脑卒中后本体感觉和视动适应障碍的独立性。

BACKGROUND: Proprioceptive impairments are common after stroke and are associated with worse motor recovery and poor rehabilitation outcomes. Motor learning may also be an important factor in motor recovery, and some evidence in healthy adults suggests that reduced proprioceptive function is associated with reductions in motor learning. It is unclear how impairments in proprioception and motor learning relate after stroke. Here we used robotics and a traditional clinical assessment to examine the link between impairments in proprioception after stroke and a type of motor learning known as visuomotor adaptation. METHODS: We recruited participants with first-time unilateral stroke and controls matched for overall age and sex. Proprioceptive impairments in the more affected arm were assessed using robotic arm position- (APM) and movement-matching (AMM) tasks. We also assessed proprioceptive impairments using a clinical scale (Thumb Localization Test; TLT). Visuomotor adaptation was assessed using a task that systematically rotated hand cursor feedback during reaching movements (VMR). We quantified how much participants adapted to the disturbance and how many trials they took to adapt to the same levels as controls. Spearman's rho was used to examine the relationship between proprioception, assessed using robotics and the TLT, and visuomotor adaptation. Data from healthy adults were used to identify participants with stroke who were impaired in proprioception and visuomotor adaptation. The independence of impairments in proprioception and adaptation were examined using Fisher's exact tests. RESULTS: Impairments in proprioception (58.3%) and adaptation (52.1%) were common in participants with stroke (n = 48; 2.10% acute, 70.8% subacute, 27.1% chronic stroke). Performance on the APM task, AMM task, and TLT scores correlated weakly with measures of visuomotor adaptation. Fisher's exact tests demonstrated that impairments in proprioception, assessed using robotics and the TLT, were independent from impairments in visuomotor adaptation in our sample. CONCLUSION: Our results suggest impairments in proprioception may be independent from impairments in visuomotor adaptation after stroke. Further studies are needed to understand factors that influence the relationship between motor learning, proprioception and other rehabilitation outcomes throughout stroke recovery.

背景：本体感觉障碍在中风后很常见，与运动恢复较差和康复效果不佳有关。运动学习也可能是运动恢复的一个重要因素，一些健康成年人的证据表明，本体感觉功能降低与运动学习的减少有关。目前尚不清楚中风后本体感觉和运动学习的损伤如何相关。在这里，我们使用机器人和传统的临床评估来检查中风后本体感觉损伤与一种称为视觉运动适应的运动学习类型之间的联系。

方法：我们招募了首次单侧中风的参与者和与整体年龄和性别相匹配的对照组。使用机器人手臂位置（APM）和运动匹配（AMM）任务评估更受影响手臂的本体感觉损伤。我们还使用临床量表（拇指定位测试；TLT）评估本体感觉损伤。使用一种在伸手运动过程中系统地旋转手光标反馈的任务（VMR）评估视觉运动适应。我们量化了参与者适应干扰的程度以及他们适应与对照组相同水平所需的次数。使用 Spearman rho 检验评估使用机器人和 TLT 评估的本体感觉与视觉运动适应之间的关系。使用健康成年人的数据来确定在本体感觉和视觉运动适应方面受损的中风患者。使用 Fisher 精确检验检验本体感觉和适应的独立性。

结果：中风参与者（n=48；2.10%为急性，70.8%为亚急性，27.1%为慢性中风）中本体感觉（58.3%）和适应（52.1%）损伤很常见。APM 任务、AMM 任务和 TLT 分数与视觉运动适应的测量值呈弱相关。Fisher 精确检验表明，在我们的样本中，使用机器人和 TLT 评估的本体感觉损伤与视觉运动适应损伤独立。

结论：我们的结果表明，中风后本体感觉损伤可能与视觉运动适应损伤无关。需要进一步的研究来了解影响运动学习、本体感觉和中风恢复过程中其他康复结果之间关系的因素。