Motor learning in unilateral cerebral palsy and the influence of corticospinal tract reorganization
Motor learning in unilateral cerebral palsy and the influence of corticospinal tract reorganization
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DOI：
10.1016/j.ejpn.2020.04.013
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发表时间：
2020-07-01
影响因子：
3.1
通讯作者：
Bolognini, Nadia
中科院分区：
文献类型：
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作者：
Carneiro, Maira I. S.;Russo, Cristina;Bolognini, Nadia
脑性瘫痪（CP）是一种复杂的神经系统疾病，其特征在于与行为、感知和认知障碍相关的先天性运动障碍。感觉运动障碍是该疾病的主要标志，显著影响生活质量。到目前为止，很少有研究调查运动学习能力的CP和他们的联系与塑性重组的运动系统仍然在很大程度上未知。本原理验证研究探讨了单侧CP和不同运动系统重组模式（双侧，同侧，对侧）儿童的外显运动序列学习。单侧CP儿童和一组年龄匹配的典型发育（TD）儿童进行了连续的手指敲击任务，CP儿童用患手进行，TD儿童用非优势手进行。通过单脉冲经颅磁刺激（TMS）评估轻偏瘫患者皮质脊髓束投射的模式。结果显示，与TD儿童相比，单侧CP儿童存在手指灵巧性障碍，表现为双侧或同侧控制受影响（训练过的）手。相反，运动序列学习受损，在单侧CP与同侧或对侧皮质脊髓重组，但不是在一个双边控制的麻痹手的情况下。这些初步的研究结果，虽然涉及到小的临床样本，表明单方面的控制麻痹上肢，从同侧或对侧运动皮层，可能不足以发展典型的运动学习与受影响的手，这似乎需要在运动皮层的双边代表。这一证据对CP的精细运动技能康复具有潜在的意义。(C)2020年欧洲儿科神经病学学会。由爱思唯尔有限公司出版。保留所有权利。
Cerebral Palsy (CP) is a complex neurological disorder, characterized by congenital motor disability associated with behaviour, perception and cognition disorders. The sensorimotor impairments represent the main hallmark of the disease, significantly impacting the quality of life. So far, few studies have investigated motor learning abilities in CP and their association with the plastic reorganization of the motor system remains largely unknown. The present proof-of-principle study explored explicit motor sequence learning in children with unilateral CP and different patterns of motor system reorganization (bilateral, ipsilateral, contralateral). Children with unilateral CP, and a group of age-matched typically developing (TD) children, underwent a sequential finger tapping task, performed with the affected hand by children with CP and with the non-dominant hand by TD children. The pattern of corticospinal tract projections in hemiparetic patients was assessed by single-pulse Transcranial Magnetic Stimulation (TMS). Results showed the presence of finger dexterity impairments in children with unilateral CP presenting with a bilateral or an ipsilateral control of the affected (trained) hand, as compared to TD children. Conversely, motor sequence learning was impaired in unilateral CP with ipsilateral or contralateral corticospinal reorganization, but not in the case of a bilateral control of the paretic hand. These preliminary findings, although referred to small clinical samples, suggest that unilateral control of the paretic upper-limb, from the ipsilateral or the contralateral motor cortex, may not be sufficient to develop typical motor learning with the affected hand, which seems to require a bilateral representation in the motor cortex. This evidence has potential implications for fine motor skills rehabilitation in CP. (C) 2020 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.