脑卒中后上肢 H 反射测量：可靠性和肢体间差异。

Upper-extremity H-reflex measurement post-stroke: reliability and inter-limb differences.

机构信息

Neural Control of Movement Laboratory - Brain Rehabilitation Research Center of Excellence, Malcom Randall VA Medical Center, Gainesville, FL 32608, USA.

出版信息

Clin Neurophysiol. 2012 Aug;123(8):1606-15. doi: 10.1016/j.clinph.2011.12.012. Epub 2012 Jan 23.

DOI:10.1016/j.clinph.2011.12.012

PMID:22277759

Abstract

OBJECTIVE

To establish test-retest reliability of flexor carpi radialis (FCR) H-reflexes in non-disabled and stroke participants. We also investigated inter-limb differences and effects of chronicity post-stroke compared to non-disabled group and age-related effects in the non-disabled group.

METHODS

Sixteen chronic stroke and twenty-two non-disabled participants were recruited. Bilateral FCR H-reflexes were tested on two separate days by stimulating the median nerve and recording surface electromyography responses. FCR recruitment curves were plotted for H-reflex (H) and motor (M) waves and normalized as a percentage of maximal M-wave (ordinate) and motor threshold (abscissa).

STATISTICS

Intraclass correlation coefficients [two-way mixed model-ICC (1, 2)], one-way ANOVA, Bland-Altman plots, standard error of measurement (SEM), and smallest real difference (SRD).

RESULTS

ICCs ranged from 0.55 to 0.95 (stroke) and 0.69-0.88 (non-disabled). SEM% (% of the mean) ranged from 9% to 24% (stroke) and 18-38% (non-disabled); SRD% ranged from 18% to 66% (stroke) and 6% to 50% (non-disabled). H-reflex amplitude and slope were greater in the paretic vs. non-paretic arm post-stroke (p=0.07 and 0.01, respectively) and the paretic arm vs. non-disabled participants (p=0.007 and 0.002, respectively). Stroke participants with longer chronicity (mean 9.4 years) revealed a significantly greater Hslp/Mslp on the paretic side compared to shorter chronicity (2.5 years; p=0.05). Mean Hslp/Mslp was significantly greater in the young (mean 29 years) compared to the older group (62 years; p=0.045).

CONCLUSIONS

These results establish reliability of FCR H-reflexes in stroke and non-disabled participants. SEM and SRD measurements can be used to interpret recovery patterns and longitudinal effects of therapeutic interventions.

SIGNIFICANCE

FCR H-reflex amplitude and slope can be reliably measured and used to investigate neurophysiological mechanisms of motor recovery post-stroke.

摘要

目的

建立非残疾和中风参与者的屈肌腕桡侧（FCR）H 反射的测试-重测信度。我们还研究了与非残疾组相比，中风后慢性期的肢体间差异和与年龄相关的影响。

方法

招募了 16 名慢性中风和 22 名非残疾参与者。通过刺激正中神经并记录表面肌电图反应，在两天内对双侧 FCR H 反射进行测试。绘制 FCR 募集曲线，用于 H 反射（H）和运动（M）波，并归一化为最大 M 波的百分比（纵坐标）和运动阈值（横坐标）。

统计

采用双向混合模型 ICC（1,2）、单因素方差分析、Bland-Altman 图、测量标准误差（SEM）和最小真实差异（SRD）。

结果

ICC 范围为 0.55 至 0.95（中风）和 0.69 至 0.88（非残疾）。SEM%（平均值的百分比）范围为 9%至 24%（中风）和 18%至 38%（非残疾）；SRD%范围为 18%至 66%（中风）和 6%至 50%（非残疾）。中风后，患侧与非患侧手臂的 H 反射幅度和斜率均较大（分别为 p=0.07 和 0.01），且患侧手臂与非残疾参与者的 H 反射幅度和斜率也较大（分别为 p=0.007 和 0.002）。慢性期较长（平均 9.4 年）的中风参与者患侧 Hslp/Mslp 明显大于慢性期较短（2.5 年；p=0.05）。年轻组（平均 29 岁）的 Hslp/Mslp 均值明显大于老年组（62 岁；p=0.045）。