Hôpital R. Poincaré, AP-HP, Garches, France.
Neurorehabil Neural Repair. 2010 Feb;24(2):141-51. doi: 10.1177/1545968309347683. Epub 2009 Sep 28.
Poor control of grasping in spastic, hemiparetic patients could be because of a combination of poor individuation of joints, weakness, spasticity, and sensory loss.
To investigate the effect of botulinum toxin injections (BTIs) on grasping objects of different shapes and to assess the effect on upper-limb function, reach-to-grasp kinematics, and hand position and orientation at the time of grasp.
We included 15 patients with spastic hemiparesis and 9 healthy controls in this open labeled study, in which the patients were assessed before (M0), 1 month after a first (M1), and 1 month after a second BTI (M4, at 4 months). A motion capture system recorded movements. Kinematic variables were computed as well as hand position and orientation at the time of grasping, and finger configurations were coded from video recordings.
In contrast with healthy participants, hemiparetic patients rarely used multipulpar grasps but used specific strategies combined with various directions of approach to the object. BTIs did not alter finger configuration but improved the final direction of the approach and the hand posture during the grasp. No significant changes in kinematic parameters were found using post hoc analysis, although a session effect was found for peak hand velocity. Individual analysis showed that the patients with the best potential for functional improvement are those with good proximal and moderate distal motor command.
BTIs can modify hand kinematics as well as the approach and posture of reach-to-grasp movements. Function and grasping strategies are probably more dependent on motor recovery.
痉挛性偏瘫患者抓握控制不佳可能是由于关节个体化不良、无力、痉挛和感觉丧失的综合作用。
研究肉毒毒素注射（BTI）对不同形状物体抓握的影响，并评估其对上肢功能、伸手抓握运动学、抓握时手的位置和方向的影响。
我们在这项开放性标记研究中纳入了 15 例痉挛性偏瘫患者和 9 名健康对照者，患者在治疗前（M0）、第一次治疗后 1 个月（M1）和第二次治疗后 1 个月（M4，4 个月时）进行评估。运动捕捉系统记录运动。计算运动学变量以及抓握时手的位置和方向，从视频记录中对手指配置进行编码。
与健康参与者相比，偏瘫患者很少使用多指抓握，但采用了结合物体不同接近方向的特定策略。BTI 不会改变手指配置，但会改善接近物体的最终方向和抓握时的手姿势。虽然在事后分析中发现了会话效应，但在手速峰值方面，没有发现运动学参数的显著变化。个体分析表明，那些近端运动指令良好且远端运动指令中等的患者具有最佳的功能改善潜力。
BTI 可以改变手的运动学以及伸手抓握运动的接近和姿势。功能和抓握策略可能更依赖于运动恢复。
