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严重偏瘫性中风幸存者患侧上肢的运动功能障碍与左侧而非右侧半球损伤后的功能独立性相关。

Motor Deficits in the Ipsilesional Arm of Severely Paretic Stroke Survivors Correlate With Functional Independence in Left, but Not Right Hemisphere Damage.

作者信息

Jayasinghe Shanie A L, Good David, Wagstaff David A, Winstein Carolee, Sainburg Robert L

机构信息

Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA, United States.

Department of Human Development and Family Studies, Pennsylvania State University, State College, PA, United States.

出版信息

Front Hum Neurosci. 2020 Dec 9;14:599220. doi: 10.3389/fnhum.2020.599220. eCollection 2020.

DOI:10.3389/fnhum.2020.599220
PMID:33362495
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7756120/
Abstract

Chronic stroke survivors with severe contralesional arm paresis face numerous challenges to performing activities of daily living, which largely rely on the use of the less-affected ipsilesional arm. While use of the ipsilesional arm is often encouraged as a compensatory strategy in rehabilitation, substantial evidence indicates that motor control deficits in this arm can be functionally limiting, suggesting a role for remediation of this arm. Previous research has indicated that the nature of ipsilesional motor control deficits vary with hemisphere of damage and with the severity of contralesional paresis. Thus, in order to design rehabilitation that accounts for these deficits in promoting function, it is critical to understand the relative contributions of both ipsilesional and contralesional arm motor deficits to functional independence in stroke survivors with severe contralesional paresis. We now examine motor deficits in each arm of severely paretic chronic stroke survivors with unilateral damage (10 left-, 10 right-hemisphere damaged individuals) to determine whether hemisphere-dependent deficits are correlated with functional independence. Clinical evaluation of arm impairment was conducted with the upper extremity portion of the Fugl-Meyer assessment (UEFM). motor performance was evaluated using the Jebsen-Taylor Hand Function Test (JTHFT), grip strength, and ipsilesional high-resolution kinematic analysis during a visually targeted reaching task. Functional independence was measured with the Barthel Index. Functional independence was better correlated with ipsilesional than contralesional arm motor performance in the left hemisphere damage group [JTHFT: [ = -0.73, = 0.017]; grip strength: [ = 0.64, = 0.047]], and by contralesional arm impairment in the right hemisphere damage group [UEFM: [ = 0.66, = 0.040]]. Ipsilesional arm kinematics were correlated with functional independence in the left hemisphere damage group only. Examination of hemisphere-dependent motor correlates of functional independence showed that ipsilesional arm deficits were important in determining functional outcomes in individuals with left hemisphere damage only, suggesting that functional independence in right hemisphere damaged participants was affected by other factors.

摘要

患有严重对侧手臂麻痹的慢性中风幸存者在进行日常生活活动时面临诸多挑战,这些活动很大程度上依赖于使用受影响较小的同侧手臂。虽然在康复过程中,经常鼓励使用同侧手臂作为一种补偿策略,但大量证据表明,该手臂的运动控制缺陷在功能上可能具有局限性,这表明对该手臂进行矫正具有重要作用。先前的研究表明,同侧运动控制缺陷的性质因损伤半球和对侧麻痹的严重程度而异。因此,为了设计出能够在促进功能恢复时考虑到这些缺陷的康复方案,了解同侧和对侧手臂运动缺陷对患有严重对侧麻痹的中风幸存者功能独立性的相对贡献至关重要。我们现在检查单侧损伤(10名左半球损伤、10名右半球损伤个体)的严重麻痹慢性中风幸存者每只手臂的运动缺陷,以确定半球依赖性缺陷是否与功能独立性相关。使用Fugl-Meyer评估(UEFM)的上肢部分对手臂损伤进行临床评估。在视觉目标伸手任务期间,使用Jebsen-Taylor手功能测试(JTHFT)、握力和同侧高分辨率运动学分析来评估运动表现。使用Barthel指数测量功能独立性。在左半球损伤组中,功能独立性与同侧手臂运动表现的相关性优于对侧手臂运动表现[JTHFT:[r = -0.73,p = 0.017];握力:[r = 0.64,p = 0.047]],而在右半球损伤组中,功能独立性与对侧手臂损伤相关[UEFM:[r = 0.66,p = 0.040]]。同侧手臂运动学仅与左半球损伤组的功能独立性相关。对功能独立性的半球依赖性运动相关性的检查表明,同侧手臂缺陷仅在确定左半球损伤个体的功能结果中起重要作用,这表明右半球损伤参与者的功能独立性受其他因素影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95f9/7756120/a859840ce785/fnhum-14-599220-g0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95f9/7756120/b3c5dfd53e2a/fnhum-14-599220-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95f9/7756120/c462bd464a37/fnhum-14-599220-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95f9/7756120/2f1e45d549ed/fnhum-14-599220-g0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95f9/7756120/a859840ce785/fnhum-14-599220-g0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95f9/7756120/b3c5dfd53e2a/fnhum-14-599220-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95f9/7756120/c462bd464a37/fnhum-14-599220-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95f9/7756120/2f1e45d549ed/fnhum-14-599220-g0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95f9/7756120/a859840ce785/fnhum-14-599220-g0004.jpg

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