OBJECTIVE To investigate whether unilateral strength training helps improve cortical excitability and clinical outcomes after stroke. DESIGN Randomized controlled trial SETTING: Rehabilitation sciences research center PARTICIPANTS: 26 patients with subacute stroke were randomly assigned to a control group (n=13) or the experimental group (n=13). INTERVENTIONS Participants in both groups received conventional physiotherapy. The experimental group also received unilateral strength training of the less affected wrist extensors. Interventions were applied for 4 weeks (12 sessions 3 days per week). MAIN OUTCOME MEASURES At baseline and after the 4-week intervention period, cortical excitability in both the ipsilesional hemisphere (ipsiH) and contralesional hemisphere (contraH) was assessed by measuring resting motor threshold (RMT), active motor threshold (AMT), motor evoked potential (MEP) and cortical silent period (CSP). Clinical outcomes were obtained by evaluating wrist extension strength in both the more affected and less affected hands, upper extremity motor function, activities of daily living (ADLs) and spasticity. RESULTS The experimental group showed greater MEP amplitude (p=0.001) in the ipsiH and shorter CSP duration in both the ipsiH (p=0.042) and contraH (p=0.038) compared to the control group. However, the reductions in RMT and AMT in both hemispheres were not significantly different between groups. Improvements in wrist extension strength in the more affected (p=0.029) and less affected (p=0.001) hand, upper extremity motor function (p=0.04) and spasticity (p=0.014) were greater in the experimental group. No significant difference in ADLs was detected between groups. CONCLUSIONS A combination of unilateral strength training and conventional physiotherapy appears to be a beneficial therapeutic modality for improving cortical excitability and some clinical outcomes in patients with stroke.

中文翻译：

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受影响较小的手的单侧力量训练可改善亚急性卒中患者的皮质兴奋性和临床结果：一项随机对照试验

目的 调查单侧力量训练是否有助于改善脑卒中后皮质兴奋性和临床结果。设计 随机对照试验 设置：康复科学研究中心 参与者：26 名亚急性卒中患者被随机分配到对照组（n=13）或实验组（n=13）。干预 两组参与者均接受常规理疗。实验组还接受了受影响较小的腕伸肌的单侧力量训练。干预措施持续 4 周（每周 3 天，12 次）。主要结局指标在基线和 4 周干预期后，通过测量静息运动阈值 (RMT) 来评估同侧半球 (ipsiH) 和对侧半球 (contraH) 的皮质兴奋性，活动运动阈值 (AMT)、运动诱发电位 (MEP) 和皮质静默期 (CSP)。通过评估受影响较大手和受影响较小手的腕部伸展强度、上肢运动功能、日常生活活动 (ADL) 和痉挛获得临床结果。结果与对照组相比，实验组在 ipsiH (p=0.042) 和 contraH (p=0.038) 中显示出更大的 MEP 幅度 (p=0.001) 和更短的 CSP 持续时间。然而，两组之间 RMT 和 AMT 的降低在两个半球没有显着差异。实验组中受影响较大 (p=0.029) 和受影响较小 (p=0.001) 的手、上肢运动功能 (p=0.04) 和痉挛状态 (p=0.014) 的手腕伸展强度改善更大。组间未检测到 ADL 的显着差异。结论 单侧力量训练和常规理疗相结合似乎是改善中风患者皮质兴奋性和一些临床结果的有益治疗方式。