum of motor rehabilitation for patients with stroke. Future research may underscore the factors that might mediate effects of CIT and bilateral trainings.