Impaired Voluntary Movement Control and Its Rehabilitation in Cerebral Palsy
Impaired Voluntary Movement Control and Its Rehabilitation in Cerebral Palsy
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DOI：
10.1007/978-3-319-47313-0_16
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发表时间：
2016-01-01
期刊：
影响因子：
--
通讯作者：
Gordon, Andrew M.
中科院分区：
文献类型：
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作者：
Gordon, Andrew M.
脑瘫是由发育中的大脑早期损伤引起的，是最常见的小儿神经系统疾病。偏瘫（单侧痉挛性脑性瘫痪）是最常见的亚型，并且所导致的损伤，偏侧到身体一侧，特别是影响上肢，限制日常功能。本章首先介绍了病理生理学和机制受损的上肢控制脑性瘫痪。它将表明，受损的手功能的严重程度密切相关的完整性皮质脊髓束支配受影响的手。它还将表明，发展中的皮质脊髓束可以重组其连接取决于中枢神经系统损伤的时间和位置，这也有手部损伤和康复的严重程度的影响。运动功能受损的机制将被强调，包括运动执行和规划和感觉运动整合的缺陷。它将被证明，尽管有单手手损伤，双手运动控制缺陷和镜像运动也影响功能。运动学习为基础的治疗，包括约束诱导运动疗法和双手训练的证据，和治疗结果和可塑性的可能的病理生理学预测将被描述。最后，将提出未来的康复方向。
Cerebral palsy is caused by early damage to the developing brain, as the most common pediatric neurological disorder. Hemiplegia (unilateral spastic cerebral palsy) is the most common subtype, and the resulting impairments, lateralized to one body side, especially affect the upper extremity, limiting daily function. This chapter first describes the pathophysiology and mechanisms underlying impaired upper extremity control of cerebral palsy. It will be shown that the severity of impaired hand function closely relates to the integrity of the corticospinal tract innervating the affected hand. It will also shown that the developing corticospinal tract can reorganize its connectivity depending on the timing and location of CNS injury, which also has implications for the severity of hand impairments and rehabilitation. The mechanisms underlying impaired motor function will be highlighted, including deficits in movement execution and planning and sensorimotor integration. It will be shown that despite having unimanual hand impairments, bimanual movement control deficits and mirror movements also impact function. Evidence for motor learning-based therapies including Constraint-Induced Movement Therapy and Bimanual Training, and the possible pathophysiological predictors of treatment outcome and plasticity will be described. Finally, future directions for rehabilitations will be presented.