指部徒手感觉刺激前后脑卒中偏瘫患者手指屈、伸肌张力及超声剪切波弹性成像的变化

doi:10.3969/j.issn.1006-9771.2022.02.011

Abstract

Abstract:

Objective To demonstrate the changes in flexor digitorum and extensor digitorum tension in the affected hands with shear-wave elastography (SWE) before and after manual digitorum sensory stimulation (MDSS) in hemiplegic patients with stroke. Methods A total of 51 hemiplegic post-stroke inpatients in the Department of Rehabilitation Medicine in Second Hospital of Anhui Medical University from April to June, 2020, underwent MDSS completed by a researcher who used a bare thumb and index finger to squeeze each nail bed as well as the sides of each fingertip in the affected hand. The stimulation intensity was the minimum that could cause finger extension without obvious pain, and the interval between two stimulations was five to ten seconds. Muscular tension of the flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus and extensor digitorum were assessed with modified Ashworth Scale (MAS) and shear-wave velocity (SWV) of SWE on the affected side before and immediately after MDSS. MAS score was -1 as low muscular tension. Results The MAS scores of all the muscles significantly reduced after MDSS (|Z| > 2.843, P < 0.001); while the changes of SWV were not significantly in all the muscles with initially MAS score of 0 or -1 (t < 1.052, P > 0.05), and it reduced in those muscles with initial MAS scores of one to three (t > 2.672, P < 0.05). The SWV were positively correlated with the MAS scores both before and after MDSS (r > 0.334, P < 0.05). Conclusion MDSS can effectively, immediately, and safely relieves muscle spasms of the flexor digitorum and facilitate active finger extension in the affected hand for hemiplegic patients with stroke. SWE is useful for quantitatively and objectively evaluating muscular tension in the affected hand for hemiplegic patients with stroke.

Key words: stroke, spasticity, manual digitorum sensory stimulation, shear-wave elastography, modified Ashworth Scale

CLC Number:

R743.3

HE Ziyan,TANG Xiaoxiao,TIAN Yaxing,JIANG Fan,KAN Xiuli,SHEN Xianshan,MAO Jing,XU Jun,LIU Xue,WU Jianxian,WU Tingting,HONG Yongfeng. Features in digitorum muscular tension and shear-wave elastography in hemiplegic patients with stroke before and after manual digitorum sensory stimulation[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(2): 204-211.

