Transmission in heteronymous spinal pathways is modified after stroke and related to motor incoordination.
Transmission in heteronymous spinal pathways is modified after stroke and related to motor incoordination.
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DOI：
10.1371/journal.pone.0004123
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发表时间：
2009
期刊：
影响因子：
3.7
通讯作者：
Forget, Robert
中科院分区：
文献类型：
--
作者：
Dyer, Joseph-Omer;Maupas, Eric;de Andrade Melo, Sibele;Bourbonnais, Daniel;Fleury, Jean;Forget, Robert
中风后反射性脊髓通路的改变已被证明会影响作用于同一关节的激动剂和拮抗剂肌肉的运动活动。然而，只有少数研究评估了异位反射通路调节不同关节的运动神经元活动。这项研究调查了连接膝关节和踝关节伸肌的脊柱促进和抑制通路是否有变化，以及这种变化是否与中风后的运动缺陷有关。研究了15名健康人以及15名中风患者的瘫侧和非瘫侧，在股四头肌运动阈值的2倍处刺激股神经所引起的比目鱼H反射的早期促进和后期抑制作用。然后研究了这种反射调节与运动恢复、协调和痉挛水平之间的关系。结果显示，脑卒中患儿患儿侧的促进峰幅度（平均±SEM：对照组H反射增强80±22%）和持续时间（4.2±0.5 ms）均较非患儿（36±6%和2.9±0.4 ms）和对照组（33±4%和2.8±0.4 ms）显著增加（P<0.05）。此外，在所有对照组中观察到的后期强抑制在中风组中有所减少。促进的峰值幅度和持续时间均与患儿腿的协调水平（LEMOCOT）呈负相关（Spearman r = - 0.65; P = 0.009和r = - 0.67; P = 0.007）。这种促进持续时间也与运动恢复（CMSA）水平相关（r = - 0.58, P = 0.024）。这些结果证实了与中风后运动缺陷相关的异源脊髓通路的传递变化。
Changes in reflex spinal pathways after stroke have been shown to affect motor activity in agonist and antagonist muscles acting at the same joint. However, only a few studies have evaluated the heteronymous reflex pathways modulating motoneuronal activity at different joints. This study investigates whether there are changes in the spinal facilitatory and inhibitory pathways linking knee to ankle extensors and if such changes may be related to motor deficits after stroke. The early facilitation and later inhibition of soleus H reflex evoked by the stimulation of femoral nerve at 2 times the motor threshold of the quadriceps were assessed in 15 healthy participants and on the paretic and the non-paretic sides of 15 stroke participants. The relationships between this reflex modulation and the levels of motor recovery, coordination and spasticity were then studied. Results show a significant (Mann-Whitney U; P<0.05) increase in both the peak amplitude (mean±SEM: 80±22% enhancement of the control H reflex) and duration (4.2±0.5 ms) of the facilitation on the paretic side of the stroke individuals compared to their non-paretic side (36±6% and 2.9±0.4 ms) and to the values of the control subjects (33±4% and 2.8±0.4 ms, respectively). Moreover, the later strong inhibition observed in all control subjects was decreased in the stroke subjects. Both the peak amplitude and the duration of the increased facilitation were inversely correlated (Spearman r = −0.65; P = 0.009 and r = −0.67; P = 0.007, respectively) with the level of coordination (LEMOCOT) of the paretic leg. Duration of this facilitation was also correlated (r = −0.58, P = 0.024) with the level of motor recovery (CMSA). These results confirm changes in transmission in heteronymous spinal pathways that are related to motor deficits after stroke.