Upper Limb Motor Impairment After Stroke.
Upper Limb Motor Impairment After Stroke.
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DOI：
10.1016/j.pmr.2015.06.008
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发表时间：
2015-11
影响因子：
1.7
通讯作者：
Raghavan P
中科院分区：
文献类型：
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作者：
Raghavan P
了解中风后的上肢损伤对于计划恢复功能的治疗工作是至关重要的。然而，由于两个原因，确定治疗哪种上肢损伤以及如何治疗是复杂的：1)损伤不是静态的，即随着运动恢复的进行，损伤的类型和性质可能会改变；因此，治疗需要发展到针对在给定时间点导致功能障碍的损伤。2)多种损伤可能同时存在，即患者可能在中风后立即出现手臂和手的无力，当痉挛在几周或几个月后出现时，这可能还没有解决；因此，随着时间的推移，可能会有分层的损伤，使得很难决定首先治疗什么。要了解损伤如何导致上肢功能障碍，最有用的方法可能是从其功能后果的角度来检查它们。损伤对上肢功能的影响主要有三种：(1)习得性不使用；(2)习得性不良使用；(3)通过对任务的行为分析确定的遗忘。对导致这些功能限制的损伤进行了描述。
Understanding upper limb impairment after stroke is essential to planning therapeutic efforts to restore function. However determining which upper limb impairment to treat and how is complex for two reasons: 1) the impairments are not static, i.e. as motor recovery proceeds, the type and nature of the impairments may change; therefore the treatment needs to evolve to target the impairment contributing to dysfunction at a given point in time. 2) multiple impairments may be present simultaneously, i.e., a patient may present with weakness of the arm and hand immediately after a stroke, which may not have resolved when spasticity sets in a few weeks or months later; hence there may be a layering of impairments over time making it difficult to decide what to treat first. The most useful way to understand how impairments contribute to upper limb dysfunction may be to examine them from the perspective of their functional consequences. There are three main functional consequences of impairments on upper limb function are: (1) learned nonuse, (2) learned bad-use, and (3) forgetting as determined by behavioral analysis of tasks. The impairments that contribute to each of these functional limitations are described.