1Center for Cognitive Science,Indian Institute of Technology Gandhinagar,Gujarat,India.
2Department of Psychiatry & Behavioral Sciences and Neurology,University of New Mexico,Albuquerque,New Mexico.
J Int Neuropsychol Soc. 2019 May;25(5):470-478. doi: 10.1017/S1355617718001261. Epub 2019 Jan 31.
To investigate whether the relationship between arm use and motor impairment post-stroke is influenced by the hemisphere of damage.
Right-handed patients with unilateral left hemisphere damage (LHD) or right (RHD) (n=58; 28 LHD, 30 RHD) were recruited for this study. The Arm Motor Ability Test and Functional Impact Assessment were used to derive arm use patterns. The Fugl-Meyer motor assessment scale was used to quantify the level of motor impairment.
A significant interaction between patient group and impairment level was observed for contralesional, but not ipsilesional arm use. For lower impairment levels, contralesional (right arm for LHD and left arm for RHD) arm use was greater in LHD than RHD patients. In contrast, for greater levels of impairment, there were no arm use differences between the two patient groups.
When motor impairment is significant, it overrides potential effects of stroke laterality on the patterns of arm use. However, a robust influence of hemisphere of damage on the patterns of arm use is evident at lower impairment levels. This may be attributed to previously described arm preference effects. These findings suggest adoption of distinct strategies for rehabilitation following left versus right hemisphere damage in right-handers, at least when the impairment is moderate to low. (JINS, 2019, 25, 470-478).
研究手臂使用与卒中后运动障碍之间的关系是否受到损伤半球的影响。
本研究纳入了 58 例右侧利手的左侧（LHD）或右侧（RHD）单侧左半球损伤（LHD）或右侧（RHD）患者（n=58；28 例 LHD，30 例 RHD）。采用上肢运动能力测试和功能影响评估得出手臂使用模式。采用 Fugl-Meyer 运动评估量表来量化运动障碍程度。
在损伤侧手臂使用方面观察到患者组与损伤程度之间存在显著的交互作用，但在非损伤侧手臂使用方面没有观察到这种交互作用。在损伤程度较低的情况下，LHD 患者的损伤侧（右侧手臂用于 LHD，左侧手臂用于 RHD）手臂使用量大于 RHD 患者。相反，在损伤程度较高的情况下，两组患者之间的手臂使用没有差异。
当运动障碍严重时，它会掩盖卒中侧位对手臂使用模式的潜在影响。然而，在损伤程度较低时，损伤半球对手臂使用模式的影响明显。这可能归因于之前描述的手臂偏好效应。这些发现表明，对于右利手患者，在损伤程度为中等到低等时，左侧和右侧半球损伤后采用不同的康复策略，至少在损伤程度为中等到低等时是这样。（JINS，2019，25，470-478）。
