Shirley Ryan AbilityLab, Chicago, Illinois.
Shirley Ryan AbilityLab, Chicago, Illinois.
Arch Phys Med Rehabil. 2020 Jul;101(7):1170-1175. doi: 10.1016/j.apmr.2020.01.018. Epub 2020 Feb 28.
To investigate the performance of the less affected upper limb in people with stroke compared with normative values. To examine less affected upper limb function in those whose prestroke dominant limb became paretic and those whose prestroke nondominant limb became paretic.
Cohort study of survivors of chronic stroke (7.2±6.7y post incident).
The study was performed at a freestanding academic rehabilitation hospital.
Survivors of chronic stroke (N=40) with severe hand impairment (Chedoke-McMaster Stroke Assessment rating of 2-3 on Stage of Hand) participated in the study. In 20 participants the prestroke dominant hand (DH) was tested (nondominant hand [NH] affected by stroke), and in 20 participants the prestroke NH was tested (DH affected by stroke).
Not applicable.
Jebsen-Taylor Hand Function Test. Data from survivors of stroke were compared with normative age- and sex-matched data from neurologically intact individuals.
When combined, DH and NH groups performed significantly worse on fine motor tasks with their nonparetic hand relative to normative data (P<.007 for all measures). Even the participants who continued to use their prestroke DH as their primary hand after the stroke demonstrated reduced fine motor skills compared with normative data. In contrast, grip strength was not significantly affected in either group of survivors of stroke (P>.140).
Survivors of stroke with severe impairment of the paretic limb continue to present significant upper extremity impairment in their nominally nonparetic limb even years after stroke. This phenomenon was observed regardless of whether the DH or NH hand was primarily affected. Because this group of survivors of stroke is especially dependent on the nonparetic limb for performing functional tasks, our results suggest that the nonparetic upper limb should be targeted for rehabilitation.
研究与参考值相比，脑卒中患者的非患侧上肢的表现。检查那些在卒中前优势手瘫痪和非优势手瘫痪的患者中，非患侧上肢的功能。
对慢性卒中幸存者（发病后 7.2±6.7 年）进行队列研究。
在一家独立的学术康复医院进行研究。
患有严重手部障碍的慢性卒中幸存者（Chedoke-McMaster 卒中评估手阶段 2-3 评分）参与了这项研究。在 20 名参与者中测试了卒中前的优势手（DH）（卒中影响了非优势手 [NH]），在 20 名参与者中测试了卒中前的 NH（DH 受卒中影响）。
不适用。
Jebsen-Taylor 手功能测试。将卒中幸存者的数据与神经功能正常个体的年龄和性别匹配的参考数据进行比较。
当将 DH 和 NH 组结合在一起时，他们的非瘫痪手在精细运动任务上的表现明显差于参考数据（所有测量值均<0.007）。即使是那些在卒中后继续将他们的卒中前 DH 作为主要手的参与者，与参考数据相比，他们的精细运动技能也有所下降。相比之下，两组卒中幸存者的握力均未受到显著影响（P>.140）。
即使在卒中后多年，严重瘫痪肢体的卒中幸存者在其名义上的非瘫痪肢体上仍继续存在明显的上肢障碍。这种现象无论 DH 或 NH 手是主要受影响的手都观察到了。由于这组卒中幸存者特别依赖非瘫痪的上肢来完成功能性任务，我们的结果表明，非瘫痪的上肢应该成为康复的目标。
