脑瘫患者的关节位置觉与运动觉
Joint-position sense and kinesthesia in cerebral palsy.
作者信息
Wingert Jason R, Burton Harold, Sinclair Robert J, Brunstrom Janice E, Damiano Diane L
机构信息
Department of Health and Wellness, University of North Carolina at Asheville, Asheville, NC 28804, USA.
出版信息
Arch Phys Med Rehabil. 2009 Mar;90(3):447-53. doi: 10.1016/j.apmr.2008.08.217.
OBJECTIVES
To examine joint-position sense and kinesthesia in all extremities in participants with diplegic or hemiplegic cerebral palsy (CP).
DESIGN
Survey of joint-position sense and kinesthesia differences between aged-matched controls and 2 groups with CP.
SETTING
University movement assessment laboratory.
PARTICIPANTS
Population-based sample of participants with CP, diplegia (n=21), hemiplegia (n=17), and age-matched volunteers (n=21) without neurologic disease.
INTERVENTIONS
Not applicable.
MAIN OUTCOME MEASURES
Joint-position sense and kinesthesia were measured in the transverse plane (forearm pronation/supination and hip internal/external rotation) using a custom-built device. For joint-position sense, participants actively rotated the tested limb to align the distal end with 10 target positions first with the limb and targets visible to assess their ability to perform the task motorically. The task was then repeated with vision of the limb occluded, with targets remaining visible. Joint-position sense error was determined by the magnitude and direction of the rotation errors for each limb in the vision and no vision conditions. Kinesthesia was evaluated by the ability to detect passive limb rotation without vision.
RESULTS
No group differences were detected in the vision condition. Indicative of joint-position sense deficits, a significant increase in errors was found in the no vision condition in all limbs except the dominant upper limb for both groups with CP. Joint-position sense errors were systematically biased toward the direction of internal rotation. Kinesthesia deficits were evident on the nondominant upper limb in diplegia and hemiplegia, and bilaterally in the lower limbs in hemiplegia. In hemiplegia, joint-position sense and kinesthesia deficits were noted on the dominant limbs, but were significantly worse on the nondominant limbs.
CONCLUSIONS
These results indicate that people with CP have proprioception deficits in all limbs.
目的
检查双侧瘫或偏瘫型脑瘫（CP）患者四肢的关节位置觉和运动觉。
设计
对年龄匹配的对照组与两组CP患者的关节位置觉和运动觉差异进行调查。
地点
大学运动评估实验室。
参与者
基于人群的CP患者样本，其中双侧瘫患者（n = 21）、偏瘫患者（n = 17），以及年龄匹配的无神经系统疾病志愿者（n = 21）。
干预措施
不适用。
主要观察指标
使用定制设备在横断面（前臂旋前/旋后和髋关节内/外旋转）测量关节位置觉和运动觉。对于关节位置觉，参与者首先主动旋转受试肢体，使远端与10个目标位置对齐，此时肢体和目标均可见，以评估其运动执行任务的能力。然后在肢体视觉被遮挡、目标仍可见的情况下重复该任务。关节位置觉误差由每个肢体在视觉和无视觉条件下旋转误差的大小和方向确定。运动觉通过在无视觉情况下检测被动肢体旋转的能力进行评估。
结果
在视觉条件下未检测到组间差异。表明存在关节位置觉缺陷的是，在无视觉条件下，两组CP患者除优势上肢外的所有肢体误差均显著增加。关节位置觉误差系统性地偏向内旋方向。双侧瘫和偏瘫患者的非优势上肢存在明显的运动觉缺陷，偏瘫患者的双侧下肢也存在运动觉缺陷。在偏瘫患者中，优势肢体存在关节位置觉和运动觉缺陷，但非优势肢体的缺陷明显更严重。
结论
这些结果表明，CP患者所有肢体均存在本体感觉缺陷。
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