Faster Reaching in Chronic Spastic Stroke Patients Comes at the Expense of Arm-Trunk Coordination
Faster Reaching in Chronic Spastic Stroke Patients Comes at the Expense of Arm-Trunk Coordination
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DOI：
10.1177/1545968315591704
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发表时间：
2016-03-01
影响因子：
4.2
通讯作者：
Roby-Brami, Agnes
中科院分区：
文献类型：
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作者：
Mandon, Laurence;Boudarham, Julien;Roby-Brami, Agnes
背景中风相关性轻偏瘫患者的伸手动作速度通常会降低，但他们能够主动增加瘫痪手的速度。以前的研究表明，更快的速度可以提高运动质量。Objective.探讨伸手距离和速度训练对躯干和瘫痪上肢协调性的联合作用。假设是速度的增加会减少肘部伸展并增加躯干的补偿运动。方法.一个单一的会话研究，其中达到运动学记录在一组14例痉挛性轻偏瘫。使用三维运动分析系统跟踪固定在手指、手腕、肘部、肩峰和胸骨上的5个反射标记的轨迹。分别在60%和90%臂长的位置，以首选和最大速度对2个目标进行伸展运动。实验重复了一遍，躯干被一条带子绑住。结果所有患者均能自主增加伸臂速度。在躯干自由、速度较快的情况下，伸肘速度增加，伸肘幅度减小，躯干运动增加。在躯干约束条件下，肘关节伸展幅度不随速度的增加而减小。7名患者缩放肘关节伸展和肘关节伸展速度作为到达距离的函数，其他7名患者主要增加躯干补偿，增加任务限制。没有明确的临床特征可以解释这种差异。结论.更快的速度可能会鼓励一些患者使用补偿。治疗的个体适应症可以基于达到协调的定量分析。
Background. The velocity of reaching movements is often reduced in patients with stroke-related hemiparesis; however, they are able to voluntarily increase paretic hand velocity. Previous studies have proposed that faster speed improves movement quality. Objective. To investigate the combined effects of reaching distance and speed instruction on trunk and paretic upper-limb coordination. The hypothesis was that increased speed would reduce elbow extension and increase compensatory trunk movement. Methods. A single session study in which reaching kinematics were recorded in a group of 14 patients with spastic hemiparesis. A 3-dimensional motion analysis system was used to track the trajectories of 5 reflective markers fixed on the finger, wrist, elbow, acromion, and sternum. The reaching movements were performed to 2 targets at 60% and 90% arm length, respectively, at preferred and maximum velocity. The experiment was repeated with the trunk restrained by a strap. Results. All the patients were able to voluntarily increase reaching velocity. In the trunk free, faster speed condition, elbow extension velocity increased but elbow extension amplitude decreased and trunk movement increased. In the trunk restraint condition, elbow extension amplitude did not decrease with faster speed. Seven patients scaled elbow extension and elbow extension velocity as a function of reach distance, the other 7 mainly increased trunk compensation with increased task constraints. There were no clear clinical characteristics that could explain this difference. Conclusions. Faster speed may encourage some patients to use compensation. Individual indications for therapy could be based on a quantitative analysis of reaching coordination.