Centre for Neuroscience Studies, Queen's University, Kingston, Ontario.
Hotchkiss Brain Institute, University of Calgary, Calgary, AB; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB.
J Rehabil Med. 2023 May 23;55:jrm2174. doi: 10.2340/jrm.v55.2174.
The classical description of poststroke upper limb impairment follows a proximalto-distal impairment gradient. Previous studies are equivocal on whether the hand is more impaired than the arm.
To compare impairment of the arm and hand during subacute stroke.
A total of 73 individuals were evaluated for impairment of the upper limb within 30 days (early subacute) and within 90-150 days (late subacute) of stroke. Impairments were quantified using the Chedoke-McMaster Stroke Assessment (CMSA) for the arm and hand, Purdue Pegboard task, and a robotic Visually Guided Reaching task.
In the early phase 42% of participants in the early phase and 59% in the late phase received the same CMSA score for the arm and hand, with 88% and 95% of participants in the early and late phases, respectively, receiving a 1-point difference. Strong correlations exist between the CMSA arm and hand scores (early r = 0.79, late r = 0.75), and moderate - strong correlations exist between CMSA arm and hand scores and Purdue Pegboard and Visually Guided Reaching performances (r = 0.66-0.81). No systematic differences were found between the arm and hand.
Impairments in the arm and hand during subacute stroke are highly correlated and do not support the presence of a proximal-to-distal gradient.
脑卒中后上肢功能障碍的经典描述呈近段到远段的损害梯度。既往研究对于手部是否比手臂更易受损存在争议。
比较亚急性期脑卒中上肢的手臂和手部的损害。
共有 73 例患者在脑卒中后 30 天（早期亚急性期）和 90-150 天（晚期亚急性期）内接受上肢损害评估。采用 Chedoke-McMaster 脑卒中评估量表（CMSA）评估手臂和手部的损害、普渡钉板测试和机器人视觉引导伸手测试。
在早期阶段，42%的参与者手臂和手部的 CMSA 评分相同，在晚期阶段，59%的参与者手臂和手部的 CMSA 评分相同，分别有 88%和 95%的早期和晚期阶段的参与者，其 CMSA 评分差值为 1 分。CMSA 手臂和手部评分之间存在强相关性（早期 r = 0.79，晚期 r = 0.75），CMSA 手臂和手部评分与普渡钉板和视觉引导伸手测试表现之间存在中强相关性（r = 0.66-0.81）。手臂和手部之间未发现系统差异。
亚急性期脑卒中上肢的手臂和手部损害高度相关，不支持存在近段到远段梯度的假设。
