Bustrén Eva-Lena, Sunnerhagen Katharina Stibrant, Alt Murphy Margit
1 Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
2 Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
Neurorehabil Neural Repair. 2017 Apr;31(4):376-386. doi: 10.1177/1545968316688798. Epub 2017 Jan 20.
An increasing number of studies have indicated that the ipsilesional arm may be impaired after stroke. There is, however, a lack of knowledge whether ipsilesional deficits influence movement performance during purposeful daily tasks.
The aim of this study was to investigate whether, and to what extent, movement impairments are present while performing an ipsilesional upper extremity task during the first 3 months after stroke.
Movement kinematics describing movement time, smoothness, velocity, strategy, and pattern were captured during a standardized drinking task in 40 persons with first-ever stroke and 20 controls. Kinematics were measured early and at 3 months poststroke, and sensorimotor impairment was assessed with Fugl-Meyer Assessment in stroke.
Half of the ipsilesional kinematics showed significant deficits early after stroke compared to controls, and the stroke severity had a significant impact on the kinematics. Movements of the ipsilesional arm were slower, less smooth, demonstrated prolonged relative time in deceleration, and increased arm abduction during drinking. Kinematics improved over time and reached a level comparable with controls at 3 months, except for angular velocity of the elbow and deceleration time in reaching for those with more severe motor impairment.
This study demonstrates that movements of the ipsilesional arm, during a purposeful daily task, are impaired after stroke. These deficits are more prominent early after stroke and when the motor impairment is more severe. In clinical studies and praxis, the use of less-affected arm as a reference may underestimate the level of impairment and extent of recovery.
越来越多的研究表明，中风后患侧上肢可能会受损。然而，对于患侧功能缺陷是否会影响有目的的日常任务中的运动表现，我们还缺乏了解。
本研究旨在调查中风后前3个月内执行患侧上肢任务时是否存在运动障碍，以及障碍的程度如何。
在一项标准化饮水任务中，对40例首次中风患者和20名对照者的运动学进行了记录，这些运动学指标包括运动时间、流畅性、速度、策略和模式。在中风后早期及3个月时测量运动学指标，并用Fugl-Meyer评估量表对中风患者的感觉运动功能障碍进行评估。
与对照组相比，一半的患侧运动学指标在中风后早期显示出显著缺陷，且中风严重程度对运动学有显著影响。患侧上肢的运动更慢、更不流畅，减速相对时间延长，饮水时手臂外展增加。随着时间推移，运动学指标有所改善，在3个月时达到与对照组相当的水平，但肘部角速度和运动障碍较严重者伸手时的减速时间除外。
本研究表明，中风后在有目的的日常任务中，患侧上肢的运动受到损害。这些缺陷在中风后早期以及运动障碍更严重时更为突出。在临床研究和实践中，将较少受影响的手臂作为参照可能会低估损伤程度和恢复程度。
