- 期刊
急性出血型腦中風的早期復健和早期活動
Early Rehabilitation and Early Mobilization after Acute Hemorrhagic Stroke
摘要
中風後的急性期會有一段神經塑性較強的時期。在此期間，損傷後的大腦對於動態活動刺激反應較為敏感，執行早期復健可能特別的有療效。這篇綜述總結了目前提供早期復健的神經塑性理論基礎，以及目前針對出血型中風在早期復健及早期下床活動的臨床實證。文獻回顧中，我們定義在出血型中風後1週內開始進行的復健，才視為「早期復健」介入。相關臨床研究證據提出，雖然在中風後24小時內高頻率且積極地早期下床活動介入可能會造成危害，但是在出血型中風後48小時內執行早期復健能降低死亡率。此外，出血型中風後24至72小時內於腦中風中心便開始執行早期下床活動，有助於增加中長期的動作功能表現及短期內行走獨立性。因而，出血型中風後24小時到7日內的早期活動或早期復健介入可以促進中風後的功能恢復。針對出血型中風後一週內的早期復健或早期下床活動相關試驗仍然很少，最佳的介入模式和開始時間依然沒有定論。
並列摘要
A period of enhanced neuroplasticity occurs after the acute post-stroke phase. During this period, the injured brain is more sensitive to stimuli such as dynamic activities, which explain why early rehabilitation could be particularly effective. In this review, we define 'early rehabilitation' as interventions that commence within the first 7 days after hemorrhagic stroke. This review consolidated current studies on the fundamentals of neuroplasticity in early rehabilitation as well as clinical evidence of the effectiveness of early rehabilitation and early mobilization after hemorrhagic stroke. In general, relevant clinical evidence has shown that even though high- intensive and frequency very early mobilization interventions implemented within 24 hours of stroke onset could result in harms, implementing early rehabilitation within 48 hours of hemorrhagic stroke onset helps reduce mortality rates. Moreover, implementing early mobilization at the stroke center within 24 to 72 hours of hemorrhagic stroke onset enhances patients' long-term motor function performance and short-term walking independence. Therefore, early out-of-bed mobilization or early rehabilitation, within 24 hours to 7 days of hemorrhagic stroke, may improve early functional recovery. Yet, there is still a dearth of trials pertaining to early rehabilitation or early mobilization within a week of hemorrhagic stroke onset, and there is no firm consensus on the optimum protocol of intervention or start time.