Loss of strength contributes more to physical disability after stroke than loss of dexterity
Loss of strength contributes more to physical disability after stroke than loss of dexterity
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DOI：
10.1191/0269215504cr715oa
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发表时间：
2004-05-01
影响因子：
3
通讯作者：
O'Dwyer, NJ
中科院分区：
文献类型：
--
作者：
Canning, CG;Ada, L;O'Dwyer, NJ
目的：中风后身体残疾的主要原因被认为是灵活性丧失的负面损害（这里定义为在任何运动任务的执行中协调肌肉活动的能力丧失）和力量丧失。本研究的目的是：(1)确定卒中后恢复过程中力量和灵活性对功能的相对贡献；(2)确定初始强度、灵巧度和功能对脑卒中后远期功能的预测价值。设计：纵向描述性研究。环境：两家城市医院的住院和门诊康复部。对象：22例急性脑卒中患者接受康复治疗。主要结果测量：在中风后3、5、7、9、11、15、19、23和27周，测量肘关节屈肌和伸肌的力量和灵活性，以及手臂功能。结果：标准多元线性回归分析显示，在任何时候，力量和灵巧度对功能都有显著影响（r(2) = 0.66-0.82, p < 0.0001）。此外，强度总是对功能有额外的单独贡献（r(2) = 0.05-0.26, p < 0.05）。第3周的功能是27周功能的最佳临床预测指标（r(2) = 0.55, p < 0.001）。结论：在脑卒中后肢体残疾中，力量丧失比灵活性丧失更重要。这表明，在存在明显弱点的地方，需要增加力量的锻炼来减少残疾。
Objective: The major contributors to physical disability after stroke are considered to be the negative impairments of loss of dexterity (defined here as loss of the ability to co-ordinate muscle activity in the performance of any motor task) and loss of strength. The aims of this study were: (1) to determine the relative contributions of strength and dexterity to function during recovery after stroke; and (2) to determine the predictive value of initial strength, dexterity and function on long-term function after stroke.Design: A longitudinal descriptive study.Setting: The inpatient and outpatient rehabilitation departments of two metropolitan hospitals.Subjects: Twenty-two patients undergoing rehabilitation after acute stroke participated.Main outcome measures: Strength and dexterity of the elbow flexors and extensors were measured, along with arm function, at 3, 5, 7, 9, 11, 15, 19, 23 and 27 weeks after stroke.Results: Standard multiple linear regression analysis demonstrated that strength and dexterity in total contributed significantly to function at all times (r(2) = 0.66-0.82, p < 0.0001). Furthermore, strength always made an additional separate contribution to function (r(2) = 0.05-0.26, p < 0.05). Function at week 3 was the best clinical predictor of function at week 27 (r(2) = 0.55, p < 0.001).Conclusions: Loss of strength is a more significant contributor than loss of dexterity to physical disability after stroke. This suggests that, where significant weakness is present, exercise designed to increase strength will be required to decrease disability.