脑卒中后肢体痉挛的识别与评估：Scoping综述

doi:10.3969/j.issn.1006-9771.2022.01.010

Abstract

Abstract:

Objective To summarize the electrophysiological indexes and scales used for evaluation of post-stroke spasticity, for integration of clinical management of spasms. Methods Literatures on identification and evaluation of post-stroke spasticity from databases of Web of Science, PubMed, CNKI, and Wanfang Data up to May 15, 2021 were retrieved and the indicators related to post-stroke spasticity were extracted for a scoping review. Results The scales of modified Asworth Scale, Comprehensive Spasticity Scale and modified Tardieu Scale; the electrophysiological indexes of F wave, H reflex, motor evoked potentials, visual-startle reaction time and vestibular evoked myogenic potentials were used to identify and evaluate post-stroke spasticity. Conclusion More clinical researches are needed to explore earlier identification and evaluation of post-stroke spasticity more objectively and accurately.

Key words: stroke, spasticity, electrophysiology, evaluation, scoping review

CLC Number:

R743.3

CHEN Lilin,HUANG Mudan,ZHENG Haiqing. Identification and evaluation of post-stroke spasticity: a scoping review[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(1): 62-68.

Figures/Tables 2

作者	国家	n	部位	评价工具	结局
Poon等^[4](2009)	中国	78	踝	CSS 比目鱼肌牵张反射肌电图肌肉共收缩指数	重测信度0.78~0.97
Choi等^[7](2018)	韩国	28	膝、踝	基于惯性传感器的MTS 传统MTS	基于惯性传感器准确率高(均方根误差< 3.2°),重测信度和评估者间信度高(组内相关系数> 0.8)
Udby Blicher等^[12] (2009)	丹麦	42	肘、腕	MAS F波振幅 F波频率 M波振幅	痉挛组和非痉挛组间F波频率无显著性差异
Leng等^[13](2021)	中国	27	腕	MAS NeuroFlexor神经、弹性和黏性成分 MyotonPRO中F值、S值 EIM中电阻和电抗	MAS评分降低不伴痉挛相关神经成分的变化
Phadke等^[14](2012)	美国	36	腕	MAS H反射 M波 H_max/M_max H_slp/M_slp H_TH/M_TH	H_max/M_max、H_slp/M_slp和H_TH/M_TH重测组内相关系数分别为0.85、0.88和0.69;H反射相关指标与MAS评分无相关性
Kumru等^[15](2010)	西班牙	21	膝	MAS H反射 M波 H_max/M_max T反射屈肌反射	MAS评分降低不伴H反射相关指标变化
Fujiwara等^[20](2015)	日本	61	腕	MAS SICI RI	RI-3的变化与腕痉挛程度的变化负相关
Sangari等^[22](2019)	美国	60	膝	MAS 钟摆实验 H_max/M_max MEP MRI	MEP与痉挛程度相关(r = 0.55)
Piscitelli等^[23](2020)	加拿大	44	肘	CSS MEP TSRT	MEP阈值与痉挛程度呈正相关(r = 0.62);MEP振幅增量与痉挛程度负相关(r = -0.464),与TSRT增量强相关(r = 0.691)
Choudhury等^[26](2019)	英国、印度	114	腕	MAS ARAT 关节活动席 VRT VART VSRT	痉挛程度越高,惊跳反射越强
Miller等^[27](2014)	美国	17	肘、踝	MAS AGSI VEMP不对称指数、非痉挛侧校正振幅、痉挛侧校正振幅	不对称指数与抗重力痉挛指数正相关;非痉挛侧与痉挛侧校正振幅比与抗重力痉挛指数负相关
Chen等^[28](2019)	美国	22	肘、腕、指	MAS 背景肌电均方根值肌电平均振幅 MEP	痉挛相关的RST兴奋抑制皮质脊髓束电活动
Rasool等^[29](2017)	美国	25	肘	MAS 肌电均方根值肌肉激活模式图(支持向量机) 肌电相关性和欧几里得距离肌肉活动域	肌肉活动域的增大、肌肉激活区的转变与痉挛程度相关
Misgeld等^[30](2016)	德国	14	膝、踝	MAS 肌电图 I_CA	I_CA与MAS评分线性相关
Ellis等^[31](2017)	丹麦	26	肘	MAS 肌电平均振幅	屈肌协同运动是脑卒中患者功能障碍的主要原因,屈肌痉挛与被动支撑下运动受阻有关
Yu等^[32](2020)	中国	15	肘	MAS 肌电图 TSRT	sEMG-ANFIS模型与MAS线性相关,R² = 0.97
Afzal等^[34](2019)	美国	19	肘	MAS 肌电图 TSRT	脑卒中患者的痉挛侧和非痉挛侧均存在TSRT调节紊乱,与RST双侧下行调节脊髓运动神经元有关
Turpin等^[36](2017)	加拿大	13	肘	DSRT TSRT ΔTSRT	ΔTSRT与CSS负相关(r = -0.68),主动与被动伸肘时的TSRT有显著性差异,与不同活动状态下脊髓运动神经元兴奋性调节有关
Levin等^[37](2018)	加拿大	33	肘	MAS DSRT TSRT	亚急性期与慢性期脑卒中患者间TSRT无显著性差异;拮抗肌和主动肌过度共同激活和交互抑制障碍可能与两组肌肉TSRT调节障碍有关

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Identification and evaluation of post-stroke spasticity: a scoping review

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