Does the contribution of the paretic hand to bimanual tasks change with grip strength capacity following stroke?
Does the contribution of the paretic hand to bimanual tasks change with grip strength capacity following stroke?
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DOI：
10.1016/j.neuropsychologia.2022.108186
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发表时间：
2022-04-15
期刊：
影响因子：
2.6
通讯作者：
Lodha, Neha
中科院分区：
文献类型：
--
作者：
Pollet, Aviva K.;Patel, Prakruti;Lodha, Neha
我们每天执行的大多数任务都需要协调使用双手。中风后，瘫痪的手对双手操作的贡献往往受损，导致不对称的手使用。握力是中风运动恢复进展的常用临床指标。在何种程度上麻痹的手的双手任务的贡献，提高了增加握力是未知的。本研究的目的是确定如何握力能力的麻痹的手影响其贡献双手的任务。21名慢性中风参与者和10名老年对照参与者自愿参加这项研究。根据麻痹手的相对握力，将中风患者分为两组，轻瘫手部力量/非轻瘫手部力量，以百分比表示。低力量能力组是指相对握力小于60%的个体，高力量能力组是指相对握力大于或等于60%的个体。所有组进行等长，握力收缩在两个双手的任务-最大力生产（MVC）的任务和次大力控制任务。我们量化了在这两项任务中由轻瘫和非轻瘫手贡献的力的大小。此外，在力控制任务中，我们使用双手的变异系数（CV）和近似熵（ApEn）量化了力变异的量和结构。在双手操作任务中，随着相对握力的增加，麻痹手所贡献的力的量增加（最大力产生：r = 0.85，p < 0.01;次大力控制：r = 0.62，p < 0.01）。在双手MVC任务和双手力控制任务中，高力量能力组双手贡献的力大小相等，而低力量能力组双手贡献的力大小不等。令人惊讶的是，双手力控制任务中的力变异的数量和结构并没有随着相对握力的增加而改变，（力的CV：r =-0.07，p = 0.77; ApEn：r =-0.23，p = 0.31）。与对照组相比，低和高力量能力卒中组的力量CV和ApEn均显著升高。随着相对握力的增加，瘫痪的手贡献更大的力量，但继续表现出持续的赤字，在双手任务的力量调制能力。因此，脑卒中康复应强调对偏瘫手进行力量调节的再训练，以最大限度地利用偏瘫手进行双手操作。
The majority of tasks we perform every day require coordinated use of both hands. Following a stroke, the paretic hand contribution to bimanual tasks is often impaired, leading to asymmetric hand use. Grip strength is a commonly used clinical indicator of progress towards stroke motor recovery. The extent to which the paretic hand’s contribution to bimanual tasks improves with increasing grip strength is not known. The purpose of this study is to determine how grip strength capacity of the paretic hand influences its contribution to bimanual tasks. Twenty-one chronic stroke participants and ten older control participants volunteered to take part in this study. The individuals with stroke were recruited in two distinct groups based on the relative grip strength of paretic hand, i.e., paretic hand strength / non-paretic hand strength, expressed as a percentage. The low strength-capacity group was identified as individuals with relative grip strength less than 60% and the high strength-capacity group was individuals with relative grip strength greater than or equal to 60%. All groups performed isometric, grip force contractions in two bimanual tasks – a maximum force production (MVC) task and a submaximal force control task. We quantified the magnitude of force contributed by the paretic and non-paretic hands during both tasks. Additionally, in the force control task we quantified the amount and structure of force variability using coefficient of variation (CV) and approximate entropy (ApEn) for both hands. The amount of force contributed by the paretic hand increased in bimanual tasks with an increase in its relative grip strength, (maximal force production: r = 0.85, p < 0.01; submaximal force control: r = 0.62, p < 0.01). In the bimanual MVC task and bimanual force control task, both hands contributed equal magnitudes of force in the high strength-capacity group but unequal forces in low strength-capacity group. Surprisingly, the amount and structure of force variability in bimanual force control tasks did not change with the increase in relative grip strength, (CV of force: r = − 0.07, p = 0.77; ApEn: r = − 0.23, p = 0.31). Both low and high strength-capacity stroke groups showed significantly higher CV of force and heightened ApEn compared with the control group. With the increase in relative grip strength, the paretic hand contributes greater magnitude of force but continues to show persistent deficits in force modulation capacity in bimanual tasks. Therefore, stroke rehabilitation should emphasize retraining of the paretic hand for force modulation to maximize the use of paretic hand in bimanual tasks.
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