背景:上肢运动性麻痹是中风的主要症状,这限制了日常生活活动并损害了生活质量。运动学分析提供了一个深入和客观的手段来评估中风后上肢轻瘫,期待其在临床上的有效应用。
目的:本研究旨在比较中风偏瘫患者和健康个体在前伸和手到口伸的运动策略,使用一种简单的方法,旨在量化各种运动成分对伸手动作的贡献。
方法:进行了3D运动分析,使用简化的标记集(放置在下颌骨上,第七颈椎,肩峰,肱骨外侧上髁,掌指关节[MP]的食指,和股骨大转子)。对于前进任务,我们测量了食指MP关节从其起始位置到前后轴上的前向目标位置的距离。对于手到手的任务,测量开始时食指MP关节和下巴位置之间的垂直距离的缩短。对于这两种测量,计算了相关上肢和躯干运动的贡献。
结果:共有20名健康人和10名中风患者参与了这项研究。在前进任务中,中风参与者的肩或肘屈曲的贡献明显小于健康参与者(平均52.5%,SD24.5%与平均值85.2%,SD4.5%;P<.001),而脑卒中参与者躯干屈曲的贡献明显大于健康参与者(平均34.0%,SD28.5%与平均值3.0%,SD2.8%;P<.001)。在手工伸手的任务中,与健康参与者相比,中风参与者的肩或肘屈曲的贡献明显较小(平均71.8%,SD23.7%与平均值90.7%,标准差11.8%;P=0.009),而中风参与者的肩带抬高和肩关节外展明显大于健康参与者(平均10.5%,SD5.7%与平均值6.5%,SD3.0%;P=0.02,平均值16.5%,SD18.7%与平均值3.0%,SD10.4%;分别为P=.02)。
结论:与健康参与者相比,中风的参与者在前伸任务中通过躯干屈曲获得了明显更大的距离,在手到嘴的任务中通过肩外展和肩带抬高获得了明显更大的距离。这两种差异都被视为补偿性运动。了解个人运动策略的特点,例如对补偿性运动的依赖,可能有助于中风康复中量身定制的目标设定。
BACKGROUND: Upper limb motor paresis is a major symptom of stroke, which limits activities of daily living and compromises the quality of life. Kinematic analysis offers an in-depth and objective means to evaluate poststroke upper limb paresis, with anticipation for its effective application in clinical settings.
OBJECTIVE: This
study aims to compare the movement strategies of patients with hemiparesis due to stroke and healthy individuals in forward reach and hand-to-mouth reach, using a simple methodology designed to quantify the contribution of various movement components to the reaching action.
METHODS: A 3D motion analysis was conducted, using a simplified marker set (placed at the mandible, the seventh cervical vertebra, acromion, lateral epicondyle of the humerus, metacarpophalangeal [MP] joint of the index finger, and greater trochanter of the femur). For the forward reach task, we measured the distance the index finger\'s MP joint traveled from its starting position to the forward target location on the anterior-posterior axis. For the hand-to-mouth reach task, the shortening of the vertical distance between the index finger MP joint and the position of the chin at the start of the measurement was measured. For both measurements, the contributions of relevant upper limb and trunk movements were calculated.
RESULTS: A total of 20 healthy individuals and 10 patients with stroke participated in this
study. In the forward reach task, the contribution of shoulder or elbow flexion was significantly smaller in participants with stroke than in healthy participants (mean 52.5%, SD 24.5% vs mean 85.2%, SD 4.5%; P<.001), whereas the contribution of trunk flexion was significantly larger in stroke participants than in healthy participants (mean 34.0%, SD 28.5% vs mean 3.0%, SD 2.8%; P<.001). In the hand-to-mouth reach task, the contribution of shoulder or elbow flexion was significantly smaller in participants with stroke than in healthy participants (mean 71.8%, SD 23.7% vs mean 90.7%, SD 11.8%; P=.009), whereas shoulder girdle elevation and shoulder abduction were significantly larger in participants with stroke than in healthy participants (mean 10.5%, SD 5.7% vs mean 6.5%, SD 3.0%; P=.02 and mean 16.5%, SD 18.7% vs mean 3.0%, SD 10.4%; P=.02, respectively).
CONCLUSIONS: Compared with healthy participants, participants with stroke achieved a significantly greater distance via trunk flexion in the forward reach task and shoulder abduction and shoulder girdle elevation in the hand-to-mouth reach task, both of these differences are regarded as compensatory movements. Understanding the characteristics of individual motor strategies, such as dependence on compensatory movements, may contribute to tailored goal setting in stroke rehabilitation.