目的 评价慢性期脑卒中患者肩关节和肘关节在等长性收缩运动中的力量控制能力。方法 2015年1月至12月,22例慢性脑卒中患者及12名健康对照者,采用手臂静力力量测量仪器测量在肩外展、内收和肘屈曲、伸展4组动作下的最大力量,计算变异系数。结果 脑卒中患者上肢最大力量低于健康人(t>2.349, P<0.05),除肘伸展外,变异系数也增加(t>1.974, P<0.05)。结论 通过力量测试及变异系数的计算,能客观反映脑卒中患者肩肘运动的控制能力。
Objective To evaluate the ability of force control of elbow and shoulder during isometric contraction in patients with chronic stroke. Methods From January to December, 2015, 22 chronic stroke patients and 12 healthy people were measured the maximum force during shoulder abduction/adduction and elbow flexion/extension with instrument for measuring force of upper extremity. The coefficient of variation was calculated. Results The maximum force was less in the patients than in the healthy controls (t>2.349, P<0.05), and the coefficient of variation increased (t>1.974, P<0.05), except those of elbow extension. Conclusion The force measure and the coefficient of variation can reflect the force control in shoulder and elbow motion in stroke patients.
[1] Kang N, Cauraugh JH. Force control in chronic stroke [J]. Neurosci Biobehav Rev, 2015, 52: 38-48.
[2] Patten C, Kothari D, Whitney J, et al. Reliability and responsiveness of elbow trajectory tracking in chronic poststroke hemiparesis [J]. J Rehabil Res Dev, 2003, 40(6): 487-500.
[3] Lodha N, Naik SK, Coombes SA, et al. Force control and degree of motor impairments in chronic stroke [J]. Clin Neurophysiol, 2010, 121(11): 1952-1961.
[4] Dewald JP, Pope PS, Given JD, et al. Abnormal muscle coactivation patterns during isometric torque generation at the elbow and shoulder in hemiparetic subjects [J]. Brain, 1995, 118(2): 495-510.
[5] 何静杰,刘璇. 脑卒中偏瘫侧上肢的评定与康复[J]. 中国康复理论与实践, 2004, 10(9): 571-572.
[6] 洪跃镇,隋建锋,季林红,等. 偏瘫手臂静力力量测量仪器的设计研究[J]. 中国康复医学杂志, 2015, 30(12): 1253-1256.
[7] Yao J, Chen A, Carmona C, et al. Cortical overlap of joint representations contributes to the loss of independent joint control following stroke [J]. Neuroimage, 2009, 45(2): 490-499.
[8] Lukács M. Electrophysiological signs of changes in motor units after ischaemic stroke [J]. Clin Neurophysiol, 2005, 116(7): 1566-1570.
[9] Landgren S, Phillips CG, Porter R. Cortical fields of origin of the monosynaptic pyramidal pathways to some alpha motoneurones of the baboon's hand and forearm [J]. J Physiol, 1962, 161: 112-125.
[10] Phillips CG, Porter R. The pyramidal projection to motoneurones of some muscle groups of the baboon's forelimb [J]. Prog Brain Res, 1964, 12: 222-245.
[11] Brouwer B, Ashby P. Corticospinal projections to upper and lower limb spinal motoneurons in man [J]. Electroencephalogr Clin Neurophysiol, 1990, 76(6): 509-519.
[12] Colebatch JG, Rothwell JC, Day BL, et al. Cortical outflow to proximal arm muscles in man [J]. Brain, 1990, 113(6): 1843-1856.
[13] Freund HJ, Hummelsheim H. Premotor cortex in man: evidence for innervation of proximal limb muscles [J]. Exp Brain Res, 1984, 53(2): 479-482.
[14] Bourbonnais D, Vanden Noven S, Carey KM, et al. Abnormal spatial patterns of elbow muscle activation in hemiparetic human subjects [J]. Brain, 1989, 112(1): 85-102.
[15] Naik SK, Patten C, Lodha N, et al. Force control deficits in chronic stroke: grip formation and release phases [J]. Exp Brain Res, 2011, 211(1): 1-15.
[16] Hu X, Newell KM. Adaptation to bimanual asymmetric weights in isometric force coordination [J]. Neurosci Lett, 2011, 490(2): 121-125.
[17] Lindberg PG, Roche N, Robertson J, et al. Affected and unaffected quantitative aspects of grip force control in hemiparetic patients after stroke [J]. Brain Res, 2012, 1452: 96-107.
[18] Bertrand AM, Mercier C, Shun PL, et al. Effects of weakness on symmetrical bilateral grip force exertion in subjects with hemiparesis [J]. J Neurophysiol, 2004, 91(4): 1579-1585.
[19] Ye Y, Ma L, Yan T, et al. Kinetic measurements of hand motor impairments after mild to moderate stroke using grip control tasks [J]. J Neuroeng Rehabil, 2014, 11: 84.
[20] Kang N, Cauraugh JH. Bimanual force variability and chronic stroke: asymmetrical hand control [J]. PLoS One, 2014, 9(7): e101817.
[21] Vaillancourt DE, Newell KM. Changing complexity in human behavior and physiology through aging and disease [J]. Neurobiol Aging, 2002, 23(1): 1-11.
[22] Latash ML, Anson JG. Synergies in health and disease: relations to adaptive changes in motor coordination [J]. Phys Ther, 2006, 86(8): 1151-1160.
[23] Ward NS. Functional reorganization of the cerebral motor system after stroke [J]. Curr Opin Neurol, 2004, 17(6): 725-730.
[24] Hu X, Loncharich M, Newell KM. Visual information interacts with neuromuscular factors in the coordination of bimanual isometric force [J]. Exp Brain Res, 2011, 209(1): 129-138.
[25] Westerveld AJ, Schouten AC, Veltink PH, et al. Control of thumb force using surface functional electrical stimulation and muscle load sharing [J]. J Neuroeng Rehabil, 2013, 10: 104.
