Recovery of upper limb dexterity in patients more than 1 year after stroke: Frequency, clinical correlates and predictors
Recovery of upper limb dexterity in patients more than 1 year after stroke: Frequency, clinical correlates and predictors
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DOI：
10.3233/nre-2011-0639
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发表时间：
2011-01-01
影响因子：
2
通讯作者：
Lee, Jeanette
中科院分区：
文献类型：
--
作者：
Kong, Keng-He;Chua, Karen S. G.;Lee, Jeanette
目的：本研究的目的是建立卒中后存活1年以上患者上肢灵活性的发生频率、临床相关性和预测因素。设计：横断面研究。地点：某三级康复中心的门诊。参与者：140名卒中后1年以上的患者。干预：主要观察指标：上肢灵巧度的运动评定量表(MAS)，痉挛程度的Ashworth评分，运动能力的上肢运动指数(UEMI)和下肢运动指数(LEMI)，功能状态的改良Barthel指数(MBI)。痉挛分为无痉挛、中度痉挛和重度痉挛。结果：患者的平均年龄为61.0±13.3岁，患者在卒中发病后41.7+/-35.1个月进行评估。上肢灵巧40例(28.3%)。感觉障碍、严重痉挛和MBI、UEMI和LEMI评分低与灵巧功能低下显著相关，其中严重痉挛(p<；0.001)和UEMI评分(p=0.025)最为重要。康复入院时出现严重卒中、忽视、感觉障碍、完全/部分前循环卒中以及MBI、UEMI和LEMI评分较低的患者灵巧功能较差。最重要的灵巧性预测因子是入院康复时的uemi评分(p=0.005)。结论：28.3%的慢性卒中患者存在上肢灵巧性。影响肢体灵巧度的最重要因素是上肢力量和严重痉挛，而灵巧度最显著的预测因素是入院康复时上肢瘫痪的严重程度。
Objective: The objectives of this study are to establish frequency, clinical correlates and predictors of upper limb dexterity in patients who have survived 1 year or more after a stroke.Design: Cross-sectional study.Setting: Outpatient clinic of a tertiary rehabilitation centre.Participants: One hundred and forty patients who were more than a year after stroke onset. Interventions: Nil.Main outcome measures: Motor Assessment Scale (MAS) for measurement of upper limb dexterity, Ashworth Scale for spasticity, Upper Extremity Motricity Index (UEMI) and Lower Extremity Motricity Index (LEMI) for motor power and Modified Barthel Index (MBI) for functional status. Spasticity was categorized as absent to moderate and severe. Potential predictors of dextrous function were chosen based on retrospective review of the patientfls medical records during admission for inpatient rehabilitation.Results: The mean age was 61.0 +/- 13.3 years and patients were evaluated at 41.7 +/- 35.1 months after stroke onset. Upper limb dexterity was present in 40 (28.3%) patients. Sensory impairment, severe spasticity and low scores on the MBI, UEMI and LEMI were significantly correlated to poor dextrous function, with severe spasticity (p < 0.001) and UEMI score (p = 0.025) being the most important. Poor dextrous function was predicted by a severe stroke, neglect, sensory impairment, total/partial anterior circulation stroke and low MBI, UEMI and LEMI scores on rehabilitation admission. The most important predictor of dexterity was UEMI score on admission to rehabilitation (p = 0.005).Conclusion: Upper limb dexterity was present in 28.3% of a cohort of chronic stroke patients. The most important correlates of limb dexterity were upper limb strength and severe spasticity and the most significant predictor of dexterity was the severity of upper limb paresis on admission to rehabilitation.