认知需求影响急性脑卒中后上肢运动功能的恢复。
Cognitive Demands Influence Upper Extremity Motor Performance During Recovery From Acute Stroke.
机构信息
From the Center for Neurotechnology and Neurorecovery (D.J.L., J.A.D., N.L., J.R., K.P., A.C., J.F., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology, Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, J. Philip Kistler Stroke Research Center (A.K.B.), Department of Neurology, Department of Occupational Therapy (J.R.), Department of Physical Therapy (K.P.), and Department of Speech, Language, and Swallowing Disorders (A.C., J.F.), Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Department of Occupational Therapy (K.S.E., N.L.), MGH Institute of Health Professions, Boston, MA; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Engineering (L.R.H.), Brown University, Providence, RI; Department of Neurology (S.C.C.), University of California, Los Angeles; and California Rehabilitation Hospital (S.C.C.), Los Angeles.
出版信息
Neurology. 2021 May 25;96(21):e2576-e2586. doi: 10.1212/WNL.0000000000011992. Epub 2021 Apr 15.
OBJECTIVE
To test the hypothesis that cognitive demands influence motor performance during recovery from acute stroke, we tested patients with acute stroke on 2 motor tasks with different cognitive demands and related task performance to cognitive impairment and neuroanatomic injury.
METHODS
We assessed the contralesional and ipsilesional upper extremities of a cohort of 50 patients with weakness after unilateral acute ischemic stroke at 3 time points with 2 tasks: the Box & Blocks Test, a task with greater cognitive demand, and Grip Strength, a simple and ballistic motor task. We compared performance on the 2 tasks, related motor performance to cognitive dysfunction, and used voxel-based lesion symptom mapping to determine neuroanatomic sites associated with motor performance.
RESULTS
Consistent across contralesional and ipsilesional upper extremities and most pronounced immediately after stroke, Box & Blocks scores were significantly more impaired than Grip Strength scores. The presence of cognitive dysfunction significantly explained up to 33% of variance in Box & Blocks performance but was not associated with Grip Strength performance. While Grip Strength performance was associated with injury largely restricted to sensorimotor regions, Box & Blocks performance was associated with broad injury outside sensorimotor structures, particularly the dorsal anterior insula, a region known to be important for complex cognitive function.
CONCLUSIONS
Together, these results suggest that cognitive demands influence upper extremity motor performance during recovery from acute stroke. Our findings emphasize the integrated nature of motor and cognitive systems and suggest that it is critical to consider cognitive demands during motor testing and neurorehabilitation after stroke.
目的
为了验证认知需求会影响急性中风后恢复过程中的运动表现这一假说，我们在 2 项具有不同认知需求的运动任务上对急性中风患者进行了测试，并将任务表现与认知障碍和神经解剖损伤相关联。
方法
我们在 3 个时间点上评估了 50 名单侧急性缺血性中风后出现虚弱的患者的对侧和同侧上肢，使用 2 项任务：盒子和方块测试（认知需求较高的任务）和握力（简单的弹道运动任务）。我们比较了这 2 项任务的表现，将运动表现与认知功能障碍相关联，并使用基于体素的病变症状映射来确定与运动表现相关的神经解剖部位。
结果
跨越对侧和同侧上肢，最明显的是在中风后立即，盒子和方块的得分明显比握力得分受损更严重。认知功能障碍的存在显著解释了盒子和方块表现的高达 33%的方差，但与握力表现无关。虽然握力表现与主要局限于感觉运动区域的损伤相关，但盒子和方块的表现与感觉运动结构外的广泛损伤相关，特别是背侧前岛叶，这是一个已知对复杂认知功能很重要的区域。
结论
总的来说，这些结果表明认知需求会影响急性中风后上肢的运动表现。我们的发现强调了运动和认知系统的综合性质，并表明在中风后的运动测试和神经康复中，考虑认知需求至关重要。
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