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首页> 美国卫生研究院文献>Frontiers in Neurology >Kinematic Components of the Reach-to-Target Movement After Stroke for Focused Rehabilitation Interventions: Systematic Review and Meta-Analysis
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Kinematic Components of the Reach-to-Target Movement After Stroke for Focused Rehabilitation Interventions: Systematic Review and Meta-Analysis

机译：重点康复干预的卒中后到达目标运动的运动学组成：系统评价和荟萃分析

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>Background: Better upper limb recovery after stroke could be achieved through tailoring rehabilitation interventions directly at movement deficits.>Aim: To identify potential; targets for therapy by synthesizing findings of differences in kinematics and muscle activity between stroke survivors and healthy adults performing reach-to-target tasks.>Methods: A systematic review with identification of studies, data extraction, and potential risk of bias was completed independently by two reviewers. Online databases were searched from their inception to November 2017 to find studies of reach-to-target in people-with-stroke and healthy adults. Potential risk-of-bias was assessed using the Down's and Black Tool. Synthesis was undertaken via: (a) meta-analysis of kinematic characteristics utilizing the standardized mean difference (SMD) [95% confidence intervals]; and (b), narrative synthesis of muscle activation.>Results: Forty-six studies met the review criteria but 14 had insufficient data for extraction. Consequently, 32 studies were included in the meta-analysis. Potential risk-of-bias was low for one study, unclear for 30, and high for one. Reach-to-target was investigated with 618 people-with-stroke and 429 healthy adults. The meta-analysis found, in all areas of workspace, that people-with-stroke had: greater movement times (seconds) e.g., SMD 2.57 [0.89, 4.25]; lower peak velocity (millimeters/second) e.g., SMD −1.76 [−2.29, −1.24]; greater trunk displacement (millimeters) e.g. SMD 1.42 [0.90, 1.93]; a more curved reach-path-ratio e.g., SMD 0.77 [0.32, 1.22] and reduced movement smoothness e.g., SMD 0.92 [0.32, 1.52]. In the ipsilateral and contralateral workspace, people-with-stroke exhibited: larger errors in target accuracy e.g., SMD 0.70 [0.39, 1.01]. In contralateral workspace, stroke survivors had: reduced elbow extension and shoulder flexion (degrees) e.g., elbow extension SMD −1.10 [−1.62, −0.58] and reduced shoulder flexion SMD −1.91 [−1.96, −0.42]. Narrative synthesis of muscle activation found that people-with-stroke, compared with healthy adults, exhibited: delayed muscle activation; reduced coherence between muscle pairs; and use of a greater percentage of muscle power.>Conclusions: This first-ever meta-analysis of the kinematic differences between people with stroke and healthy adults performing reach-to-target found statistically significant differences for 21 of the 26 comparisons. The differences identified and values provided are potential foci for tailored rehabilitation interventions to improve upper limb recovery after stroke.
机译：>背景：通过针对运动缺陷直接制定康复干预措施，可以使卒中后上肢恢复更好。>目的：通过综合卒中幸存者与执行可达到目标任务的健康成年人之间在运动学和肌肉活动方面的差异的发现，对治疗目标进行研究。>方法：：系统地审查研究，数据提取和潜在风险偏见由两名审稿人独立完成。搜索在线数据库从开始到2017年11月，以查找卒中患者和健康成年人达到目标的研究。使用唐氏和黑色工具评估了潜在的偏见风险。通过以下方式进行合成：（a）使用标准化平均差（SMD）[95％置信区间]对运动学特征进行荟萃分析； >结果：46项研究符合审查标准，但14项研究数据不足以提取。因此，荟萃分析包括32项研究。一项研究的潜在偏见风险低，有30项不清楚，而一项则高。对618名中风患者和429名健康成年人进行了研究，以达到目标。荟萃分析发现，在工作场所的所有区域中，中风的人都有：更长的移动时间（秒），例如SMD 2.57 [0.89，4.25]；较低的峰值速度（毫米/秒），例如SMD -1.76 [-2.29，-1.24];更大的行李箱位移（毫米） SMD 1.42 [0.90，1.93];更弯曲的到达路径比（例如SMD 0.77 [0.32，1.22]）和降低的运动平滑度（例如SMD 0.92 [0.32，1.52]）。在同侧和对侧工作区中，出现中风的人：目标准确性的较大误差，例如SMD 0.70 [0.39，1.01]。在对侧工作空间中，中风幸存者具有：肘部伸展和肩部屈曲（度）降低，例如，肘部伸展SMD -1.10 [-1.62，-0.58]和肩部屈曲SMD -1.91 [-1.96，-0.42]。肌肉激活的叙述性合成发现，与健康成年人相比，卒中患者表现出：延迟的肌肉激活；降低肌肉对之间的连贯性； >结论：这是首次对患有卒中的人与达到目标的健康成年人之间的运动学差异进行荟萃分析，发现其中21个具有统计学意义上的显着差异26个比较。识别出的差异和提供的值是量身定制的康复干预措施的潜在重点，以改善中风后上肢的恢复。

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