Recovery of grasp versus reach in people with hemiparesis poststroke
Recovery of grasp versus reach in people with hemiparesis poststroke
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DOI：
10.1177/1545968306289299
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发表时间：
2006-12-01
影响因子：
4.2
通讯作者：
Dromerick, Alexander W.
中科院分区：
文献类型：
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作者：
Lang, Catherine E.;Wagner, Joanne M.;Dromerick, Alexander W.
背景和目的。作者最近发现，在急性偏瘫患者中，抓握并不比伸手更容易受到干扰。他们现在将这项工作扩展到伸手与抓握的恢复。方法。偏瘫患者分别在中风后90天和1年后进行急性测试，对照组进行一次评估。使用运动学技术，研究受试者执行伸手和伸手抓握动作。作者量化了每个动作的3个表现特征：速度、准确性和效率，其中有效的动作被定义为直接向目标移动，没有额外的或异常的迂回移动。为了评估相对缺陷和抓握的恢复，使用对照组均值和标准差将表现指标转换为z分数。结果。作者的研究结果表明，从速度上的小缺陷开始，随着时间的推移，到达速度和把握速度都得到了改善。伸臂动作的准确度缺陷大于抓握动作的准确度缺陷，这些缺陷逐渐减小，到90天时，两种动作的相对准确度相同。相比之下，抓握效率的缺陷大于抓握的急性，抓握效率没有恢复。到达和抓握的恢复主要发生在90天时间点，90天和1年时间点之间变化不大。结论。作者假设，在慢性偏瘫中，需要远端控制的有目的运动可能比需要近端控制的有目的运动受损更严重，不是因为最初的病变，而是因为，在恢复过程中，下行运动系统的剩余部分可能能够补偿到达（近端控制）的准确性缺陷，但不能补偿抓取（远端肌肉控制）的效率缺陷。
Background and Objective. The authors recently found that grasping was not relatively more disrupted than reaching in people with acute hemiparesis. They now extend this work to the recovery of reach versus grasp. Methods. Hemiparetic subjects were tested acutely, after 90 days, and then after 1 year poststroke, and a control group was evaluated once. Using kinematic techniques, subjects were studied performing reach and reach-to-grasp movements. The authors quantified 3 characteristics of performance for each movement: speed, accuracy, and efficiency, where an efficient movement was defined as a movement directly to the target without extraneous or abnormally circuitous movements. To evaluate the relative deficits and recovery in reach versus grasp, performance measures were converted to z scores using control group means and standard deviations. Results. The authors' results showed that, starting with small deficits in speed acutely, both reach speed and grasp speed improved over time. Deficits in accuracy were greater in the reach than the grasp acutely, and these deficits lessened such that by the 90-day time point, the relative accuracy of the 2 movements was the same. In contrast, deficits in efficiency were greater in the grasp than the reach acutely, and grasp efficiency did not recover. The majority of recovery in reaching and grasping occurred by the 90-day time point, with little change occurring between the 90-day and I-year time points. Conclusions. The authors hypothesize that, in chronic hemiparesis, purposeful movements requiring distal control may be more impaired than purposeful movements requiring proximal control, not because of the initial lesion, but because, over the course of recovery, spared components of the descending motor systems may be able to compensate for the accuracy deficits in reaching (proximal control) but not the efficiency deficits in grasping (distal muscular control).