中风后1周和6个月时上肢感觉运动障碍之间的关联。

Associations Between Sensorimotor Impairments in the Upper Limb at 1 Week and 6 Months After Stroke.

作者信息

Meyer Sarah, De Bruyn Nele, Krumlinde-Sundholm Lena, Peeters Andre, Feys Hilde, Thijs Vincent, Verheyden Geert

机构信息

Departments of Rehabilitation Sciences (S.M., N.D.B., H.F., G.V.) and Neurosciences, and Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (V.T.), KU Leuven-University of Leuven, Leuven, Belgium; Department of Women's and Children's Health, Neuropediatric Unit (L.K.-S.), Karolinska Institutet, Astrid Lindgren Children's Hospital, Stockholm, Sweden; Department of Neurology (A.P.), Cliniques Universitaires Saint-Luc, Brussels, Belgium; Laboratory of Neurobiology (V.T.), Vesalius Research Center, VIB, Leuven, Belgium; and Department of Neurology (V.T.), University Hospitals Leuven, Leuven, Belgium.

出版信息

J Neurol Phys Ther. 2016 Jul;40(3):186-95. doi: 10.1097/NPT.0000000000000138.

DOI:10.1097/NPT.0000000000000138

PMID:27214520

Abstract

BACKGROUND AND PURPOSE

Longitudinal information regarding the prevalence of upper limb somatosensory deficits and the association with motor impairment and activity limitations is scarce. The aim of this prospective cohort study was to map the extent and distribution of somatosensory deficits, and to determine associations over time between somatosensory deficits and motor impairment and activity limitations.

METHODS

We recruited 32 participants who were assessed 4 to 7 days after stroke, and reassessed at 6 months. Somatosensory measurements included the Erasmus-modified Nottingham sensory assessment (Em-NSA), perceptual threshold of touch, thumb finding test, 2-point discrimination, and stereognosis subscale of the NSA. Evaluation of motor impairment comprised the Fugl-Meyer assessment, Motricity Index, and Action Research Arm Test. In addition, at 6 months, activity limitation was determined using the adult assisting hand assessment stroke, the ABILHAND, and hand subscale of the Stroke Impact Scale.

RESULTS

Somatosensory impairments were common, with 41% to 63% experiencing a deficit in one of the modalities within the first week and 3% to 50% at 6 months. In the acute phase, there were only very low associations between somatosensory and motor impairments (r = 0.03-0.20), whereas at 6 months, low to moderate associations (r = 0.32-0.69) were found for perceptual threshold of touch, thumb finding test, and stereognosis with motor impairment and activity limitations. Low associations (r = 0.01-0.29) were found between somatosensory impairments in the acute phase and motor impairments and activity limitations at 6 months.

DISCUSSION AND CONCLUSIONS

This study showed that somatosensory impairments are common and suggests that the association with upper limb motor and functional performance increases with time after stroke.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A138).

摘要

背景与目的

关于上肢躯体感觉功能障碍的患病率以及与运动障碍和活动受限之间关联的纵向信息较为匮乏。这项前瞻性队列研究的目的是描绘躯体感觉功能障碍的程度和分布情况，并确定躯体感觉功能障碍与运动障碍及活动受限之间随时间变化的关联。

方法

我们招募了32名参与者，在中风后4至7天进行评估，并在6个月时进行重新评估。躯体感觉测量包括伊拉斯谟改良诺丁汉感觉评估（Em-NSA）、触觉感知阈值、拇指定位测试、两点辨别觉以及NSA的立体觉子量表。运动障碍评估包括Fugl-Meyer评估、运动指数和动作研究上肢测试。此外，在6个月时，使用成人辅助手评估中风量表、ABILHAND以及中风影响量表的手部子量表来确定活动受限情况。

结果

躯体感觉障碍很常见，在第一周内，41%至63%的参与者在其中一种感觉模式上存在功能障碍，6个月时这一比例为3%至50%。在急性期，躯体感觉障碍与运动障碍之间的关联非常低（r = 0.03 - 0.20），而在6个月时，触觉感知阈值、拇指定位测试和立体觉与运动障碍及活动受限之间存在低至中度的关联（r = 0.32 - 0.69）。急性期的躯体感觉障碍与6个月时的运动障碍及活动受限之间的关联较低（r = 0.01 - 0.29）。