Figures/Tables 5

References 40

[1]	COUPLAND A P, THAPAR A, QURESHI M I, et al. The definition of stroke[J]. J R Soc Med, 2017, 110(1): 9-12. doi: 10.1177/0141076816680121
[2]	MIYASAKA H, ORAND A, OHNISHI H, et al. Ability of electrical stimulation therapy to improve the effectiveness of robotic training for paretic upper limbs in patients with stroke[J]. Med Eng Phys, 2016, 38(11): 1172-1175. doi: 10.1016/j.medengphy.2016.07.010
[3]	HE W, LIU Y, FENG J, et al. The epidemiological characteristics of stroke in Hunan Province, China[J]. Front Neurol, 2018, 9: 583. doi: 10.3389/fneur.2018.00583
[4]	BRAININ M. Stroke epidemiology in China: which are the next steps?[J]. Lancet Neurol, 2019, 18(4): 325-326. doi: 10.1016/S1474-4422(19)30023-7
[5]	ZOROWITZ R D, GILLARD P J, BRAININ M. Poststroke spasticity: sequelae and burden on stroke survivors and caregivers[J]. Neurology, 2013, 80(3 Suppl 2): S45-S52.
[6]	LI S, FRANCISCO G E. New insights into the pathophysiology of post-stroke spasticity[J]. Front Hum Neurosci, 2015, 9: 192. doi: 10.3389/fpsyg.2018.00192
[7]	DRESSLER D, BHIDAYASIRI R, BOHLEGA S, et al. Botulinum toxin therapy for treatment of spasticity in multiple sclerosis: review and recommendations of the IAB-Interdisciplinary Working Group for Movement Disorders task force[J]. J Neurol, 2017, 264(1): 112-120. doi: 10.1007/s00415-016-8304-z
[8]	GART M S, ADKINSON J M. Considerations in the management of upper extremity spasticity[J]. Hand Clin, 2018, 34(4): 465-471. doi: 10.1016/j.hcl.2018.06.004
[9]	CHEN C L, CHEN C Y, CHEN H C, et al. Responsiveness and minimal clinically important difference of Modified Ashworth Scale in patients with stroke[J]. Eur J Phys Rehabil Med, 2019, 55(6): 754-760.
[10]	ZEMANOVA M. Shear wave elastography in ophthalmic diagnosis[J]. J Fr Ophtalmol, 2019, 42(1): 73-80. doi: 10.1016/j.jfo.2018.05.006
[11]	SIGRIST R M S, LIAU J, KAFFAS A E, et al. Ultrasound elastography: review of techniques and clinical applications[J]. Theranostics, 2017, 7(5): 1303-1329. doi: 10.7150/thno.18650
[12]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志, 2019, 52(9): 710-715.
	Chinese Society of Neurology, Chinese Stroke Society. Diagnosis of cerebrovascular diseases in China (version 2019)[J]. Chin J Neurol, 2019, 52(9): 710-715.
[13]	KAYA T, KARATEPE A G, GUNAYDIN R, et al. Inter-rater reliability of the Modified Ashworth Scale and modified Modified Ashworth Scale in assessing poststroke elbow flexor spasticity[J]. Int J Rehabil Res, 2011, 34(1): 59-64. doi: 10.1097/MRR.0b013e32833d6cdf
[14]	PARK J H, KIM Y, LEE K J, et al. Artificial neural network learns clinical assessment of spasticity in Modified Ashworth Scale[J]. Arch Phys Med Rehabil, 2019, 100(10): 1907-1915. doi: 10.1016/j.apmr.2019.03.016
[15]	LENG Y, WANG Z, BIAN R, et al. Alterations of elastic property of spastic muscle with its joint resistance evaluated from shear wave elastography and biomechanical model[J]. Front Neurol, 2019, 10: 736. doi: 10.3389/fneur.2019.00736
[16]	TALJANOVIC M S, GIMBER L H, BECKER G W, et al. Shear-wave elastography: basic physics and musculoskeletal applications[J]. Radiographics, 2017, 37(3): 855-870. doi: 10.1148/rg.2017160116
[17]	WANG Y, JIANG J. Influence of tissue microstructure on shear wave speed measurements in plane shear wave elastography: a computational study in lossless fibrotic liver media[J]. Ultrason Imaging, 2018, 40(1): 49-63. doi: 10.1177/0161734617719055
[18]	BRANDENBURG J E, EBY S F, SONG P F, et al. Ultrasound elastography: the new frontier in direct measurement of muscle stiffness[J]. Arch Phys Med Rehabil, 2014, 95(11): 2207-2219. doi: 10.1016/j.apmr.2014.07.007
[19]	LIN C Y, CHEN P Y, SHAU Y W, et al. An artifact in supersonic shear wave elastography[J]. Ultrasound Med Biol, 2017, 43(2): 517-530. doi: 10.1016/j.ultrasmedbio.2016.09.018
[20]	MELLEMA D C, SONG P, KINNICK R R, et al. Probe oscillation shear wave elastography: initial in vivo results in liver[J]. IEEE Trans Med Imaging, 2018, 37(5): 1214-1223. doi: 10.1109/TMI.2017.2780855
[21]	TAŞ S, ONUR M R, YILMAZ S, et al. Shear wave elastography is a reliable and repeatable method for measuring the elastic modulus of the rectus femoris muscle and patellar tendon[J]. J Ultrasound Med, 2017, 36(3): 565-570. doi: 10.7863/ultra.16.03032
