Driving plasticity in the motor cortex in recurrent low back pain
Driving plasticity in the motor cortex in recurrent low back pain
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DOI：
10.1016/j.ejpain.2010.01.001
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发表时间：
2010-09-01
影响因子：
3.6
通讯作者：
Hodges, Paul W.
中科院分区：
文献类型：
--
作者：
Tsao, Henry;Galea, Mary P.;Hodges, Paul W.
感觉和运动系统可以在受伤和学习新的运动技能后重新组织。最近，我们观察到复发性腰痛（LBP）患者运动皮质组织的适应性变化，这与运动协调的改变有关。虽然运动协调性的改变可以通过训练并与症状和功能的改善相关，但这些训练引起的改变是否与运动皮层的重组有关尚不清楚。本研究采用20例复发性腰痛患者的深腹肌、腹横肌（TrA）体位激活延迟模型进行了研究。受试者被分配到运动技能训练，包括孤立的自发性TrA收缩，或自我调节步行运动的对照干预，为期2周。肌内细丝电极记录双侧TrA肌电图活动。在训练前后，研究了经颅磁刺激（TMS）和单臂快速运动相关的体位激活的运动皮质组织。运动技能训练诱导TrA的运动皮质表征向我们之前的研究中观察到的健康个体的前部和内侧移动。这种转变与TrA的早期姿势激活有关。不熟练的步行运动没有观察到变化。这是第一次观察到运动训练可以逆转复发性疼痛患者运动皮层神经元网络的重组。观察到的皮层重组和运动训练后运动协调变化之间的关系，为潜在的康复机制提供了独特的见解。(C) 2010年欧洲国际疼痛研究协会联合会分会。Elsevier Ltd.出版。版权所有。
The sensory and motor systems can reorganise following injury and learning of new motor skills. Recently we observed adaptive changes in motor cortical organisation in patients with recurrent low back pain (LBP), which are linked to altered motor coordination. Although changes in motor coordination can be trained and are associated with improved symptoms and function, it remains unclear whether these training-induced changes are related to reorganisation of the motor cortex. This was investigated using the model of a delay in postural activation of the deep abdominal muscle, transversus abdominis (TrA) in 20 individuals with recurrent LBP. Subjects were allocated to either motor skill training that involved isolated voluntary contractions of TrA, or a control intervention of self-paced walking exercise for 2 weeks. Electromyographic (EMG) activity was recorded from TrA bilaterally using intramuscular fine-wire electrodes. Motor cortical organisation using transcranial magnetic stimulation (TMS) and postural activation associated with single rapid arm movements were investigated before and after training. Motor skill training induced an anterior and medial shift in motor cortical representation of TrA, towards that observed in healthy individuals from our previous study. This shift was associated with earlier postural activation of TrA. Changes were not observed following unskilled walking exercise. This is the first observation that motor training can reverse reorganisation of neuronal networks of the motor cortex in people with recurrent pain. The observed relationship between cortical reorganisation and changes in motor coordination following motor training provides unique insight into potential mechanisms that underlie recovery. (C) 2010 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved.