Semrau Jennifer A, Herter Troy M, Kenzie Jeffrey M, Findlater Sonja E, Scott Stephen H, Dukelow Sean P
1 Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
2 University of South Carolina, Columbia, SC, USA.
Neurorehabil Neural Repair. 2017 Jun;31(6):571-582. doi: 10.1177/1545968317704903. Epub 2017 Apr 26.
Poststroke impairments of the ipsilesional arm are often discussed, but rarely receive focused rehabilitation. Ipsilesional deficits may affect daily function and although many studies have investigated them in chronic stroke, few characterizations have been made in the subacute phase. Furthermore, most studies have quantified ipsilesional deficits using clinical measures that can fail to detect subtle, but important deficits in motor function.
We aimed to quantify reaching deficits of the contra- and ipsilesional limbs in the subacute phase poststroke.
A total of 227 subjects with first-time, unilateral stroke completed a unilateral assessment of motor function (visually guided reaching) using a KINARM robot. Subjects completed the task with both the ipsi- and contralesional arms. Subjects were assessed on a variety of traditional clinical measures (Functional Independence Measure, Chedoke-McMaster Stroke Assessment, Purdue Pegboard, Behavioral Inattention Test) to compare with robotic measures of motor function.
Ipsilesional deficits were common and occurred in 37% (n = 84) of subjects. Impairments of the ipsilesional and contralesional arm were weakly to moderately correlated on robotic measures. Magnitude of impairment of the contralesional arm was similar for subjects with and without ipsilesional deficits. Furthermore, we found that a higher percentage of subjects with right-hemisphere stroke had ipsilesional deficits and more subjects with left-hemisphere subcortical strokes did not have ipsilesional deficits.
Magnitude of contralesional impairment and lesion location may be poor predictors of individuals with ipsilesional impairments after stroke. Careful characterization of ipsilesional deficits could identify individuals who may benefit from rehabilitation of the less affected arm.
中风后患侧上肢的功能障碍经常被讨论，但很少得到针对性的康复治疗。患侧功能缺陷可能会影响日常功能，尽管许多研究在慢性中风患者中对其进行了调查，但在亚急性期的特征描述却很少。此外，大多数研究使用临床测量方法来量化患侧功能缺陷，这些方法可能无法检测到运动功能中细微但重要的缺陷。
我们旨在量化中风亚急性期健侧和患侧肢体的够物功能缺陷。
共有227例首次发生单侧中风的患者使用KINARM机器人完成了运动功能的单侧评估（视觉引导下的够物）。患者分别用患侧和健侧手臂完成任务。对患者进行了多种传统临床测量（功能独立性测量、切多克-麦克马斯特中风评估、普渡钉板测试、行为疏忽测试），以与运动功能的机器人测量结果进行比较。
患侧功能缺陷很常见，37%（n = 84）的患者出现该情况。在机器人测量中，患侧和健侧手臂的功能障碍呈弱至中度相关。有和没有患侧功能缺陷的患者，健侧手臂的功能障碍程度相似。此外，我们发现右半球中风的患者中患侧功能缺陷的比例更高，而左半球皮质下中风的患者中没有患侧功能缺陷的更多。
健侧功能障碍的程度和病变位置可能不是中风后患侧功能障碍个体的良好预测指标。仔细描述患侧功能缺陷可以识别出可能从较少受影响手臂的康复中获益的个体。
