Schindler-Ivens Sheila, Desimone Davalyn, Grubich Sarah, Kelley Carolyn, Sanghvi Namita, Brown David A
Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
J Neurol Phys Ther. 2008 Mar;32(1):21-31. doi: 10.1097/NPT.0b013e31816594ea.
Physical therapists may prescribe stretching exercises for individuals with stroke to improve joint integrity and to reduce the risk of secondary musculoskeletal impairment. While deficits in passive range of motion (PROM) exist in stroke survivors with severe hemiparesis and spasticity, the extent to which impaired lower extremity PROM occurs in community-ambulating stroke survivors remains unclear. This study compared lower extremity PROM in able-bodied individuals and independent community-ambulatory stroke survivors with residual stroke-related neuromuscular impairments. Our hypothesis was that the stroke group would show decreased lower extremity PROM in the paretic but not the nonparetic side and that decreased PROM would be associated with increased muscle stiffness and decreased muscle length.
Individuals with chronic poststroke hemiparesis who reported the ability to ambulate independently in the community (n = 17) and age-matched control subjects (n = 15) participated. PROM during slow (5 degrees/sec) hip extension, hip flexion, and ankle dorsiflexion was examined bilaterally using a dynamometer that measured joint position and torque. The maximum angular position of the joint (ANGmax), torque required to achieve ANGmax (Tmax), and mean joint stiffness (K) were measured. Comparisons were made between able-bodied and paretic and able-bodied and nonparetic limbs.
Contrary to our expectations, between-group differences in ANGmax were observed only during hip extension in which ANGmax was greater bilaterally in people post-stroke compared to control subjects (P <or= 0.05; stroke = 13 degrees, able-bodied = -1 degree). Tmax, but not K, was also significantly higher during passive hip extension in paretic and nonparetic limbs compared to control limbs (P <or= 0.05; stroke = 40 Nm, able-bodied = 29 Nm). Compared to the control group, Tmax was increased during hip flexion in the paretic and nonparetic limbs of post-stroke subjects (P <or= 0.05, stroke = 25 Nm, able-bodied = 18 Nm). K in the nonparetic leg was also increased during hip flexion (P <or= 0.05, nonparetic = 0.52 Nm/degree, able-bodied = 0.37 Nm/degree.)
This study demonstrates that community-ambulating stroke survivors with residual neuromuscular impairments do not have decreased lower extremity PROM caused by increased muscle stiffness or decreased muscle length. In fact, the population of stroke survivors examined here appears to have more hip extension PROM than age-matched able-bodied individuals. The clinical implications of these data are important and suggest that lower extremity PROM may not interfere with mobility in community-ambulating stroke survivors. Hence, physical therapists may choose to recommend activities other than stretching exercises for stroke survivors who are or will become independent community ambulators.
物理治疗师可能会为中风患者开具伸展运动处方，以改善关节完整性并降低继发性肌肉骨骼损伤的风险。虽然严重偏瘫和痉挛的中风幸存者存在被动关节活动度（PROM）缺陷，但社区行走的中风幸存者中下肢PROM受损的程度尚不清楚。本研究比较了身体健全者与有残留中风相关神经肌肉损伤的独立社区行走中风幸存者的下肢PROM。我们的假设是，中风组患侧下肢PROM会降低，但非患侧不会，且PROM降低与肌肉僵硬增加和肌肉长度减少有关。
纳入有慢性中风后偏瘫且报告能够在社区独立行走的个体（n = 17）以及年龄匹配的对照受试者（n = 15）。使用测量关节位置和扭矩的测力计双侧检查慢（5度/秒）髋伸展、髋屈曲和踝背屈时的PROM。测量关节的最大角度位置（ANGmax）、达到ANGmax所需的扭矩（Tmax）和平均关节刚度（K）。对身体健全者与患侧肢体以及身体健全者与非患侧肢体进行比较。
与我们的预期相反，仅在髋伸展时观察到组间ANGmax差异，中风后患者双侧的ANGmax均大于对照受试者（P≤0.05；中风组 = 13度，身体健全组 = -1度）。与对照肢体相比，患侧和非患侧肢体在被动髋伸展时Tmax也显著更高（P≤0.05；中风组 = 40 Nm，身体健全组 = 29 Nm）。与对照组相比，中风后受试者患侧和非患侧肢体在髋屈曲时Tmax增加（P≤0.05，中风组 = 25 Nm，身体健全组 = 18 Nm）。非患侧腿在髋屈曲时K也增加（P≤0.05，非患侧 = 0.52 Nm/度，身体健全组 = 0.37 Nm/度）。
本研究表明，有残留神经肌肉损伤的社区行走中风幸存者不会因肌肉僵硬增加或肌肉长度减少而导致下肢PROM降低。事实上，此处检查的中风幸存者群体的髋伸展PROM似乎比年龄匹配的身体健全个体更多。这些数据的临床意义很重要，表明下肢PROM可能不会干扰社区行走中风幸存者的活动能力。因此，对于正在或即将成为独立社区行走者的中风幸存者，物理治疗师可能会选择推荐除伸展运动之外的其他活动。
