Changing motor synergies in chronic stroke
Changing motor synergies in chronic stroke
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DOI：
10.1152/jn.01295.2006
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发表时间：
2007-08-01
影响因子：
2.5
通讯作者：
Hogan, N.
中科院分区：
文献类型：
--
作者：
Dipietro, L.;Krebs, H. I.;Hogan, N.
协同作用被认为是脊椎动物运动的基石。无法以适当的时间和分级方式执行协同作用会妨碍足够的功能性运动表现。在患有中风的人中，异常的协同作用是持续性神经缺陷的征兆，并导致独立关节控制的丧失，从而扰乱随意运动的运动学。本研究旨在表征运动运动学中明显的与训练相关的协同作用变化，特别是评估：1）它们表征恢复的程度，2）它们是否遵循现有异常协同作用增强的模式，或者相反，以异常协同作用消失的过程为特征。我们使用机器人治疗设备来训练和分析 117 名慢性中风患者的瘫痪手臂运动。在一项没有接受过训练的任务中，受试者通过放电能够更好地画圆圈。与入院时的运动学机器人衍生指标的表现进行比较表明，受试者能够以显着更大的独立性执行肩关节和肘关节运动，或者使用临床描述，以更孤立的控制进行运动。我们认为，我们在拟议指标中观察到的变化反映了协同效应的变化。我们表明，根据临床 Fugl-Meyer 量表的测量，它们捕获了恢复过程的很大一部分。 “调整”或增强现有异常协同作用的过程，而不是消除异常协同作用，似乎是恢复的基础。
Synergies are thought to be the building blocks of vertebrate movements. The inability to execute synergies in properly timed and graded fashion precludes adequate functional motor performance. In humans with stroke, abnormal synergies are a sign of persistent neurological deficit and result in loss of independent joint control, which disrupts the kinematics of voluntary movements. This study aimed at characterizing training-related changes in synergies apparent from movement kinematics and, specifically, at assessing: 1) the extent to which they characterize recovery and 2) whether they follow a pattern of augmentation of existing abnormal synergies or, conversely, are characterized by a process of extinction of the abnormal synergies. We used a robotic therapy device to train and analyze paretic arm movements of 117 persons with chronic stroke. In a task for which they received no training, subjects were better able to draw circles by discharge. Comparison with performance at admission on kinematic robot-derived metrics showed that subjects were able to execute shoulder and elbow joint movements with significantly greater independence or, using the clinical description, with more isolated control. We argue that the changes we observed in the proposed metrics reflect changes in synergies. We show that they capture a significant portion of the recovery process, as measured by the clinical Fugl-Meyer scale. A process of "tuning" or augmentation of existing abnormal synergies, not extinction of the abnormal synergies, appears to underlie recovery.