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成人脑卒中患者过顶运动中的手臂-躯干协调性。

Arm-trunk coordination for beyond-the-reach movements in adults with stroke.

机构信息

1McGill University, Montreal, Quebec, Canada.

出版信息

Neurorehabil Neural Repair. 2014 May;28(4):355-66. doi: 10.1177/1545968313510973. Epub 2013 Nov 22.

Abstract

BACKGROUND

By involving additional degrees of freedom, the nervous system may preserve hand trajectories when making pointing movements with or without trunk displacement. Previous studies indicate that the potential contribution of trunk movement to hand displacement for movements made within arm reach is neutralized by appropriate compensatory shoulder and elbow rotations. For beyond-the-reach movements, compensatory coordination is attenuated after the hand peak velocity, allowing trunk movement to contribute to hand displacement.

OBJECTIVE

To investigate if the timing and spatial coordination of arm and trunk movements during beyond-the-reach movements is preserved in stroke.

METHODS

Eleven healthy control subjects and 11 individuals with mild-to-moderate chronic unilateral hemiparesis participated. Arm and trunk kinematics during 60 target reaches to an ipsilaterally placed target were recorded. In 30% of randomly chosen trials, trunk movement was unexpectedly prevented (blocked-trunk trials) by an electromagnetic device, resulting in divergence of the hand trajectory from that in free-trunk trials. Hand trajectories and elbow-shoulder interjoint coordination were compared between trials.

RESULTS

In stroke participants, hand trajectory divergence occurred at a shorter movement extent and interjoint coordination patterns diverged at a relatively greater distance compared to controls. Thus, arm movements in stroke participants only partially compensated trunk displacement resulting in the trunk movement contributing to arm movement earlier and to a larger extent during reaching.

CONCLUSION

Individuals with mild-to-moderate stroke have deficits in timing and spatial coordination of arm and trunk movements during different parts of a reaching movement. This deficit may be targeted in therapy to improve upper limb function.

摘要

背景

通过增加自由度,神经系统在进行指向运动时,无论是有躯干位移还是没有躯干位移,都可以保持手部轨迹。先前的研究表明,对于在臂长范围内进行的运动,躯干运动对手部位移的潜在贡献会被适当的肩部和肘部旋转补偿所抵消。对于超出臂长范围的运动,在手部达到峰值速度后,补偿协调会减弱,从而允许躯干运动对手部位移产生影响。

目的

研究在脑卒中患者中,超出臂长范围的运动中手臂和躯干运动的时间和空间协调是否得到保留。

方法

11 名健康对照组和 11 名轻度至中度慢性单侧偏瘫患者参与了本研究。记录了他们在向同侧目标进行 60 次目标到达时的手臂和躯干运动的运动学。在随机选择的 30%试验中,通过电磁装置意外地阻止了躯干运动(阻断躯干试验),导致手部轨迹与自由躯干试验中的轨迹偏离。在手轨迹和肘肩关节间协调方面对试验进行了比较。

结果

在脑卒中患者中,与对照组相比,手部轨迹的偏离发生在较小的运动幅度上,关节间协调模式的偏离发生在相对较大的距离上。因此,脑卒中患者的手臂运动仅部分补偿了躯干位移,导致躯干运动更早且更大程度地参与了手臂运动。

结论

轻度至中度脑卒中患者在到达运动的不同阶段存在手臂和躯干运动的时间和空间协调缺陷。这种缺陷可以在治疗中作为靶点,以改善上肢功能。

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