Mechanisms of short-term training-induced reaching improvement in severely hemiparetic stroke patients: a TMS study.
Mechanisms of short-term training-induced reaching improvement in severely hemiparetic stroke patients: a TMS study.
复制标题
DOI：
10.1177/1545968310395600
复制
发表时间：
2011-06
影响因子：
4.2
通讯作者：
Cohen LG
中科院分区：
文献类型：
--
作者：
Harris-Love ML;Morton SM;Perez MA;Cohen LG
改善上肢运动技能的神经生理机制已在运动恢复良好的患者中进行了部分研究，但在更多受损个体（大多数卒中幸存者）中了解甚少。作者研究了与严重手臂轻瘫卒中患者（n = 11;上肢Fugl-Meyer评分（F-M）= 27 ± 6）训练诱导的伸展改善相关的初级运动皮层（M1）兴奋性（运动诱发电位[MEP]、对侧和同侧沉默期[CSP和ISP]）的变化。所有患者进行了一个单一的会议达到训练的重点是移动受影响的手从休息场所的目标放置在80%的最大向前达到的幅度，以响应视觉“GO”的线索。三头肌主要作为激动剂和二头肌主要作为拮抗剂的训练向前延伸的运动。记录每个到达运动的响应时间。在训练前（基线），在F-M评分较低（更严重的运动障碍）的患者中观察到受影响的三头肌中更大的半球间抑制（通过ISP测量），反映了从非病变到病变的M1的抑制。在基线时反应时间较慢的患者中，训练诱导的伸手改善更大。MEP振幅增加和减少ISPs和CSP观察到在受影响的三头肌，但不是在训练后的二头肌。这些结果表明，沿着训练诱导的运动改善，训练特异性的半球内和半球间机制的调制发生在手臂严重受损的慢性中风患者达到实践后。
The neurophysiological mechanisms underlying improved upper-extremity motor skills have been partially investigated in patients with good motor recovery but are poorly understood in more impaired individuals, the majority of stroke survivors. The authors studied changes in primary motor cortex (M1) excitability (motor evoked potentials [MEPs], contralateral and ipsilateral silent periods [CSPs and ISPs] using transcranial magnetic stimulation [TMS]) associated with training-induced reaching improvement in stroke patients with severe arm paresis (n = 11; Upper-Extremity Fugl-Meyer score (F-M) = 27 ± 6). All patients underwent a single session of reaching training focused on moving the affected hand from a resting site to a target placed at 80% of maximum forward reaching amplitude in response to a visual “GO” cue. Triceps contribute primarily as agonist and biceps primarily as antagonist to the trained forward reaching movement. Response times were recorded for each reaching movement. Preceding training (baseline), greater interhemispheric inhibition (measured by ISP) in the affected triceps muscle, reflecting inhibition from the nonlesioned to the lesioned M1, was observed in patients with lower F-M scores (more severe motor impairment). Training-induced improvements in reaching were greater in patients with slower response times at baseline. Increased MEP amplitudes and decreased ISPs and CSPs were observed in the affected triceps but not in the biceps muscle after training. These results indicate that along with training-induced motor improvements, training-specific modulation of intrahemispheric and interhemispheric mechanisms occurs after reaching practice in chronic stroke patients with substantial arm impairment.
登录
查看更多内容
DOI：
10.1016/s0924-980x(98)00014-9
发表时间：
1998-06-01
期刊：
ELECTROMYOGRAPHY AND MOTOR CONTROL-ELECTROENCEPHALOGRAPHY AND CLINICAL NEUROPHYSIOLOGY
影响因子：
--
作者：
Ahonen, JP;Jehkonen, M;Häkkinen, V
通讯作者：
Häkkinen, V
影响因子：
4.4
作者：
Boroojerdi, B;Diefenbach, K;Ferbert, A
通讯作者：
Ferbert, A
影响因子：
2
作者：
Barker, Ruth Nancy;Brauer, Sandra;Carson, Richard
通讯作者：
Carson, Richard
影响因子：
2.5
作者：
Chen, R;Yung, D;Li, JY
通讯作者：
Li, JY
影响因子：
4.7
作者：
Gerachshenko, Tatyana;Rymer, W. Zev;Stinear, James W.
通讯作者：
Stinear, James W.