Doussoulin A, Rivas C, Bacco J, Sepúlveda P, Carvallo G, Gajardo C, Soto A, Rivas R
Physiotherapist, Associate Professor, Departamento de Pediatría y Cirugía Infantil - Universidad de La Frontera Temuco, Hochstetter 405, Temuco, Chile.
Physiotherapist MV Clinical Temuco, Chile.
J Stroke Cerebrovasc Dis. 2020 Nov;29(11):105253. doi: 10.1016/j.jstrokecerebrovasdis.2020.105253. Epub 2020 Aug 29.
A high number of patients with stroke develop upper extremity spasticity, causing abnormal postures and patterns. These alterations limit the use of arm in functional activities and affect social participation.
To determine the prevalence of spasticity and postural patterns of the upper extremity post stroke.
A cross-sectional descriptive design was used with a prospective follow-up. The sample included 136 patients. The study included 3 measuring times; at 10 days (T1), applying a record with sociodemographic-clinical data, the evaluation of muscle tone in the elbow and wrist and the postural patterns of the UE, and at 3 months (T2) and 12 months (T3) post stroke, re-evaluating tone and patterns. Prevalence was calculated through the one-sample chi-squared (χ2) test followed by inspection of the standardized residuals (z) in each cell. The Kappa coefficient evaluated the degree of agreement in elbow and wrist tone.
The prevalence of spasticity in the elbow was 37.5% at T1, 57.4% at T2, and 57.4% at T3. At each time there was a high degree of agreement between elbow and wrist tone. Patients developed increased elbow tone between T1 and T2, with maintained tone between T2 and T3. Postural pattern III was the most prevalent according to Hefter's classification.
The prevalence of spasticity in the elbow and wrist increases between 10 days and 3 months post stroke, and is maintained between 3 and 12 months. The onset of spasticity occurs in almost half of patients during the first 10 days post stroke. Postural pattern III according to Hefter's classification presented the greatest prevalence in the spastic UE.
大量中风患者会出现上肢痉挛，导致异常姿势和模式。这些改变限制了手臂在功能活动中的使用，并影响社会参与。
确定中风后上肢痉挛和姿势模式的患病率。
采用横断面描述性设计并进行前瞻性随访。样本包括136名患者。该研究包括3个测量时间点；在中风后10天（T1），记录社会人口统计学-临床数据，评估肘部和腕部的肌张力以及上肢的姿势模式，在中风后3个月（T2）和12个月（T3），重新评估肌张力和模式。患病率通过单样本卡方（χ2）检验计算，随后检查每个单元格中的标准化残差（z）。kappa系数评估肘部和腕部肌张力的一致程度。
肘部痉挛的患病率在T1为37.5%，T2为57.4%，T3为57.4%。在每个时间点，肘部和腕部肌张力之间都有高度一致性。患者在T1和T2之间肘部肌张力增加，在T2和T3之间保持稳定。根据赫夫特分类，姿势模式III最为普遍。
中风后10天至3个月期间，肘部和腕部痉挛的患病率增加，在3至12个月期间保持稳定。几乎一半的患者在中风后的前10天内出现痉挛。根据赫夫特分类，姿势模式III在痉挛性上肢中患病率最高。
