Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL 60611 USA.
IEEE Trans Neural Syst Rehabil Eng. 2012 Nov;20(6):762-70. doi: 10.1109/TNSRE.2012.2205943. Epub 2012 Aug 1.
This study characterizes the recovery patterns of motor impairment after stroke, and uses neuromuscular measures of the elbow joint at one month after the event to predict the ensuing recovery patterns over 12 months. Motor impairment was assessed using the Fugl-Meyer Assessment (FMA) of the upper extremity at various intervals after stroke. A parallel-cascade system identification technique characterized the intrinsic and reflex stiffness at various elbow angles. We then used "growth-mixture" modeling to identify three distinct recovery classes for FMA. While class 1 and class 3 subjects both started with low FMA, those in class 1 increased FMA significantly over 12-month recovery period, whereas those in class 3 presented no improvement. Class 2 subjects started with high FMA and also exhibited significant FMA improvement, but over a smaller range and at a slower recovery rate than class 1. Our results showed that the one-month reflex stiffness was able to distinguish between classes 1 and 3 even though both showed similarly low month-1 FMA. These findings demonstrate that, using reflex stiffness, we were able to accurately predict arm function recovery in stroke subjects over one year and beyond. This information is clinically significant and can be helpful in developing targeted therapeutic interventions.
本研究描述了中风后运动障碍的恢复模式，并利用事件发生后一个月肘部的神经肌肉测量来预测随后 12 个月的恢复模式。运动障碍使用中风后不同时间的上肢 Fugl-Meyer 评估（FMA）进行评估。平行级联系统识别技术在不同的肘部角度下描述了内在和反射刚度。然后，我们使用“增长混合”建模来识别 FMA 的三个不同恢复类别。虽然第 1 类和第 3 类受试者的 FMA 均较低，但第 1 类受试者在 12 个月的恢复期间 FMA 显著增加，而第 3 类受试者则没有改善。第 2 类受试者的 FMA 起始值较高，并且也表现出显著的 FMA 改善，但改善范围较小，恢复速度比第 1 类慢。我们的结果表明，尽管第 1 类和第 3 类受试者的 FMA 起始值均较低，但一个月的反射刚度仍能区分这两类。这些发现表明，通过反射刚度，我们能够准确预测中风患者一年以上的手臂功能恢复情况。这些信息具有临床意义，有助于制定有针对性的治疗干预措施。
