Department of Rehabilitation Medicine, Ome Municipal Hospital, Tokyo, Japan.
Arch Phys Med Rehabil. 2010 Aug;91(8):1210-7. doi: 10.1016/j.apmr.2010.01.023.
To investigate the effects of hemiparesis on handwriting using a 3-dimensional movement analyzer.
Comparative case study.
Ambulatory care clinic.
Right-handed patients (n=25; mean age +/- SD, 62.3+/-10y) with mild right hemiparesis secondary to subcortical stroke, and age-matched (n=10; 65.6+/-13y) and age-unmatched (n=15; 32.4+/-10y) control subjects.
Not applicable.
Time required to write a Japanese character of 2 different sizes and average speed of handwriting at the pen tip. Average radii of tracks of the moving pen tip, metacarpal head of the index finger, and distal end of the forearm during writing. Correlation coefficients of the instantaneous speed-time graph of the pen tip with that of the index finger and with that of the distal forearm during writing.
Time for writing with the hemiparetic right hand was longer than that with the unaffected left hand (P=.05 approximately .03), while it was shorter in healthy control subjects (P=.07 approximately .05). In contrast with the left-hand writing, the track radius of the pen tip of the right-hand writing in patients with hemiparesis with normal joint position sense was significantly larger than that of the finger or distal forearm (P=.01). The finding was the same as in the young and elderly control subjects. This right-left difference disappeared in the patients with hemiparesis with position sense impairment. The correlation coefficient of speed between the pen tip and the finger was larger in right-hand than left-hand writing in the control and sensory-normative patients with hemiparesis even though the difference was significant only in the healthy elderly subjects (P=.03). Irrespective of the right or left hand use, the correlation coefficient between the pen tip and the finger or distal forearm significantly increased as the character size increased (P=.03 approximately 6 x10(-6)) in all subjects and patients. However, this size-related difference was less significant in the patients with sensory impairment.
The characteristics of handwriting movement by the dominant hand were preserved in patients with mild dominant-hand hemiparesis when joint position sense was normative but were lost in those with position sense impairment.
使用三维运动分析器研究偏瘫对手写的影响。
对比病例研究。
门诊诊所。
25 名右侧偏瘫患者（平均年龄 +/- 标准差，62.3 +/- 10 岁），继发于皮质下卒中；10 名年龄匹配的对照组患者（平均年龄 65.6 +/- 13 岁）和 15 名年龄不匹配的对照组患者（平均年龄 32.4 +/- 10 岁）。
不适用。
书写两种不同大小的日本字符所需的时间和笔尖的平均书写速度。书写过程中笔尖、食指掌骨头部和前臂远端移动笔的平均轨迹半径。笔尖的即时速度-时间图与食指和前臂远端的相关系数。
偏瘫右手的书写时间长于健侧左手（P=.05 约.03），而健康对照组患者的书写时间较短（P=.07 约.05）。与左手书写相比，偏瘫患者在正常关节位置感下用右手书写时笔尖的轨迹半径明显大于手指或前臂远端（P=.01）。在年轻和年长的对照组中也发现了同样的结果。在位置感受损的偏瘫患者中，这种左右差异消失了。即使仅在健康老年组中差异有统计学意义（P=.03），偏瘫患者在控制组和感觉正常组中，右手书写的笔尖与手指之间的速度相关系数大于左手。无论使用右手还是左手，在所有受试者和患者中，笔尖与手指或远端前臂之间的相关系数随着字符大小的增加而显著增加（P=.03 约 6 x10(-6))。然而，在感觉受损的患者中，这种与大小相关的差异不那么显著。
在本体感觉正常的情况下，轻度优势手偏瘫患者的主导手手写运动特征得以保留，但在本体感觉受损时则丧失。
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