ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France.
J Rehabil Med. 2019 Apr 1;51(4):307-311. doi: 10.2340/16501977-2528.
To elucidate the adverse consequences of spasticity and spastic co-contraction of elbow flexors on motor impairment and upper limb functional limitation.
A pilot case-controlled prospective observational study.
Ten brain-injured adults, and 10 healthy controls.
The co-contraction index was computed from electromyographic recordings of elbow flexors during sub-maximal (25% Maximal Voluntary Contraction) isometric elbow extension. Spasticity was assessed with the Tardieu scale, upper limb limitation using a goniometer during active elbow extension, motor selectivity with the Fugl-Meyer Assessment for the upper limb, and motor function with the Action Research Arm Test.
Greater co-contraction occurred in patients with brain injury compared with controls. In contrast to spasticity, strong associations were found between the co-contraction index, the limitation of active elbow extension, the Fugl-Meyer Assessment, and the Action Research Arm Test.
This pilot study suggests that spastic co-contraction rather than spasticity is an important factor in altered upper limb motricity in subjects with brain injury, leading to abnormal restricting arm movement patterns in subjects with more severe motor impairment. Practical applications directly concern the pre- and post-therapeutic evaluation of treatments aimed at improving motor skills in subjects with brain injury.
阐明肘部屈肌痉挛和痉挛性协同收缩对运动功能障碍和上肢功能受限的不良后果。
一项初步的病例对照前瞻性观察研究。
10 名脑损伤成年人和 10 名健康对照者。
在最大随意收缩（25%最大随意收缩）的等长肘部伸展过程中，通过肘部屈肌的肌电图记录计算协同收缩指数。采用 Tardieu 量表评估痉挛程度，使用量角器在主动肘部伸展时评估上肢受限程度，采用 Fugl-Meyer 上肢评估评估运动选择性，采用 Action Research Arm Test 评估运动功能。
与对照组相比，脑损伤患者的协同收缩更为明显。与痉挛不同，协同收缩指数与主动肘部伸展受限、Fugl-Meyer 评估和 Action Research Arm Test 之间存在较强的关联。
这项初步研究表明，痉挛性协同收缩而非痉挛是脑损伤患者上肢运动功能改变的重要因素，导致运动功能障碍更严重的患者出现异常限制手臂运动模式。实际应用直接涉及旨在改善脑损伤患者运动技能的治疗的治疗前和治疗后评估。
