How do strength, sensation, spasticity and joint individuation relate to the reaching deficits of people with chronic hemiparesis?
How do strength, sensation, spasticity and joint individuation relate to the reaching deficits of people with chronic hemiparesis?
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DOI：
10.1093/brain/awh116
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发表时间：
2004-05
期刊：
影响因子：
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通讯作者：
K. Zackowski;Alexander W. Dromerick;Shirley A. Sahrmann;W. T. Thach;Amy J. Bastian
中科院分区：
文献类型：
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作者：
K. Zackowski;Alexander W. Dromerick;Shirley A. Sahrmann;W. T. Thach;Amy J. Bastian
偏瘫受试者表现出运动缺陷，包括虚弱、痉挛和不能将运动隔离到一个或几个关节。随意尝试移动单个关节通常会导致相邻关节的过度运动。我们调查了是否无法个性化的关节运动与功能性达到赤字。对照组和轻偏瘫受试者进行两种不同的达到运动和三个个性化的手臂运动，所有在parasystrophic平面。伸展运动是矢状的“向上伸展”（肩屈曲和肘屈曲）和“向外伸展”（肩屈曲和肘伸展）。通过让每个受试者在肩关节、肘关节和腕关节进行单独的屈伸运动来评估关节个性化。此外，我们使用标准临床仪器测量了力量、肌肉张力和感觉。偏瘫患者表现出不同程度的损害时，执行达到的运动和个性化的关节运动。达到障碍（手路径曲率，速度）更糟的是在伸出与达到了条件。典型的关节个体化异常是关节过度屈曲，在指导关节运动期间应保持固定。偏瘫患者在尝试任何运动时，往往会同时产生肩关节和肘关节的屈曲运动，这也解释了为什么他们在“向上伸展”的任务中比在“向外伸展”的任务中表现得更好。分层回归分析表明，受损的联合个性化解释了大部分的到达路径曲率和终点误差的方差;强度解释了大部分的到达速度的方差。感觉也有显着贡献，但痉挛和力量在模型中不显着。我们的结论是，在联合个性化的赤字反映了一个基本的运动控制问题，在很大程度上解释了偏瘫患者自愿达到赤字的某些方面。
Hemiparetic subjects present with movement deficits including weakness, spasticity and an inability to isolate movement to one or a few joints. Voluntary attempts to move a single joint often result in excessive motion at adjacent joints. We investigated whether the inability to individuate joint movements is associated with deficits in functional reaching. Controls and hemiparetic subjects performed two different reaching movements and three individuated arm movements, all in the parasagittal plane. The reaching movements were a sagittal 'reach up' (shoulder flexion and elbow flexion) and 'reach out' (shoulder flexion and elbow extension). Joint individuation was assessed by getting each subject to perform an isolated flexion-extension movement at each of the shoulder, elbow and wrist joints. In addition, we measured strength, muscle tone and sensation using standard clinical instruments. Hemiparetic subjects showed varying degrees of impairment when performing reaching movements and individuated joint movements. Reaching impairments (hand path curvature, velocity) were worse in the reach out versus the reach up condition. Typical joint individuation abnormalities were excessive flexion of joints that should have been held fixed during movement of the instructed joint. Hemiparetic subjects tended to produce concurrent flexion motions of shoulder and elbow joints when attempting any movement, one explanation for why they were better at the 'reach up' than the 'reach out' task. Hierarchical regression analysis showed that impaired joint individuation explained most of the variance in the reach path curvature and end point error; strength explained most of the variance in reaching velocity. Sensation also contributed significantly, but spasticity and strength were not significant in the model. We conclude that the deficit in joint individuation reflects a fundamental motor control problem that largely explains some aspects of voluntary reaching deficits of hemiparetic subjects.