[22]	GERBER L, KASPER D, FITTING D, et al. Assessment of liver fibrosis with 2-D shear wave elastography in comparison to transient elastography and acoustic radiation force impulse imaging in patients with chronic liver disease[J]. Ultrasound Med Biol, 2015, 41(9): 2350-2359. doi: 10.1016/j.ultrasmedbio.2015.04.014
[23]	崔利华, 山磊, 杨宇琦. 首次脑卒中后6个月内肢体痉挛情况调查[J]. 中国康复理论与实践, 2014, 20(12): 1144-1146.
	CUI L H, SHAN L, YANG Y Q. Incidence of spasticity after first stroke within 6 months[J]. Chin J Rehabil Theory Pract, 2014, 20(12): 1144-1146.
[24]	PATEJDL R, ZETTL U K. Spasticity in multiple sclerosis: contribution of inflammation, autoimmune mediated neuronal damage and therapeutic interventions[J]. Autoimmun Rev, 2017, 16(9): 925-936. doi: 10.1016/j.autrev.2017.07.004
[25]	DING X, HUANG L, WANG Q, et al. Clinical study of botulinum toxin A injection combined with spasmodic muscle therapeutic instrument on lower limb spasticity in patients with stroke[J]. Exp Ther Med, 2017, 13(6): 3319-3326. doi: 10.3892/etm.2017.4376
[26]	LI S, CHEN Y T, FRANCISCO G E, et al. A unifying pathophysiological account for post-stroke spasticity and disordered motor control[J]. Front Neurol, 2019, 10: 468. doi: 10.3389/fneur.2019.00468
[27]	LI S, FRANCISCO G E. New insights into the pathophysiology of post-stroke spasticity[J]. Front Hum Neurosci, 2015, 9: 192. doi: 10.3389/fpsyg.2018.00192
[28]	缪永娟, 干峥, 沈显山, 等. 间歇性Theta节律刺激对脑梗死患者偏瘫侧肱二、三头肌表面肌电信号及其功能的影响[J]. 中国康复医学杂志, 2020, 35(4): 440-446.
	MIAO Y J, GAN Z, SHEN X S, et al. The effect of intermittent θ burst stimulation on sEMG and function of biceps brachii and triceps in patients with cerebral infarction[J]. Chin J Rehabil Med, 2020, 35(4): 440-446.
[29]	SALAZAR A P, PINTO C, RUSCHEL MOSSI J V, et al. Effectiveness of static stretching positioning on post-stroke upper-limb spasticity and mobility: systematic review with meta-analysis[J]. Ann Phys Rehabil Med, 2019, 62(4): 274-282. doi: 10.1016/j.rehab.2018.11.004
[30]	SIMPSON D M, HALLETT M, ASHMAN E J, et al. Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: report of the Guideline Development Subcommittee of the American Academy of Neurology[J]. Neurology, 2016, 86(19): 1818-1826. doi: 10.1212/WNL.0000000000002560
[31]	LEE S S, GAEBLER-SPIRA D, ZHANG L Q, et al. Use of shear wave ultrasound elastography to quantify muscle properties in cerebral palsy[J]. Clin Biomech (Bristol, Avon), 2016, 31: 20-28. doi: 10.1016/j.clinbiomech.2015.10.006
[32]	LEE S S, SPEAR S, RYMER W Z. Quantifying changes in material properties of stroke-impaired muscle[J]. Clin Biomech (Bristol, Avon), 2015, 30(3): 269-275. doi: 10.1016/j.clinbiomech.2015.01.004
[33]	RASOOL G, WANG A B, RYMER W Z, et al. Altered viscoelastic properties of stroke-affected muscles estimated using ultrasound shear waves-preliminary data[J]. Conf Proc IEEE Eng Med Biol Soc, 2016: 2869-2872.
[34]	DEFFIEUX T, MONTALDO G, TANTER M, et al. Shear wave spectroscopy for in vivo quantification of human soft tissues visco-elasticity[J]. IEEE Trans Med Imaging, 2009, 28(3): 313-322. doi: 10.1109/TMI.2008.925077
[35]	陈明珍, 姜凡, 单永, 等. 多模态超声成像在脑卒中患者腓肠肌痉挛评估中的应用[J]. 中国康复理论与实践, 2021, 27(7): 791-796.
	CHEN M Z, JIANG F, SHAN Y, et al. Measurement of structure and stiffness of gastrocnemius muscle for stroke patients with multimodal ultrasound imaging[J]. Chin J Rehabil Theory Pract, 2021, 27(7): 791-796.
[36]	OZTURK A, GRAJO J R, DHYANI M, et al. Principles of ultrasound elastography[J]. Abdom Radiol (NY), 2018, 43(4): 773-785.
[37]	KOPPENHAVER S, KNISS J, LILLEY D, et al. Reliability of ultrasound shear-wave elastography in assessing low back musculature elasticity in asymptomatic individuals[J]. J Electromyogr Kinesiol, 2018, 39: 49-57. doi: 10.1016/j.jelekin.2018.01.010
[38]	NIELSEN A J, GRADY S, SUSSMAN C, et al. A brushup on Rood's technique[J]. Phys Ther, 1986, 66(4): 579-580.
[39]	HUMMELSHEIM H, MAURITZ K H. [The neurophysiological basis of exercise physical therapy in patients with central hemiparesis][J]. [in German]. Fortschr Neurol Psychiatr, 1993, 61(6): 208-216.
[40]	DI PINO G, PELLEGRINO G, ASSENZA G, et al. Modulation of brain plasticity in stroke: a novel model for neurorehabilitation[J]. Nat Rev Neurol, 2014, 10(10): 597-608. doi: 10.1038/nrneurol.2014.162

