Poststroke Hypertonicity: Upper Limb Assessment and Treatment
Poststroke Hypertonicity: Upper Limb Assessment and Treatment
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DOI：
10.1310/tsr1803-179
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发表时间：
2011-05-01
影响因子：
2.2
通讯作者：
Marciniak, Christina
中科院分区：
文献类型：
--
作者：
Marciniak, Christina
高渗在偏瘫卒中后上肢功能障碍患者中很常见，并与更大的损害、更差的功能和更低的健康相关生活质量相关。除了增加休息活动外，肌肉激活的异常模式，如痉挛性共收缩，也可能导致残疾。在上肢，屈肌更常受累于远端，而在肩部，最常观察到内收肌、屈肌和内旋肌的痉挛。在进行干预之前，应了解有关先前干预、合并症诊断和异常音调所施加的限制的历史。常用的高张力量表包括改良Ashworth量表、改良Tardieu量表、痉挛频率量表、残疾评定量表、Fugl-Meyer量表和运动评定量表。上肢高张力的治疗干预措施包括拉伸、夹板、增强拮抗肌、口服药物和局部注射（苯酚或肉毒杆菌毒素）。鞘内注射巴氯芬也可能影响上肢张力。对于局灶性注射，通过在休息时引起运动阻力和观察肢体功能使用时的紧绷模式来评估导致问题张力的肌肉的正确识别。肉毒杆菌毒素已被证明可以降低中风幸存者的情绪，改善他们的主动和被动功能。由于继发性变化，如挛缩和无力，可能会随着长期的高张力而发生，在局灶性注射、口服药物或鞘内泵放置后，应考虑改善活动范围、加强衰弱肌肉和合并肢体使用的治疗。
Hypertonicity is common in patients with upper limb dysfunction following hemiplegic stroke and is associated with greater impairment, worse function, and lower health-related quality of life. In addition to increased rest activity, abnormal patterns of muscle activation, such as spastic co-contraction, may contribute to disability. In the upper limb, flexor muscles are more commonly involved distally, and at the shoulder, spasticity of adductors, flexors, and internal rotators is most often observed. Prior to interventions, a history regarding prior interventions, comorbid diagnoses, and limitations imposed by abnormal tone should be elicited. Commonly used scales to assess hypertonicity include the Modified Ashworth, the Modified Tardieu, the Spasm Frequency, the Disability Assessment, the Fugl-Meyer, and the Motor Assessment Scales. Treatment interventions for upper limb hypertonicity include stretching, splinting, strengthening of antagonist muscles, oral medications, and focal injections (phenol or botulinum toxins). Intrathecal baclofen may also impact upper limb tone. For focal injections, correct identification of muscles contributing to problematic tone is evaluated by eliciting resistance to movement at rest and observation of patterns of tightness as the limb is used functionally. The botulinum toxins have been shown to decrease tone in stroke survivors and improve active and passive functioning. Because secondary changes such as contractures and weakness may occur with prolonged hypertonicity, therapy to improve range of motion, strengthen weakened muscles, and incorporate use of the limb should be considered following focal injections, oral medications, or intrathecal pump placement.