Biomecànica dels dits de la mà com a factor pronòstic de la recuperació funcional de l'extremitat parètica en pacients amb ictus aguts.
- Autores: Maria Neus Ticó Falguera
- Directores de la Tesis: Esteban Peña Pitarch (dir. tes.)
- Lectura: En la Universitat Politècnica de Catalunya (UPC) ( España ) en 2016
- Idioma: español
- Tribunal Calificador de la Tesis: Rosa Terré Boliart (presid.), Anas Al Omar Mesnaoui (secret.), Carme Unyó i Sallent (voc.)
- Materias:
- Enlaces
- Resumen
Stroke is one of the most serious and common public health problems. Impairment of the upper extremity (UE) following stroke affects 50 - 80 % of patients. Full UE function is achieved in 79 % of patients with initial mild paresis, but only in 15 % of patients with severe initial impairment of the UE. The most reliable prognostic factors associated with UE recovery are localised motor impairments, especially in the musculature of the hand and abduction of the shoulder in the first days after a stroke. Evaluation of the biomechanics of the hand allows an accurate identification of the motion arcs of the digital joints. Objective: Assess the prognostic value of the range of motion of the finger joints using an instrumental glove (CyberGlove II) one week after stroke for UE functional recovery at 6 months. Methods: A prospective, longitudinal, observational study with follow-ups at 3 - 4 days, 1 week, 3 and 6 months of patients with UE motor impairment. Variables collected included: demographic data, level of stroke severity (NIHSS), deep sensitivity, sphincter incontinence, Fugl Meyer of UE (FM-UE), muscle balance with Medical Research Council (MRC), muscle tone (Modified Ashworth Scale) and pre- and post- stroke functional ability (Barhel Index amb Modified Rankin Scale). Active range of motion of the metacarpophalangeal and interphalangeal joints of the index, middle finger, annulary, and little finger was assessed with CyberGlove II without and against gravity. The dependent variable UE function was evaluated with the Action Research Arm Test (ARAT) categorized as good function (ARAT>=10) and poor function (ARAT menor que 10). Results: 31 patients were included, 18 of which completed the 6-month follow-up. Mean age was 68.2 years (SD = 9.1) and 72,2 % were men. A total of 77,8 % of strokes were ischemic, and 50 % of these were lacunar. Mean NIHSS score was 9.2 (SD = 5.5). Motor NIHSS of UE, FM-UE and MRC of the flexion-extension musculature of the digits and wrist were prognostic factors for the recovery of UE function. At 1-week follow-up, statistically significant differences were observed in the range of motion of proximal and distal interphalangeal joints of the index and annulary against gravity between the two ARAT groups and in maxium flexion for the same joints of the index, middle finger and annulary in both positions. At 3-month follow-up, statistically significant differences were observed in the range of motion for: the proximal and distal interphalangeal joints of the index, middle, annulary and little finger in both positions; the metacarpophalangeal joints of the annulary and little for both positions and only of the middle finger for the zero-gravity position. Statistically significan differences were also found in maxium flexion, for interphalangeal joints of the same digits and positions and for the metacarophalanela joint of the little finger in the zero-gravity position. Conclusions: The biomechanical assessment of the range of motion of the proximal and distal interphalangeal joints of the index,middle finger and annulary of the hand one week post stroke has prognostic value for UE function recovery after stroke.