肌张力	评级	指浅屈肌		指深屈肌		拇长屈肌		指伸肌
肌张力	评级	MDSS前	MDSS后	MDSS前	MDSS后	MDSS前	MDSS后	MDSS前	MDSS后
低张力	-1	2.218±0.288	2.133±0263^a	2.385±0.431	2.373±0.185^b	2.365±0.191	2.390±0.042^c	2.623±0.489	2.550±0.785^d
MAS	0	2.761±0.560	2.562±0.210^e	2.521±0.483	2.420±0.565^f	2.585±0.417	2.515±0.476^g	2.742±0.549	2.645±0.463^h
	1	3.587±0.348	2.609±0.597ⁱ	3.499±1.051	2.484±0.488^j	3.708±0.570	2.671±0.621^k	3.934±0.738	2.808±0.543^l
	1⁺	4.285±1.034	2.713±0.283^m	4.021±0.417	2.467±0.605ⁿ	-	-	4.845±0.530	2.850±0.679^o
	2	4.497±1.155	2.947±0.760^p	3.631±0.965	2.704±0.708^q	4.278±0.774	2.903±0.889^r	5.396±0.714	3.451±0.702^s
	3	4.929±1.030	3.256±0.731^t	3.731±1.089	2.895±0.832^u	5.530±0.636	3.340±0.438^v	5.295±0.615	3.920±0.679^w
	4	-	-	-	-	-	-	-	-
F值		11.329	-	3.765	-	26.385	-	20.962	-
P值		< 0.001	-	0.006	-	< 0.001	-	< 0.001	-

项目	MDSS前		MDSS后
项目	r值	P值	r值	P值
指浅屈肌	0.780	< 0.001	0.552	< 0.001
指深屈肌	0.494	< 0.001	0.334	0.017
拇长屈肌	0.829	< 0.001	0.493	< 0.001
指伸肌	0.847	< 0.001	0.371	0.007

Features in digitorum muscular tension and shear-wave elastography in hemiplegic patients with stroke before and after manual digitorum sensory stimulation

