Contralesional motor deficits after unilateral stroke reflect hemisphere-specific control mechanisms
Contralesional motor deficits after unilateral stroke reflect hemisphere-specific control mechanisms
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DOI：
10.1093/brain/aws283
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发表时间：
2013-04-01
期刊：
影响因子：
14.5
通讯作者：
Sainburg, Robert L.
中科院分区：
文献类型：
--
作者：
Mani, Saandeep;Mutha, Pratik K.;Sainburg, Robert L.
我们已经提出了一个模型的运动侧化，其中的左，右半球是专门为不同方面的运动控制：左半球的预测和占肢体动力学和右半球稳定肢体位置，通过阻抗控制机制。我们以前的研究，证明不同的运动障碍的中风患者的同侧臂与左或右半球的损害，提供了一个关键的测试，我们的模型。然而，中风后的运动障碍在对侧病灶最为突出。中风后康复也自然地集中在改善对侧臂损伤和功能上。因此，了解对侧运动缺陷是否因损伤半球而异，对于评估脑损伤对功能的影响以及设计针对损伤偏侧性的康复干预措施至关重要。因此，我们想知道单侧中风患者对侧臂的运动缺陷是否反映了大脑半球依赖的控制机制。由于我们的偏侧化模型预测，对侧损伤缺陷将根据损伤半球而不同，因此本研究也是对我们模型的重要评估。由于对侧中风而导致左臂或右臂轻度至中度轻偏瘫的中风患者和健康对照受试者在不同方向上进行有针对性的多关节伸展运动。正如预测的那样，我们的研究结果表明了双重分离;虽然左半球损伤与轨迹曲率和运动方向的更大误差相关，但右半球损伤后运动范围的误差最大。因此，我们的研究结果提供了第一个证明半球特定的运动控制缺陷的对侧臂中风患者。我们的研究结果还表明，这是至关重要的，以考虑由右半球或左半球病变引起的差异缺陷，以加强脑卒中后的康复干预。
We have proposed a model of motor lateralization, in which the left and right hemispheres are specialized for different aspects of motor control: the left hemisphere for predicting and accounting for limb dynamics and the right hemisphere for stabilizing limb position through impedance control mechanisms. Our previous studies, demonstrating different motor deficits in the ipsilesional arm of stroke patients with left or right hemisphere damage, provided a critical test of our model. However, motor deficits after stroke are most prominent on the contralesional side. Post-stroke rehabilitation has also, naturally, focused on improving contralesional arm impairment and function. Understanding whether contralesional motor deficits differ depending on the hemisphere of damage is, therefore, of vital importance for assessing the impact of brain damage on function and also for designing rehabilitation interventions specific to laterality of damage. We, therefore, asked whether motor deficits in the contralesional arm of unilateral stroke patients reflect hemisphere-dependent control mechanisms. Because our model of lateralization predicts that contralesional deficits will differ depending on the hemisphere of damage, this study also served as an essential assessment of our model. Stroke patients with mild to moderate hemiparesis in either the left or right arm because of contralateral stroke and healthy control subjects performed targeted multi-joint reaching movements in different directions. As predicted, our results indicated a double dissociation; although left hemisphere damage was associated with greater errors in trajectory curvature and movement direction, errors in movement extent were greatest after right hemisphere damage. Thus, our results provide the first demonstration of hemisphere specific motor control deficits in the contralesional arm of stroke patients. Our results also suggest that it is critical to consider the differential deficits induced by right or left hemisphere lesions to enhance post-stroke rehabilitation interventions.