| Background and ObjectiveUpper limb motor dysfunction is one of the common complications of patients with hemiplegia after stroke,and it is also the most difficult and slowest in the recovery of limb function after stroke,which seriously affects patients' quality of life and daily living ability.A number of studies have found that stroke not only causes damage to brain motor cortex neurons and their descending fibers,but also causes peripheral nerve damage,and this abnormal change of peripheral nerve is positively correlated with the severity of central nerve injury.With the rapid development and application of neurophysiological detection technology,it is found that the peripheral electrophysiological changes caused by stroke are mainly caused by axonal dysfunction.Previous studies have found that peripheral nerve injury caused by stroke has secondary changes in the acute phase,but the specific changes in the recovery period are not clear.In order to observe the electrophysiological changes of peripheral nerves and the relationship with the recovery of motor function after stroke,this study selected the median nerve at the distal end of the upper extremity,mainly to observe the characteristics of the median nerve electrophysiological parameters of the hemiplegia during the recovery period of stroke and the course of disease.The correlation between these electrophysiological changes and limb function.Initially explore its mechanism and provide an objective basis for limb function assessment and rehabilitation.Subjects and Methods1.Subjects selection: Fifteen patients with unilateral hemiplegia in the first stroke of the rehabilitation center of the Fifth Affiliated Hospital of Zhengzhou University from September 2017 to August 2018 were selected as subjects.The hemiplegia was considered as the experimental group and the non-hemiplegic limb was Used as a control group.2.Examination procedures and methods: The motor conduction and sensory conduction of the median nerve of both upper limbs were performed at T1,T2 and T3 at 1,3 and 6 months of the course of the stroke,at the same time the needle electromyography of the median nerve innervating muscle-abductor pollicis brevis(APB)was examined,and Brunnstrom functional stages of the hemiplegic hand were assessed.During the observation period,all patients received routine rehabilitation treatment and the clinic was followed up regularly.Results1.At the same time,the amplitudes of CMAP and SNAP of the median nerve in the hemiplegic side were significantly lower than those in the non-hemiplegic side(P< 0.05).There were statistical differences between the CMAP amplitude groups of the median nerves at different time on the hemiplegia side(P<0.05).The CMAP amplitudes of the median nerves in the T1 period were significantly higher than those in the T2 and T3 periods(P<0.05).2.There were statistical differences in APB abnormal spontaneous potential classification of hemiplegic side at different time points(P<0.05).APB abnormal spontaneous potential classification of T2 was significantly higher than that of T1(P< 0.05).APB abnormal spontaneous potential classification of T3 was significantly lower than that of T1 and T2(P<0.05).3.There were significant differences in the Brunnstrom staging between the two groups during the different periods(P<0.05).The CMAP amplitude ratios of hemiplegic/non-hemiplegic sides at T2 and T3 were positively correlated with Brunnstrom stages(T2: r=0.805,P <0.05;T3: r=0.695,P<0.05).The abnormal spontaneous potential grading of hemiplegic side at T2 was negatively correlated with Brunnstrom stages(T2: r=-0.755,P < 0.05).Conclusions1.In the recovery period of stroke,the peripheral nerve injury of the hemiplegic side is mainly caused by axonal damage,which is mainly caused by the decrease of CMAP amplitude and the appearance of abnormal spontaneous potential.2.The median nerve function was the most severe at the 3rd month.3.The function of the median nerve in the hemiplegia is closely related to the recovery of hand function. |
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