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脑卒中后早期上肢运动功能恢复是否依赖于感觉功能的恢复?

Is Recovery of Somatosensory Impairment Conditional for Upper-Limb Motor Recovery Early After Stroke?

机构信息

Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.

Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA.

出版信息

Neurorehabil Neural Repair. 2020 May;34(5):403-416. doi: 10.1177/1545968320907075.

Abstract

. Spontaneous recovery early after stroke is most evident during a time-sensitive window of heightened neuroplasticity, known as spontaneous neurobiological recovery. It is unknown whether poststroke upper-limb motor and somatosensory impairment both reflect spontaneous neurobiological recovery or if somatosensory impairment and/or recovery influences motor recovery. . Motor (Fugl-Meyer upper-extremity [FM-UE]) and somatosensory impairments (Erasmus modification of the Nottingham Sensory Assessment [EmNSA-UE]) were measured in 215 patients within 3 weeks and at 5, 12, and 26 weeks after a first-ever ischemic stroke. The longitudinal association between FM-UE and EmNSA-UE was examined in patients with motor and somatosensory impairments (FM-UE ≤ 60 and EmNSA-UE ≤ 37) at baseline. . A total of 94 patients were included in the longitudinal analysis. EmNSA-UE increased significantly up to 12 weeks poststroke. The longitudinal association between motor and somatosensory impairment disappeared when correcting for progress of time and was not significantly different for patients with severe baseline somatosensory impairment. Patients with a FM-UE score ≥18 at 26 weeks (n = 55) showed a significant positive association between motor and somatosensory impairments, irrespective of progress of time. . Progress of time, as a reflection of spontaneous neurobiological recovery, is an important factor that drives recovery of upper-limb motor as well as somatosensory impairments in the first 12 weeks poststroke. Severe somatosensory impairment at baseline does not directly compromise motor recovery. The study rather suggests that spontaneous recovery of somatosensory impairment is a prerequisite for full motor recovery of the upper paretic limb.

摘要

. 中风后早期的自发性恢复在神经可塑性增强的时间敏感窗口最为明显,称为自发性神经生物学恢复。尚不清楚中风后上肢运动和感觉障碍均反映自发性神经生物学恢复,还是感觉障碍和/或恢复影响运动恢复。. 在首次缺血性中风后 3 周内以及 5、12 和 26 周时,对 215 例患者进行运动(Fugl-Meyer 上肢[FM-UE])和感觉障碍(Erasmus 改良的诺丁汉感觉评估[EmNSA-UE])的测量。在基线时患有运动和感觉障碍(FM-UE≤60 和 EmNSA-UE≤37)的患者中,检查了 FM-UE 和 EmNSA-UE 之间的纵向关联。. 共有 94 例患者纳入纵向分析。EmNSA-UE 在中风后 12 周内显著增加。当校正时间进展时,运动和感觉障碍之间的纵向关联消失,并且对于基线感觉障碍严重的患者没有显著差异。在 26 周时 FM-UE 评分≥18 的患者(n=55)表现出运动和感觉障碍之间的显著正相关,无论时间进展如何。. 时间的进展,反映自发性神经生物学恢复,是驱动中风后前 12 周上肢运动和感觉障碍恢复的重要因素。基线时严重的感觉障碍不会直接影响运动恢复。该研究表明,感觉障碍的自发性恢复是上肢瘫痪肢体完全运动恢复的前提。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cf6d/7222963/10c2b1154efd/10.1177_1545968320907075-fig1.jpg

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