Mirbagheri Mehdi M, Rymer W Zev
Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL 60611, USA.
Arch Phys Med Rehabil. 2008 Aug;89(8):1507-13. doi: 10.1016/j.apmr.2008.02.017. Epub 2008 Jun 30.
To characterize the time-course of changes in motor recovery in the upper extremity of hemiparetic stroke survivors over a 1-year interval after stroke, and to use kinematic and kinetic recordings of elbow voluntary movement at 1 month to predict recovery over this 1-year period.
Motor impairment was assessed using the Fugl-Meyer Assessment (FMA) of the upper extremity. The angular elbow movement trajectory and its derivatives were recorded. Limb kinetics were quantified using maximum voluntary contractions. Subjects were examined at 1, 2, 3, 6, and 12 months after stroke. The growth mixture model was used to characterize the recovery patterns of the FMA over 1 year, and a logistic regression analysis was used to predict these patterns with the kinematic and kinetic measures recorded at 1 month.
A hospital-based laboratory with a movement testing system including position and torque sensors.
Hemiparetic stroke survivors (N=20) with upper-extremity impairment recruited within 4 weeks poststroke.
Not applicable.
Kinematic parameters, including active range of motion, peak velocity, peak acceleration, movement smoothness, and movement speed; kinetic parameters, including isometric voluntary contraction of elbow extensors and flexors; and clinical measurement of motor impairment (FMA).
We found 2 classes of recovery patterns. Class 1 subjects started with a low-level FMA score and then increased quickly before tapering off gradually. Conversely, class 2 subjects started with a high-level FMA score that remained constant or increased slightly. Using logistic regression, the impact of each kinematic and kinetic measure on class membership was characterized. The class assignment helped predict the recovery pattern of motor impairment for each subject.
Using elbow kinematic and kinetic measures 1 month after stroke, we were able to predict accurately the recovery of arm impairment in subjects with hemiparetic stroke at different time points in the first year. This information is of potential value for planning targeted therapeutic interventions.
描述偏瘫性脑卒中幸存者上肢运动恢复在卒中后1年期间的时间变化过程，并利用卒中后1个月时肘关节自主运动的运动学和动力学记录来预测这1年期间的恢复情况。
采用上肢Fugl-Meyer评估量表（FMA）评估运动功能障碍。记录肘关节的角运动轨迹及其导数。使用最大自主收缩来量化肢体动力学。在卒中后1、2、3、6和12个月对受试者进行检查。采用生长混合模型来描述FMA在1年期间的恢复模式，并使用逻辑回归分析，以卒中后1个月记录的运动学和动力学指标来预测这些模式。
一家设有运动测试系统（包括位置和扭矩传感器）的医院实验室。
卒中后4周内招募的上肢功能障碍的偏瘫性脑卒中幸存者（N = 20）。
不适用。
运动学参数，包括主动运动范围、峰值速度、峰值加速度、运动平滑度和运动速度；动力学参数，包括肘关节伸肌和屈肌的等长自主收缩；以及运动功能障碍的临床测量指标（FMA）。
我们发现了2种恢复模式。第1类受试者开始时FMA评分较低，随后迅速上升，之后逐渐趋于平稳。相反，第2类受试者开始时FMA评分较高，且保持不变或略有上升。通过逻辑回归分析，确定了每种运动学和动力学指标对分类的影响。分类有助于预测每个受试者的运动功能障碍恢复模式。
利用卒中后1个月时的肘关节运动学和动力学指标，我们能够准确预测偏瘫性脑卒中患者在第一年不同时间点的上肢功能恢复情况。这些信息对于规划有针对性的治疗干预措施具有潜在价值。
