Lang Catherine E, Beebe Justin A
Program in Physical Therapy, Washington University, St. Louis, MO 63108, USA.
Neurorehabil Neural Repair. 2007 May-Jun;21(3):279-91. doi: 10.1177/1545968306296964. Epub 2007 Mar 12.
Loss of hand function in people with hemiparesis is a major contributor to disability poststroke. To use the hand for functional activities, a person may need control of the more proximal upper extremity segments to position and orient the hand with respect to the environment and may need control of the fingers to manipulate objects within the environment. The purpose of this project was to investigate how movement control at proximal, middle, and distal upper extremity segments contributed to loss of hand function in people with chronic hemiparesis.
32 patients with hemiparesis (avg 21.4 months postlesion) were studied making isolated movements of shoulder flexion, elbow flexion, forearm pronation/supination, wrist flexion/extension, and individual finger flexion using 3D kinematic techniques. For each segment, 3 variables were obtained: how far a segment could move (active range of motion [AROM]), how well a segment could move by itself (individuation index), and how well a segment could remain still when it was not supposed to move (stationary index). Hand function was measured with a battery of clinical tests, and principal components analysis was used to create a single hand function score for each patient from the test battery. Correlation and regression analyses were used to examine relationships between segmental movement control and hand function.
Movement control at all 9 segments of the upper extremity was related to hand function. Of the 9 segments, the thumb tended to have the weakest relationship with hand function. Of the 3 measures of movement control, AROM had strong relationships with and predicted the most variance in hand function (73%). Most of this variance was shared across segments, such that, for AROM, there were no unique contributions provided by proximal, middle, or distal segments.
These data support the idea that loss of movement control covaries across segments and that loss of hand function is due to loss of movement control at all segments, not just at distal ones.
偏瘫患者手部功能丧失是卒中后致残的主要因素。为了使用手进行功能性活动，患者可能需要控制上肢更近端的节段，以便将手相对于环境进行定位和定向，并且可能需要控制手指以在环境中操作物体。本项目的目的是研究上肢近端、中间和远端节段的运动控制如何导致慢性偏瘫患者手部功能丧失。
对32例偏瘫患者（平均病后21.4个月）进行研究，使用三维运动学技术让他们进行肩部屈曲、肘部屈曲、前臂旋前/旋后、腕部屈曲/伸展以及单个手指屈曲的孤立运动。对于每个节段，获取3个变量：节段能够移动的距离（主动活动范围[AROM]）、节段自身能够移动的程度（个体化指数）以及节段在不应移动时保持静止的程度（静止指数）。通过一系列临床测试测量手部功能，并使用主成分分析从测试组中为每位患者创建一个单一的手部功能评分。使用相关性和回归分析来检查节段运动控制与手部功能之间的关系。
上肢所有9个节段的运动控制均与手部功能相关。在这9个节段中，拇指与手部功能的关系往往最弱。在运动控制的3项测量中，AROM与手部功能有很强的关系，并预测了手部功能中最大的方差（73%）。大部分方差在各节段之间共享，因此，对于AROM，近端、中间或远端节段没有独特的贡献。
这些数据支持这样的观点，即运动控制的丧失在各节段之间是共同变化的，并且手部功能的丧失是由于所有节段运动控制的丧失，而不仅仅是远端节段。
