A Short and Distinct Time Window for Recovery of Arm Motor Control Early After Stroke Revealed With a Global Measure of Trajectory Kinematics
A Short and Distinct Time Window for Recovery of Arm Motor Control Early After Stroke Revealed With a Global Measure of Trajectory Kinematics
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DOI：
10.1177/1545968317697034
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发表时间：
2017-06-01
影响因子：
4.2
通讯作者：
Kitago, Tomoko
中科院分区：
文献类型：
--
作者：
Cortes, Juan C.;Goldsmith, Jeff;Kitago, Tomoko
背景。研究表明，当用标准临床量表测量时，大多数手臂运动恢复发生在中风后的三个月内。然而，这些措施的改善反映了运动控制的恢复，力量的增加和补偿策略的获得的结合。目标。分离和表征中风后第一年手臂运动控制恢复的时间过程。方法。18例急性缺血性脑卒中患者的纵向研究。电机控制使用全局运动学测量来评估，该测量来源于一个二维到达任务，旨在最大限度地减少对反重力强度的需求并防止补偿。用Fugl-Meyer上肢评估（FMA-UE）评估手臂损伤，用动作研究臂测试（ARAT）评估活动受限，用二头肌动力测量法评估力量。评估分别在中风后1.5、5、14、27和54周进行。结果。到第5周，患儿的运动控制得到改善，在此时间点之后没有进一步改善。相比之下，FMA-UE、ARAT和肱二头肌动力测量的改善持续超过5周，第5周至第54周的改善程度与第1.5周至第5周观察到的改善程度相似。结论。与用临床量表评估的运动功能相比，用整体运动学测量隔离的手臂运动控制在中风后恢复稳定的时间要早得多。运动恢复的时间过程和临床恢复测量之间的分离可能是由于力量改善对后者的贡献。新的干预措施，集中在中风后的第一个月，将需要利用运动控制自发恢复的较窄窗口。
Background. Studies demonstrate that most arm motor recovery occurs within three months after stroke, when measured with standard clinical scales. Improvements on these measures, however, reflect a combination of recovery in motor control, increases in strength, and acquisition of compensatory strategies. Objective. To isolate and characterize the time course of recovery of arm motor control over the first year poststroke. Methods. Longitudinal study of 18 participants with acute ischemic stroke. Motor control was evaluated using a global kinematic measure derived from a 2-dimensional reaching task designed to minimize the need for antigravity strength and prevent compensation. Arm impairment was evaluated with the Fugl-Meyer Assessment of the upper extremity (FMA-UE), activity limitation with the Action Research Arm Test (ARAT), and strength with biceps dynamometry. Assessments were conducted at: 1.5, 5, 14, 27, and 54 weeks poststroke. Results. Motor control in the paretic arm improved up to week 5, with no further improvement beyond this time point. In contrast, improvements in the FMA-UE, ARAT, and biceps dynamometry continued beyond 5 weeks, with a similar magnitude of improvement between weeks 5 and 54 as the one observed between weeks 1.5 and 5. Conclusions. Recovery after stroke plateaued much earlier for arm motor control, isolated with a global kinematic measure, compared to motor function assessed with clinical scales. This dissociation between the time courses of kinematic and clinical measures of recovery may be due to the contribution of strength improvement to the latter. Novel interventions, focused on the first month poststroke, will be required to exploit the narrower window of spontaneous recovery for motor control.