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 5

References 40

Related Articles 15

Metrics

Comments

Recommended 0

[1]	LIN Na, GAO Hanlu, LU Huiping, CHEN Yanqing, ZHENG Junfan, CHEN Shurong. Effect of virtual reality on upper limb function after stroke: a study of diffusion tensor imaging [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 61-67.
[2]	WANG Haoyi, SHI Yawei, LU Jun, XU Guangxu. Impact of subjective vertical perception impairment on function in stroke patients: a retrospective study [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 68-73.
[3]	CHEN Junwen, CHEN Qian, CHEN Cheng, LI Shuyue, LIU Lingling, WU Cunshu, GONG Xiang, LU Jun, XU Guangxu. Effect of modified Baduanjin exercise on cardiopulmonary function, motor function and activities of daily living for stroke patients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 74-80.
[4]	HU Yonglin, MA Ying, DOU Chao, LU Anmin, JIANG Xiaoge, SONG Xinjian, XIAO Yuhua. Effect of neural mobilization based on shoulder control training on shoulder pain and upper limb function in stroke patients with hemiplegia [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2024, 30(1): 81-86.
[5]	WANG He, HAN Liang, KAN Mengfan, YU Shaohong. Efficacy of electrical stimulation on shoulder-hand syndrome after stroke: a systematic review and meta-analysis [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(9): 1048-1056.
[6]	SUN Tengfang, REN Mengting, YANG Lin, WANG Yaoting, WANG Hongyu, YAN Xingzhou. Effect of hyperbaric oxygen therapy combined with repetitive peripheral magnetic stimulation on ankle motor function and balance of stroke patients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 875-881.
[7]	WANG Ya'nan, LIU Xihua. Correlation and predictive effect of subjective and objective balance function measurements in stroke patients with hemiplegia [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 890-895.
[8]	WANG Haiyun, WANG Yin, ZHOU Xinjie, HE Aiqun. Effect of transcranial direct current stimulation combined with acupuncture on central and upper limb function in stroke patients based on central-peripheral-central theory [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 919-925.
[9]	CHEN Yiting, WANG Qian, CUI Shenhong, LI Yingcai, ZHANG Siyu, WEI Yanxu, REN Hui, LENG Jun, CHEN Bin. Effect of bilateral sequential repetitive transcranial magnetic stimulation on motor function of upper limbs in stroke patients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 926-932.
[10]	LI Zhenya, SUN Jie, GUO Pengfei, WANG Guangming. Correlation between changes of swallowing function in oral and pharyngeal phases, and aspiration in stroke patients based on videofluroscopic swallowing study [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 933-939.
[11]	HUA Ling, ZHANG Yi'nan, ZHENG Yu, SUN Qiaoyi, FANG Hui, SONG Da. Effect of hand controlled rhythm music therapy on unilateral spatial neglect after stroke [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(7): 833-838.
[12]	JIANG Xiaocui, LIU Zhen, SU Qinglun, ZHAO Qin, XIA Xiaomei, LU Fei. Effect of intermittent theta burst transcranial magnetic stimulation on non-fluent aphasia after stroke [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(7): 839-843.
[13]	XU Miaomiao, LI Nan, YING Ying, YANG Kaixiang, YANG Jingrui, LI Jie, QIU Yanqun. Effect of repetitive peripheral magnetic stimulation on upper limb motor function of stroke patients after contralateral seventh cervical nerve transfer [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(6): 686-690.
[14]	ZHENG Li, BAO Zhicheng, ZHANG Qi, REN Xuyan, SU Min. Effect of transcutaneous auricular vagus nerve stimulation combined with robot-assisted therapy on upper limb function of stroke patients [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(6): 691-696.
[15]	GU Bin, ZHANG Jinqin, XIA Yuanhao, HU Jingran, NAOKI Morohashi, HUANG Fubiao. Effect of repetitive facilitative exercise on hand function of stroke patients with hemiplegic during recovery period [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(6): 697-702.