Fukutake T, Hirayama K
Department of Neurology, School of Medicine, Chiba University.
Rinsho Shinkeigaku. 1992 Nov;32(11):1213-9.
Certain proprioceptive sense is utilized in localizing a part of the limb passively held in space. In the previous study (Hirayama, Fukutake, et al., 1986), we demonstrated that such kind of proprioception, which we called "proprioceptive localization", could be detected by making the patient pick up the thumb with the opposite fingers (the thumb localizing test, TLT). As a further development of the TLT, another test, named a big-toe localizing test (BTLT), was devised. In the BTLT, the patient, with eyes closed and a lower limb passively immobilized by the examiner (the fixed limb), is asked to point to the big toe with the index finger of one hand or the other (the reaching limb). Firstly, we assessed the unselected series of 33 patients with thoracic or lumbar myelopathy regarding their sensory impairment and obtained the following conclusions on the BTLT similar to those in our previous study on the TLT. (1) BTLT deficits results from perceptive impairment in the fixed limb. (2) The perceptual information involved in the proprioceptive localization is different from that of the test for the appreciation of passive movement and posture. (3) On the basis of the correlation to other symptomatology, it is suggested that BTLT deficits arise from lesions of the posterior column-medical lemniscal system. (4) The BTLT is more sensitive than the test for the appreciation of passive movement and posture. Secondly, we evaluated another unselected series of 63 patients with unilateral TLT deficits due to CNS lesions. Eight patterns of BTLT deficits were identified and classified into 3 following types.(ABSTRACT TRUNCATED AT 250 WORDS)
某些本体感觉可用于定位被动置于空间中的肢体部位。在之前的研究中(平山、深竹等,1986年),我们证明了这种本体感觉,即我们所称的“本体感觉定位”,可通过让患者用对侧手指捡起拇指(拇指定位试验,TLT)来检测。作为TLT的进一步发展,设计了另一种试验,称为大脚趾定位试验(BTLT)。在BTLT中,患者双眼闭合,下肢由检查者被动固定(固定肢体),被要求用一只手或另一只手的食指指向大脚趾(触及肢体)。首先,我们评估了33例胸椎或腰椎脊髓病患者的未筛选系列,了解他们的感觉障碍情况,并在BTLT方面得出了与我们之前关于TLT的研究相似的以下结论。(1)BTLT缺陷是由固定肢体的感知障碍导致的。(2)本体感觉定位所涉及的感知信息与被动运动和姿势感知试验的信息不同。(3)基于与其他症状学的相关性,提示BTLT缺陷源于后柱-内侧丘系系统的病变。(4)BTLT比被动运动和姿势感知试验更敏感。其次,我们评估了另一组63例因中枢神经系统病变导致单侧TLT缺陷的未筛选患者。确定了8种BTLT缺陷模式,并分为以下3种类型。(摘要截短于250字)