Relating movement control at 9 upper extremity segments to loss of hand function in people with chronic hemiparesis
Relating movement control at 9 upper extremity segments to loss of hand function in people with chronic hemiparesis
复制标题
DOI：
10.1177/1545968306296964
复制
发表时间：
2007-05-01
影响因子：
4.2
通讯作者：
Beebe, Justin A.
中科院分区：
文献类型：
--
作者：
Lang, Catherine E.;Beebe, Justin A.
背景和目的。偏瘫患者的手功能丧失是中风后残疾的主要原因。为了使用手进行功能活动，人可能需要控制更近端的上肢段以相对于环境定位和定向手，并且可能需要控制手指以操纵环境内的物体。本研究的目的是探讨慢性轻偏瘫患者上肢近端、中段和远端的运动控制如何导致手功能的丧失。方法. 32例轻偏瘫患者（平均21.4个月后病变）进行了研究，使孤立的运动，肩屈，肘屈，前臂旋前/旋后，腕屈/伸展，和个人手指屈曲使用3D运动技术。对于每个节段，获得3个变量：节段可以移动多远（活动范围[AROM]），节段可以自行移动的程度（个性化指数），以及节段在不应该移动时保持静止的程度（静止指数）。用一组临床测试测量手功能，并使用主成分分析从测试组中为每个患者创建单个手功能评分。相关和回归分析被用来研究节段性运动控制和手功能之间的关系。结果上肢9个节段的运动控制与手功能有关。在9个节段中，拇指与手功能的关系最弱。在运动控制的3项指标中，AROM与手功能有很强的相关性，并预测了最大的变化（73%）。这种差异大部分是跨节段共享的，因此，对于AROM，近端、中间或远端节段没有提供独特的贡献。结论.这些数据支持这样的观点，即运动控制的丧失在各个节段之间存在协变，并且手功能的丧失是由于所有节段的运动控制的丧失，而不仅仅是远端节段。
Background and Objective. Loss of hand function in people with hemiparesis is a major contributor to disability post-stroke. To use the hand for functional activities, a person may need control of the more proximal upper extremity segments to position and orient the hand with respect to the environment and may need control of the fingers to manipulate objects within the environment. The purpose of this project was to investigate how movement control at proximal, middle, and distal upper extremity segments contributed to loss of hand function in people with chronic hemiparesis. Methods. 32 patients with hemiparesis (avg 21.4 months postlesion) were studied making isolated movements of shoulder flexion, elbow flexion, forearm pronation/supination, wrist flexion/extension, and individual finger flexion using 3D kinematic techniques. For each segment, 3 variables were obtained: how far a segment could move (active range of motion [AROM]), how well a segment could move by itself (individuation index), and how well a segment could remain still when it was not supposed to move (stationary index). Hand function was measured with a battery of clinical tests, and principal components analysis was used to create a single hand function score for each patient from the test battery. Correlation and regression analyses were used to examine relationships between segmental movement control and hand function. Results. Movement control at all 9 segments of the upper extremity was related to hand function. Of the 9 segments, the thumb tended to have the weakest relationship with hand function. Of the 3 measures of movement control, AROM had strong relationships with and predicted the most variance in hand function (73%). Most of this variance was shared across segments, such that, for AROM, there were no unique contributions provided by proximal, middle, or distal segments. Conclusions. These data support the idea that loss of movement control covaries across segments and that loss of hand function is due to loss of movement control at all segments, not just at distal ones.