Beebe Justin A, Lang Catherine E
Program in Physical Therapy, Washington University, 4444 Forest Park, Campus Box 8502, St. Louis, MO 63108, USA.
Clin Neurophysiol. 2008 Sep;119(9):2074-85. doi: 10.1016/j.clinph.2008.04.293. Epub 2008 Jun 20.
Our first purpose was to determine whether there was a proximal to distal gradient in motor deficits in nine segments of the affected upper extremity (shoulder, elbow, forearm, wrist, and five fingers) post-stroke. Our second purpose was to determine which upper extremity segments made the greatest contributions to hand function.
Thirty-three subjects were tested on average 18.6 (+/-5.6) days after stroke. The ability to move each segment was measured by active range of motion (AROM). Hand function was measured by a battery of standardized clinical tests which were synthesized into a single, sensitive score for hand function using principal component analysis.
AROM at all nine segments of the upper extremity was reduced and there was no evidence of a proximal to distal gradient in AROM values. Strength of each segment was reduced and there was also no evidence of a gradient in strength values. AROM at each segment was strongly correlated with hand function scores (range 0.76-0.94). General multiple regression analysis showed that AROM explained 82% of the variance in hand function, with most of the variance shared across proximal, middle, and distal segments. Hierarchical regression analysis showed that shoulder AROM alone could explain 88% of the variance in hand function.
Early after stroke a proximal to distal gradient of motor deficits was not present, and loss of hand function was due to a loss of ability to move many segments of the upper extremity and not just the distal ones.
These results suggest that a change in the clinical perception of motor deficits post-stroke is needed. Our finding that shoulder AROM predicted almost all the variance in hand function opens up the possibility that this quick, simple measure may be predictive of future hand function. This would be of high economic and clinical utility compared to other ongoing efforts attempting to predict outcomes post-stroke (e.g. fMRI, MEG).
我们的首要目的是确定中风后受累上肢九个节段（肩部、肘部、前臂、腕部和五指）的运动功能障碍是否存在从近端到远端的梯度变化。我们的第二个目的是确定上肢的哪些节段对手部功能贡献最大。
33名受试者在中风后平均18.6（±5.6）天接受测试。通过主动活动范围（AROM）测量每个节段的活动能力。通过一系列标准化临床测试测量手部功能，并使用主成分分析将这些测试综合成一个单一的、敏感的手部功能评分。
上肢所有九个节段的AROM均降低，且没有证据表明AROM值存在从近端到远端的梯度变化。每个节段的力量均降低，且也没有证据表明力量值存在梯度变化。每个节段的AROM与手部功能评分密切相关（范围为0.76 - 0.94）。一般多元回归分析表明，AROM解释了手部功能变异的82%，大部分变异在近端、中间和远端节段之间共享。分层回归分析表明，仅肩部AROM就能解释手部功能变异的88%。
中风后早期不存在从近端到远端的运动功能障碍梯度变化，手部功能丧失是由于上肢多个节段活动能力丧失，而不仅仅是远端节段。
这些结果表明中风后运动功能障碍的临床认知需要改变。我们发现肩部AROM几乎预测了手部功能的所有变异，这表明这种快速、简单的测量方法可能预测未来的手部功能。与其他试图预测中风后结果的正在进行的研究（如功能磁共振成像、脑磁图）相比，这将具有很高的经济和临床应用价值。
