Defining the Role of Sensation, Strength, and Prehension for Upper Limb Function in Cervical Spinal Cord Injury
Defining the Role of Sensation, Strength, and Prehension for Upper Limb Function in Cervical Spinal Cord Injury
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DOI：
10.1177/1545968313490998
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发表时间：
2014-01-01
影响因子：
4.2
通讯作者：
Verrier, Mary C.
中科院分区：
文献类型：
--
作者：
Kalsi-Ryan, Sukhvinder;Beaton, Dorcas;Verrier, Mary C.
背景。上肢功能在增强四肢瘫痪患者的独立性方面起着重要作用。然而，关于上肢功能的感觉运动缺陷的具体输入的知识有限。因此，设计的理论框架开发的强度，敏感性和理解的分级重新定义评估（GRASSP）被用作假设模型来分析损伤对功能的影响。目标。通过功能测量（上肢能力问卷、脊髓独立性测量）来定义损伤（由GRASSP测量的感觉、力量和抓握能力）与上肢功能的关联。方法。应用结构方程模型建立了一个假设的关系模型来估计GRASSP损伤域对上肢功能的影响。收集了72名慢性四肢瘫痪患者的数据来检验假设模型。结果。结构方程模型证实了感觉、力量和抓握与上肢功能之间的强烈关联，并确定72%的感觉运动上肢功能方差可以用该模型解释。拟合统计表明数据确实符合假设模型。感觉和力量以抓握为中介直接或间接影响上肢功能。结论。GRASSP是一种灵敏的诊断工具，可以区分力量、感觉和抓握对功能的相对贡献。因此，干预对特定损伤领域的影响以及对上肢临床康复的相关贡献可以被详细描述，以优化康复计划。
Background. Upper limb function plays a significant role in enhancing independence for individuals with tetraplegia. However, there is limited knowledge about the specific input of sensorimotor deficits on upper limb function. Thus the theoretical framework designed to develop the Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP) was used as a hypothetical model to analyze the impact of impairment on function. Objective. To define the association of impairment (sensation, strength, and prehension measured by the GRASSP) to upper limb function as defined by functional measures (Capabilities of Upper Extremity Questionnaire, Spinal Cord Independence Measure). Methods. A hypothetical model representing relationships by applying structural equation modeling was used to estimate the effect of the impairment domains in GRASSP on upper limb function. Data collected on 72 chronic individuals with tetraplegia was used to test the hypothetical model. Results. Structural equation modeling confirmed strong associations between sensation, strength, and prehension with upper limb function, and determined 72% of the variance in sensorimotor upper limb function was explained by the model. Statistics of fit showed the data did fit the hypothesized model. Sensation and strength influence upper limb function directly and indirectly with prehension as the mediator. Conclusions. The GRASSP is a sensitive diagnostic tool in distinguishing the relative contribution of strength, sensation and prehension to function. Thus, the impact of interventions on specific domains of impairment and related contribution on clinical recovery of the upper limb can be detailed to optimize rehabilitation programs.