Katz D I, Alexander M P, Klein R B
Neurology Department, Healthsouth Braintree Hospital Rehabilitation Network, MA 02185, USA.
Arch Phys Med Rehabil. 1998 May;79(5):488-93. doi: 10.1016/s0003-9993(98)90060-0.
To characterize the frequency of recovery of arm paresis in patients with traumatic brain injury (TBI) admitted to rehabilitation.
Retrospective review identifying a cohort of patients with moderate or severe arm paresis after TBI followed at least 6 months postinjury.
Freestanding acute rehabilitation hospital TBI unit.
Forty-four patients with moderate to severe arm paresis were selected from 264 consecutive admissions and characterized by injury pathology subtype, injury severity (duration of unconsciousness [loss of consciousness, LOC] and posttraumatic amnesia [PTA]), age, and level of paresis according to Brunnstrom Stages of Recovery (BS 1 to 6). Patient groups with and without arm paresis were compared according to these variables (t tests and chi(2)).
Recovery of arm paresis to isolated motor function (BS 5 or 6) and time to achieve recovery. Recovered and nonrecovered patients were compared (Mann-Whitney, t tests, and chi(2)) on injury severity, initial level of paresis, age, time to rehabilitation admission, and pathology subtype. Time to recovery was compared for patients at different levels of initial paresis, ranges of LOC, and pathology subtypes (Mann-Whitney and Kruskal-Wallis tests).
Forty-four patients (17%) had moderate (BS 3 to 4) or severe (BS 1 to 2) paresis at rehabilitation admission. They were more severely injured than nonparetic patients based on longer LOC (p < .002) and PTA (p < .009). Thirty-six patients (82%) recovered by 6 months; 72% of these recovered by 2 months. If still paretic at 2 months, only 56% recovered. Mean recovery time was 6.9 weeks (SD, 6.1) from injury. Time to recovery was best predicted by initial level of paresis and injury severity (r2 = .48), but not age. Patients with diffuse injury tended towards a more protracted recovery (7.9 weeks, SD 6.5) than patients with focal injury (4.2 weeks, SD 3.9) (p = .08) and only those with diffuse injury showed further recovery after 3 months.
Arm paresis after TBI is relatively infrequent. Most patients recover by 2 months but later recovery is possible, especially in patients with primarily diffuse brain damage. Recovery is highly related to initial impairment, injury severity, and distribution of brain injury.
描述入住康复机构的创伤性脑损伤（TBI）患者手臂轻瘫恢复的频率。
回顾性研究，确定一组创伤性脑损伤后出现中度或重度手臂轻瘫且伤后至少随访6个月的患者。
独立的急性康复医院的创伤性脑损伤病房。
从264例连续入院患者中选取44例中度至重度手臂轻瘫患者，根据损伤病理亚型、损伤严重程度（昏迷持续时间[意识丧失，LOC]和创伤后遗忘症[PTA]）、年龄以及根据布鲁恩斯特伦恢复阶段（BS 1至6）划分的轻瘫程度进行特征描述。根据这些变量（t检验和卡方检验）对有和没有手臂轻瘫的患者组进行比较。
手臂轻瘫恢复至孤立运动功能（BS 5或6）以及达到恢复的时间。对恢复和未恢复的患者在损伤严重程度、初始轻瘫程度、年龄、康复入院时间和病理亚型方面进行比较（曼-惠特尼检验、t检验和卡方检验）。比较不同初始轻瘫程度、LOC范围和病理亚型患者的恢复时间（曼-惠特尼检验和克鲁斯卡尔-沃利斯检验）。
44例患者（17%）在康复入院时有中度（BS 3至4）或重度（BS 1至2）轻瘫。基于更长的LOC（p <.002）和PTA（p <.009），他们比无轻瘫患者受伤更严重。36例患者（82%）在6个月时恢复；其中72%在2个月时恢复。如果在2个月时仍为轻瘫，只有56%会恢复。从受伤到恢复的平均时间为6.9周（标准差，6.1）。恢复时间最好由初始轻瘫程度和损伤严重程度预测（r2 =.48），而不是年龄。弥漫性损伤患者的恢复往往比局灶性损伤患者更持久（7.9周，标准差6.5）（p =.08），并且只有弥漫性损伤患者在3个月后仍有进一步恢复。
创伤性脑损伤后的手臂轻瘫相对不常见。大多数患者在2个月内恢复，但后期恢复也是可能的，尤其是主要为弥漫性脑损伤的患者。恢复与初始损伤、损伤严重程度和脑损伤分布高度相关。
