Tsao Cheng-Chi, Mirbagheri Mehdi M
Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, USA.
J Neuroeng Rehabil. 2007 Nov 29;4:45. doi: 10.1186/1743-0003-4-45.
While upper-extremity movement in individuals with neurological disorders such as stroke and spinal cord injury (SCI) has been studied for many years, the effects of spasticity on arm movement have been poorly quantified. The present study is designed to characterize the nature of impaired arm movements associated with spasticity in these two clinical populations. By comparing impaired voluntary movements between these two groups, we will gain a greater understanding of the effects of the type of spasticity on these movements and, potentially a better understanding of the underlying impairment mechanisms.
We characterized the kinematics and kinetics of rapid arm movement in SCI and neurologically intact subjects and in both the paretic and non-paretic limbs in stroke subjects. The kinematics of rapid elbow extension over the entire range of motion were quantified by measuring movement trajectory and its derivatives; i.e. movement velocity and acceleration. The kinetics were quantified by measuring maximum isometric voluntary contractions of elbow flexors and extensors. The movement smoothness was estimated using two different computational techniques.
Most kinematic and kinetic and movement smoothness parameters changed significantly in paretic as compared to normal arms in stroke subjects (p < 0.003). Surprisingly, there were no significant differences in these parameters between SCI and stroke subjects, except for the movement smoothness (p < or = 0.02). Extension was significantly less smooth in the paretic compared to the non-paretic arm in the stroke group (p < 0.003), whereas it was within the normal range in the SCI group. There was also no significant difference in these parameters between the non-paretic arm in stroke subjects and the normal arm in healthy subjects.
The findings suggest that although the cause and location of injury are different in spastic stroke and SCI subjects, the impairments in arm voluntary movement were similar in the two spastic groups. Our results also suggest that the non-paretic arm in stroke subjects was not distinguishable from the normal, and might therefore be used as an appropriate control for studying movement of the paretic arm.
虽然针对患有中风和脊髓损伤（SCI）等神经系统疾病的个体的上肢运动已开展了多年研究，但痉挛对手臂运动的影响尚未得到充分量化。本研究旨在描述这两个临床群体中与痉挛相关的手臂运动受损的本质。通过比较这两组之间的受损自主运动，我们将更深入地了解痉挛类型对这些运动的影响，并有可能更好地理解潜在的损伤机制。
我们对脊髓损伤患者、神经功能正常的受试者以及中风患者患侧和健侧肢体的快速手臂运动的运动学和动力学进行了描述。通过测量运动轨迹及其导数，即运动速度和加速度，对整个运动范围内的快速伸肘运动学进行量化。通过测量肘屈肌和伸肌的最大等长自主收缩来量化动力学。使用两种不同的计算技术估计运动平滑度。
与中风患者的正常手臂相比，患侧的大多数运动学、动力学和运动平滑度参数均有显著变化（p < 0.003）。令人惊讶的是，除了运动平滑度（p ≤ 0.02）外，脊髓损伤患者和中风患者在这些参数上没有显著差异。与中风组的健侧手臂相比，患侧的伸展明显不那么平滑（p < 0.003），而在脊髓损伤组中则在正常范围内。中风患者的健侧手臂与健康受试者的正常手臂在这些参数上也没有显著差异。
研究结果表明，尽管痉挛性中风和脊髓损伤患者的损伤原因和部位不同，但两个痉挛组的手臂自主运动损伤相似。我们的结果还表明，中风患者的健侧手臂与正常手臂没有区别，因此可作为研究患侧手臂运动的合适对照。
