Spasticity and muscle contracture following stroke
Spasticity and muscle contracture following stroke
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DOI：
10.1093/brain/119.5.1737
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发表时间：
1996-10-01
期刊：
影响因子：
14.5
通讯作者：
Neilson, PD
中科院分区：
文献类型：
--
作者：
ODwyer, NJ;Ada, L;Neilson, PD
人们越来越认识到，脑损伤后的主要功能缺陷主要是由于“负面”特征，例如虚弱和灵活性丧失，而不是痉挛。各种研究表明，痉挛是一个独特的问题，与灵活性丧失无关，但它可能与肌肉挛缩的形成甚至力量的恢复有关。为了解决这些问题，我们研究了中风后受影响上肢的痉挛、挛缩、力量和灵活性之间的关系。痉挛的测量表现为强直牵张反射的增加和被动牵拉阻力的增加（张力亢进）。 24 名患者是在中风后 13 个月内从三个康复中心非选择性招募的。很少有患者表现出强直反射增强，但有一半患者被发现出现肌肉挛缩，最早出现在中风后 2 个月。张力亢进与挛缩有关，但与反射过度兴奋无关。仅在挛缩患者的亚组中观察到强直牵张反射增加，并且通常只能在肌肉范围末端引起。这一发现表明，挛缩实际上可能会加剧某些患者的痉挛，而不是痉挛导致挛缩。然而;大多数挛缩患者的强直牵张反射并未增强。此外，我们发现痉挛与虚弱或灵活性丧失之间没有关系。因此，虽然张力亢进仍然是脑损伤后的一个重要问题，但对与痉挛相关的反射性过度兴奋的关注似乎与其影响不成比例。因此，需要将痉挛患者的肌张力亢进与反射性过度兴奋区分开来。
It has become increasingly recognized that the major functional deficits following brain damage are largely due to 'negative' features such as weakness and loss of dexterity rather than spasticity A variety of studies suggest that spasticity is a distinct problem and separate from the loss of dexterity, but that it may be implicated in the formation of muscle contracture and even in the recovery of strength. In order to address these issues, we examined the relationship between spasticity, contracture, strength and dexterity in the affected upper limb following stroke. Spasticity was measured both as increased tonic stretch reflexes and increased resistance to passive stretch (hypertonia). Twenty-four patients were recruited non-selectively from three rehabilitation units within 13 months of their stroke. Few patients exhibited increased tonic reflexes but half were found to have muscle contracture, the earliest at 2 months following stroke. Hypertonia was associated with contracture but not with reflex hyperexcitability. Increased tonic stretch reflexes were observed only In a subgroup of those with contracture and where present could usually be elicited only at the end of muscle range. This finding suggests that instead of spasticity causing contracture, contracture may actually potentiate spasticity in some patients. However; the majority of patients with contracture did not have increased tonic stretch reflexes. In addition, we found no relationship between spasticity and either weakness or loss of dexterity. Therefore, while hypertonia remains an important problem following cerebral lesions, it would appear that the amount of attention directed to reflex hyperexcitability associated with spasticity is out of proportion with its effects. Consequently, hypertonia needs to be clearly distinguished from reflex hyperexcitability in patients with spasticity.