Modification of Spastic Stretch Reflexes at the Elbow by Flexion Synergy Expression in Individuals With Chronic Hemiparetic Stroke.
Modification of Spastic Stretch Reflexes at the Elbow by Flexion Synergy Expression in Individuals With Chronic Hemiparetic Stroke.
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DOI：
10.1016/j.apmr.2017.06.019
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发表时间：
2018-03
影响因子：
4.3
通讯作者：
Dewald JP
中科院分区：
文献类型：
--
作者：
McPherson JG;Stienen AH;Drogos JM;Dewald JP
系统表征屈曲协同表达对卒中后肘关节屈肌拉伸反射的影响，并将这些发现与无神经损伤个体的肘关节屈肌拉伸反射联系起来。对照队列研究。学术医疗中心。参与者（N=20）包括慢性偏瘫性中风患者（N= 10）和无神经或肌肉骨骼损伤的方便样本（N= 10）。中风参与者使用一个机器人装置，该装置精确地操纵屈曲协同表达（通过调节肩部外展负荷），同时在大范围的速度范围内提供受控的肘部伸展扰动。该装置还被用于在自发性肘关节屈肌激活时引发肘关节屈肌拉伸反射，无论是在中风个体队列中还是在对照队列中。在这两种情况下，自发性肘关节屈肌预激活的幅度与屈曲协同表达过程中不自主产生的幅度相匹配。通过肌电图评估肱二头肌短潜伏期和长潜伏期拉伸反射的振幅，并以背景肌肉激活和拉伸速度的函数表示。肩关节外展负荷增加通过屈曲协同表达增强了肘关节屈曲伸展反射。与没有神经损伤的个体的拉伸反射相比，休息时的麻痹反射更大，但在匹配的预激活水平下与对照肌肉的反射大致相等。由于屈曲协同表达改变了受累肌肉的拉伸反射，因此减少屈曲协同表达的干预措施可能会带来减少手臂功能性使用时痉挛的额外好处。
To systematically characterize the effect of flexion synergy expression on the manifestation of elbow flexor stretch reflexes poststroke, and to relate these findings to elbow flexor stretch reflexes in individuals without neurologic injury. Controlled cohort study. Academic medical center. Participants (N=20) included individuals with chronic hemiparetic stroke (n=10) and a convenience sample of individuals without neurologic or musculoskeletal injury (n=10). Participants with stroke were interfaced with a robotic device that precisely manipulated flexion synergy expression (by regulating shoulder abduction loading) while delivering controlled elbow extension perturbations over a wide range of velocities. This device was also used to elicit elbow flexor stretch reflexes during volitional elbow flexor activation, both in the cohort of individuals with stroke and in a control cohort. In both cases, the amplitude of volitional elbow flexor preactivation was matched to that generated involuntarily during flexion synergy expression. The amplitude of short- and long-latency stretch reflexes in the biceps brachii, assessed by electromyography, and expressed as a function of background muscle activation and stretch velocity. Increased shoulder abduction loading potentiated elbow flexor stretch reflexes via flexion synergy expression in the paretic arm. Compared with stretch reflexes in individuals without neurologic injury, paretic reflexes were larger at rest but were approximately equal to control muscles at matched levels of preactivation. Because flexion synergy expression modifies stretch reflexes in involved muscles, interventions that reduce flexion synergy expression may confer the added benefit of reducing spasticity during functional use of the arm.
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影响因子：
2.5
作者：
McPherson, Jacob G.;Ellis, Michael D.;Dewald, Julius P. A.
通讯作者：
Dewald, Julius P. A.
影响因子：
4.7
作者：
Lorentzen, Jakob;Grey, Michael J.;Nielsen, Jens B.
通讯作者：
Nielsen, Jens B.
影响因子：
4.2
作者：
Mandon, Laurence;Boudarham, Julien;Roby-Brami, Agnes
通讯作者：
Roby-Brami, Agnes
影响因子：
2
作者：
Ellis, Michael D.;Acosta, Ana Maria;Dewald, Julius P. A.
通讯作者：
Dewald, Julius P. A.
影响因子：
2.5
作者：
Ellis, Michael D.;Drogos, Justin;Dewald, Julius P. A.
通讯作者：
Dewald, Julius P. A.