Fine motor control in adults with and without chronic hemiparesis: Baseline comparison to nondisabled adults and effects of bilateral arm training
Fine motor control in adults with and without chronic hemiparesis: Baseline comparison to nondisabled adults and effects of bilateral arm training
复制标题
DOI：
10.1016/j.apmr.2003.10.020
复制
发表时间：
2004-07-01
影响因子：
4.3
通讯作者：
Whitall, J
中科院分区：
文献类型：
--
作者：
Waller, SM;Whitall, J
目的：通过10名慢性中风患者双臂的手指敲击来表征精细运动控制，与匹配对照进行基线比较，并检查6周双侧手臂训练后中风患者中出现的缺陷的反应性。设计：非随机对照，队列前后试验。设置：研究机构。参与者：来自社区的10名慢性单侧缺血性卒中患者和10名年龄和性别匹配的健康对照者。偏瘫患者已完成所有常规护理，且卒中后超过6个月。入选标准为单侧卒中后至少6个月，能够遵循简单的指令和两步命令，非瘫痪手臂的意志控制，瘫痪手臂的肩部至少有最小的反重力运动。干预：不适用。主要结果测量：测量包括单侧叩击的频率和时间的一致性，最佳频率和最大频率，以及肢体间的准确性和稳定性，在双侧同时（同相）和交替（反相）敲击中以优选的速率进行协调。结果如下：非麻痹性手指控制与非残疾参与者相似，除了在双侧条件下，不太一致。一个亚组与残留的parefic手指功能，有缓慢和不太一致的parefic手指敲击，以及不太准确和更可变的肢体间协调，但是，基本的双边耦合关系被保留。双侧手臂训练改善了双侧非麻痹一致性，但减慢了单侧首选叩击。训练还改善了4名轻度卒中参与者中的2名的精细运动控制。2应答者，占主导地位的半球病变，表明可能的恢复优势，双边培训，这样的insulines.Conclusions：在一般情况下，非轻瘫手指控制敲击保存，但parefic手指控制受到损害。非轻瘫控制的敲击，特别是一致性的敲击，发生在双边敲击任务，但响应6周的双边手臂为基础的训练。尽管明显缺乏训练特异性，但双侧手臂训练对精细运动肢体间协调的可推广效果可能反映了上肢协调的中枢运动控制机制，这可能会影响中风后手臂功能的恢复。
Objectives: To characterize fine motor control through finger tapping in both arms of 10 patients with chronic stroke, to make baseline comparisons with matched controls, and to examine the responsiveness of deficits seen in stroke patients after 6 weeks of bilateral arm-based training.Design: Nonrandomized controlled, cohort before-after trial.Setting: Research institution.Participants: Ten people from the community with chronic unilateral ischemic stroke and 10 age- and sex-matched healthy controls. Participants with hemiparesis had completed all conventional care and were more than 6 month poststroke. Inclusion criteria were at least 6 months since a unilateral stroke, ability to follow simple instructions and 2-step commands, volitional control of the nonparetic arm, and at least minimal antigravity movement in the shoulder of the paretic arm.Interventions: Not applicable.Main Outcome Measures: Measurements included rate and timing consistency of unilateral tapping at a preferred and a maximal rate and the accuracy and stability of interlimb, coordination in bilateral simultaneous (inphase) and alternating (antiphase) tapping at a preferred rate. Results: Nonparetic finger control was similar to that of the nondisabled participants except under bilateral conditions, where it was less consistent. A subgroup with residual parefic finger function, had slower and less consistent parefic finger tapping, as well as less accurate and more variable interlimb coordination; however, basic bilateral coupling relationships were preserved. Bilateral arm-based training improved bilateral nonparetic consistency but slowed unilateral preferred tapping. Training also improved parefic fine motor control in 2 of 4 participants with mild stroke severity. The 2 responders, with dominant hemisphere lesions, indicated a possible recovery advantage with bilateral training for such lesions.Conclusions: In general, nonparetic finger control for tapping was preserved but parefic finger control was compromised. Disruption of nonparetic control of tapping, particularly consistency of tapping, occurred during bilateral tapping tasks but was responsive to 6 weeks of bilateral arm-based training. Despite the apparent lack of training specificity, the generalizable effects of bilateral arm training to fine motor interlimb coordination may reflect central motor control mechanisms for upper-extremity coordination, which may be accessed and may influence the recovery of arm function after stroke.