Narai Emi, Hagino Hiroshi, Komatsu Taiki, Togo Fumiharu
1School of Health Science, Department of Fundamental Nursing and Rehabilitation Division, Tottori University, Japan. 2School of Health Science, Department of Physical Therapy, Tokyo University of Technology, Japan. 3Educational Physiology Laboratory, Graduate School of Education, The University of Tokyo, Japan.
J Geriatr Phys Ther. 2016 Oct-Dec;39(4):171-7. doi: 10.1519/JPT.0000000000000067.
Use of the affected extremity during daily life is important if disuse atrophy is to be prevented after stroke. This study examined whether objectively measured real-world upper limb movement is associated with the amount of use of the affected upper limb, as assessed by a standardized assessment tool in older adults with acute or subacute stroke. This study also examined whether the real-world upper limb movement is associated with the extent of impairment of upper and lower extremities.
The participants were 19 older adults with hemiparesis from acute or subacute stroke [17 (7) days after the stroke]. All the participants wore 3 accelerometers-1 on each wrist (bilateral accelerometry) and 1 on the waist-throughout a 24-hour period. They were interviewed about use of their upper limb in the real-world setting using a Motor Activity Log. Functions of the affected upper limb or upper and lower limbs were assessed using the National Institute of Health Stroke Scale, the Brunnstrom Recovery Stage (BRS), the Simple Test for Evaluating Hand Function, and the Functional Independence Measure tests.
Movement counts measured with the wrist accelerometer on the affected upper limb (unilateral accelerometry) over 24 hours and during the 12-hour daytime period (08:00 to 20:00) were significantly correlated with scores for affected upper limb use (the Motor Activity Log) and functions (the upper extremity BRS and the affected side Simple Test for Evaluating Hand Function), upper and lower extremity functions (the National Institute of Health Stroke Scale, the lower extremity BRS, and the motor Functional Independence Measure), and step counts measured over the same period. To estimate the affected upper limb use or disuse, we subtracted the movement counts of the unaffected upper limb from those of the affected upper limb. As a result, the subtracted counts over 24 hours and during the 12-hour daytime period were only related to scores for affected upper limb use and functions.
Bilateral accelerometry for monitoring upper limb movements in a real-world setting might be useful to clinicians for objective assessment of affected upper limb use or disuse and function among older adults with hemiparesis from acute or subacute stroke.
如果要预防中风后出现废用性萎缩，那么在日常生活中使用患侧肢体就很重要。本研究调查了在急性或亚急性中风的老年人中，通过客观测量得出的现实世界中的上肢运动，是否与使用标准化评估工具评估出的患侧上肢使用量相关。本研究还调查了现实世界中的上肢运动是否与上下肢的损伤程度相关。
参与者为19名急性或亚急性中风后出现偏瘫的老年人（中风后[17(7)]天）。所有参与者在24小时内佩戴3个加速度计，每个手腕佩戴1个（双侧加速度测量），腰部佩戴1个。使用运动活动日志对他们在现实世界中上肢的使用情况进行访谈。使用美国国立卫生研究院卒中量表、布鲁恩斯特伦恢复阶段（BRS）、手功能简易评估测试和功能独立性测量测试来评估患侧上肢或上下肢的功能。
在24小时以及12小时白天时段（08:00至20:00），使用患侧上肢手腕加速度计测量的运动计数（单侧加速度测量）与患侧上肢使用情况（运动活动日志）得分、功能（上肢BRS以及患侧手功能简易评估测试）、上下肢功能（美国国立卫生研究院卒中量表、下肢BRS以及运动功能独立性测量）以及同期测量的步数显著相关。为了估计患侧上肢的使用或不用情况，我们用患侧上肢的运动计数减去未受影响上肢的运动计数。结果，24小时以及12小时白天时段的相减计数仅与患侧上肢使用情况和功能得分相关。
在现实世界中监测上肢运动的双侧加速度测量，可能对临床医生客观评估急性或亚急性中风后偏瘫的老年人患侧上肢的使用或不用情况及功能有用。
