脑卒中后手的双侧使用的恢复和预测。
Recovery and Prediction of Bimanual Hand Use After Stroke.
机构信息
From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France.
出版信息
Neurology. 2021 Aug 17;97(7):e706-e719. doi: 10.1212/WNL.0000000000012366. Epub 2021 Jun 14.
OBJECTIVE
To determine similarities and differences in key predictors of recovery of bimanual hand use and unimanual motor impairment after stroke.
METHOD
In this prospective longitudinal study, 89 patients with first-ever stroke with arm paresis were assessed at 3 weeks and 3 and 6 months after stroke onset. Bimanual activity performance was assessed with the Adult Assisting Hand Assessment Stroke (Ad-AHA), and unimanual motor impairment was assessed with the Fugl-Meyer Assessment (FMA). Candidate predictors included shoulder abduction and finger extension measured by the corresponding FMA items (FMA-SAFE; range 0-4) and sensory and cognitive impairment. MRI was used to measure weighted corticospinal tract lesion load (wCST-LL) and resting-state interhemispheric functional connectivity (FC).
RESULTS
Initial Ad-AHA performance was poor but improved over time in all (mild-severe) impairment subgroups. Ad-AHA correlated with FMA at each time point ( > 0.88, < 0.001), and recovery trajectories were similar. In patients with moderate to severe initial FMA, FMA-SAFE score was the strongest predictor of Ad-AHA outcome ( = 0.81) and degree of recovery ( = 0.64). Two-point discrimination explained additional variance in Ad-AHA outcome ( = 0.05). Repeated analyses without FMA-SAFE score identified wCST-LL and cognitive impairment as additional predictors. A wCST-LL >5.5 cm strongly predicted low to minimal FMA/Ad-AHA recovery (≤10 and 20 points respectively, specificity = 0.91). FC explained some additional variance to FMA-SAFE score only in unimanual recovery.
CONCLUSION
Although recovery of bimanual activity depends on the extent of corticospinal tract injury and initial sensory and cognitive impairments, FMA-SAFE score captures most of the variance explained by these mechanisms. FMA-SAFE score, a straightforward clinical measure, strongly predicts bimanual recovery.
CLINICALTRIALSGOV IDENTIFIER
NCT02878304.
CLASSIFICATION OF EVIDENCE
This study provides Class I evidence that the FMA-SAFE score predicts bimanual recovery after stroke.
目的
确定影响脑卒中后双手使用和单手运动障碍恢复的关键预测因素的异同。
方法
本前瞻性纵向研究纳入 89 例首发脑卒中后出现手臂瘫痪的患者，在脑卒中发病后 3 周、3 个月和 6 个月时进行评估。采用成人辅助手评估脑卒中（Ad-AHA）评估双手活动表现，采用 Fugl-Meyer 评估（FMA）评估单手运动障碍。候选预测因素包括肩部外展和手指伸展，通过相应的 FMA 项目（FMA-SAFE；范围 0-4）以及感觉和认知障碍来测量。磁共振成像（MRI）用于测量加权皮质脊髓束病变负荷（wCST-LL）和静息状态半球间功能连通性（FC）。
结果
初始 Ad-AHA 表现较差，但在所有（轻度至重度）损伤亚组中均随时间改善。Ad-AHA 与每个时间点的 FMA 均相关（>0.88，<0.001），且恢复轨迹相似。在初始 FMA 为中度至重度的患者中，FMA-SAFE 评分是 Ad-AHA 结局（ = 0.81）和恢复程度（ = 0.64）的最强预测指标。两点辨别力可进一步解释 Ad-AHA 结局的差异（ = 0.05）。不包含 FMA-SAFE 评分的重复分析确定 wCST-LL 和认知障碍为额外的预测指标。wCST-LL＞5.5 cm 强烈预测 FMA/Ad-AHA 恢复程度低至最小（分别为≤10 分和 20 分，特异性=0.91）。FC 仅在单手恢复中可进一步解释 FMA-SAFE 评分的部分差异。
结论
尽管双手活动的恢复取决于皮质脊髓束损伤的程度以及初始感觉和认知障碍，但 FMA-SAFE 评分可捕获这些机制解释的大部分差异。简单的临床测量 FMA-SAFE 评分可强烈预测双手恢复。
临床试验注册
NCT02878304。
证据分类
本研究提供了 1 级证据，表明 FMA-SAFE 评分可预测脑卒中后双手的恢复情况。
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