Bhakta B B, Cozens J A, Chamberlain M A, Bamford J M
Rheumatology and Rehabilitation Research Unit, School of Medicine, University of Leeds, UK.
Clin Rehabil. 2001 Apr;15(2):195-206. doi: 10.1191/026921501671342614.
(1) To present a measurement protocol for assessing associated reactions (AR) in the paretic arm and (2) to use it to investigate the pattern of AR and its association with spasticity.
Inpatient rehabilitation unit.
Associated reactions in 49 adults with stroke were measured in terms of force generated, electrical muscle activity and wrist movement in the paretic arm using hand dynamometry, surface electromyography and electrogoniometry respectively. Simultaneous recording of the effort used to elicit the associated reaction was made using a second hand dynamometer. The magnitude and persistence of AR was compared with the clinical assessment of spasticity (using the modified Ashworth Scale, MAS).
There was poor correlation between peak AR and MAS, suggesting that AR are not confined to patients with severe spasticity. Co-activation of forearm flexors and extensors was evident during the AR. AR fluctuated during a single period of effort in some patients. Only 12 out of 31 patients who maintained uniform effort over the measurement period produced a uniform AR. AR often persisted for some time after effort had ceased. Eight were classified as minimal (median AR 0.23 N), 25 as mild (median AR 2.7 N), 11 as moderate (median AR 6.4 N) and 3 as severe (median AR 11.0 N). AR tended to persist in patients with higher MAS although this result was not statistically significant.
The magnitude, profile and persistence of AR varied considerably between individuals. Associated reactions were present in people with minimal spasticity. As this technique allows the magnitude of AR to be quantified in relation to effort it has the potential to be a useful outcome measure in clinical trials evaluating the treatments (e.g. physiotherapy) directed at reducing associated reactions.
（1）提出一种用于评估偏瘫侧上肢联合反应（AR）的测量方案；（2）使用该方案研究联合反应的模式及其与痉挛的关系。
住院康复单元。
分别采用握力计、表面肌电图和电子测角仪，对49例中风成年患者偏瘫侧上肢的联合反应进行了测量，测量指标包括产生的力量、肌肉电活动和腕部运动。同时使用第二个握力计记录引发联合反应所用的力量。将联合反应的大小和持续时间与痉挛的临床评估（使用改良Ashworth量表，MAS）进行比较。
联合反应峰值与MAS之间的相关性较差，这表明联合反应并不局限于严重痉挛的患者。在联合反应期间，前臂屈肌和伸肌的共同激活很明显。在某些患者中，联合反应在单次用力期间会波动。在测量期间保持用力均匀的31例患者中，只有12例产生了均匀的联合反应。联合反应在用力停止后通常会持续一段时间。8例被分类为轻度（联合反应中位数为0.23 N），25例为中度（联合反应中位数为2.7 N），11例为重度（联合反应中位数为6.4 N），3例为极重度（联合反应中位数为11.0 N）。尽管该结果无统计学意义，但联合反应在MAS较高的患者中往往持续存在。
联合反应的大小、特征和持续时间在个体之间差异很大。轻度痉挛患者也存在联合反应。由于该技术能够根据用力情况对联合反应的大小进行量化，因此在评估旨在减少联合反应的治疗方法（如物理治疗）的临床试验中，它有可能成为一种有用的疗效指标。
