上肢运动流畅性度量在中重度亚急性期脑卒中患者上肢运动中的测量性能。

Measurement properties of movement smoothness metrics for upper limb reaching movements in people with moderate to severe subacute stroke.

机构信息

Department of Physical and Rehabilitation Medicine, CHU Brest, Brest, F-29200, France.

UMR 1101 LaTIM, Univ Brest, INSERM, Brest, F-29200, France.

出版信息

J Neuroeng Rehabil. 2024 May 29;21(1):90. doi: 10.1186/s12984-024-01382-1.

DOI:10.1186/s12984-024-01382-1

PMID:38812037

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11134951/

Abstract

BACKGROUND

Movement smoothness is a potential kinematic biomarker of upper extremity (UE) movement quality and recovery after stroke; however, the measurement properties of available smoothness metrics have been poorly assessed in this group. We aimed to measure the reliability, responsiveness and construct validity of several smoothness metrics.

METHODS

This ancillary study of the REM-AVC trial included 31 participants with hemiparesis in the subacute phase of stroke (median time since stroke: 38 days). Assessments performed at inclusion (Day 0, D0) and at the end of a rehabilitation program (Day 30, D30) included the UE Fugl Meyer Assessment (UE-FMA), the Action Research Arm Test (ARAT), and 3D motion analysis of the UE during three reach-to-point movements at a self-selected speed to a target located in front at shoulder height and at 90% of arm length. Four smoothness metrics were computed: a frequency domain smoothness metric, spectral arc length metric (SPARC); and three temporal domain smoothness metrics (TDSM): log dimensionless jerk (LDLJ); number of submovements (nSUB); and normalized average rectified jerk (NARJ).

RESULTS

At D30, large clinical and kinematic improvements were observed. Only SPARC and LDLJ had an excellent reliability (intra-class correlation > 0.9) and a low measurement error (coefficient of variation < 10%). SPARC was responsive to changes in movement straightness (r=0.64) and to a lesser extent to changes in movement duration (r=0.51) while TDSM were very responsive to changes in movement duration (r>0.8) and not to changes in movement straightness (non-significant correlations). Most construct validity hypotheses tested were verified except for TDSM with low correlations with clinical metrics at D0 (r<0.5), ensuing low predictive validity with clinical metrics at D30 (non-significant correlations).

CONCLUSIONS

Responsiveness and construct validity of TDSM were hindered by movement duration and/or noise-sensitivity. Based on the present results and concordant literature, we recommend using SPARC rather than TDSM in reaching movements of uncontrolled duration in individuals with spastic paresis after stroke.

TRIAL REGISTRATION

NCT01383512, https://clinicaltrials.gov/ , June 27, 2011.

摘要

背景

运动平滑度是上肢（UE）运动质量和中风后恢复的潜在运动学生物标志物；然而，在该人群中，已有平滑度指标的测量性能评估较差。我们旨在测量几种平滑度指标的可靠性、反应性和结构有效性。

方法

这项 REM-AVC 试验的辅助研究包括 31 名处于中风亚急性期的偏瘫患者（中风后中位数时间：38 天）。纳入时（第 0 天，D0）和康复计划结束时（第 30 天，D30）进行的评估包括 UE Fugl Meyer 评估（UE-FMA）、动作研究臂测试（ARAT）和 UE 在三个自我选择速度的指向点运动中的 3D 运动分析到达位于肩部高度和 90%手臂长度的前方目标。计算了四个平滑度指标：频域平滑度指标、谱弧长指标（SPARC）；和三个时域平滑度指标（TDSM）：对数无量纲急动度（LDLJ）；子运动数量（nSUB）；和归一化平均整流急动度（NARJ）。

结果

在 D30 时，观察到了显著的临床和运动学改善。只有 SPARC 和 LDLJ 具有极好的可靠性（组内相关系数>0.9）和低测量误差（变异系数<10%）。SPARC 对运动直线度的变化反应灵敏（r=0.64），对运动持续时间的变化反应稍差（r=0.51），而 TDSM 对运动持续时间的变化非常敏感（r>0.8），对运动直线度的变化不敏感（无显著相关性）。大多数检验的结构有效性假设均得到验证，除了 TDSM 在 D0 时与临床指标的相关性较低（r<0.5），导致 D30 时与临床指标的预测有效性较低（无显著相关性）。