van der Heide Jolanda C, Hadders-Algra Mijna
Department of Neurology, University of Groningen, The Netherlands.
Neural Plast. 2005;12(2-3):197-203; discussion 263-72. doi: 10.1155/NP.2005.197.
The present paper gives an overview of the knowledge currently available on muscular dyscoordination underlying postural problems in children with cerebral palsy (CP). Such information is a prerequisite for developing successful therapeutic interventions in children with CP. Until now, three children with CP functioning at GMFCS (Gross Motor Function Classification System) level V have been documented. The children totally or partially lacked direction specificity in their postural adjustments and could not sit independently for more than 3 seconds. Some children functioning at GMFCS level IV have intact direction-specific adjustments, whereas others have problems in generating consistently direction-specific adjustments. Children at GMFCS levels I to III have an intact basic level of control but have difficulties in fine-tuning the degree of postural muscle contraction to the task-specific conditions, a dysfunction more prominently present in children with bilateral spastic CP than in children with spastic hemiplegia. The problems in the adaptation of the degree of muscle contraction might be the reason that children with CP, more often than typically developing children, show an excess of antagonistic coactivation during difficult balancing tasks and a preference for cranial-caudal recruitment during during reaching. This might imply that both stereotypies might be regarded as functional strategies to compensate for the dysfunctional capacity to modulate subtly postural activity.
本文概述了目前已知的有关脑瘫（CP）患儿姿势问题背后肌肉失调的知识。这些信息是为CP患儿制定成功治疗干预措施的先决条件。到目前为止，已有三名GMFCS（粗大运动功能分类系统）V级的CP患儿被记录在案。这些患儿在姿势调整中完全或部分缺乏方向特异性，无法独立坐立超过3秒。一些GMFCS IV级的患儿具有完整的方向特异性调整能力，而另一些患儿在持续产生方向特异性调整方面存在问题。GMFCS I至III级的患儿具有完整的基本控制水平，但在根据特定任务条件微调姿势肌肉收缩程度方面存在困难，这种功能障碍在双侧痉挛型CP患儿中比在痉挛型偏瘫患儿中更为突出。肌肉收缩程度适应方面的问题可能是CP患儿比正常发育儿童更常出现以下情况的原因：在困难的平衡任务中拮抗肌过度共同激活，以及在伸手过程中倾向于从头部到尾部募集肌肉。这可能意味着这两种刻板动作都可被视为补偿姿势活动精细调节功能障碍的功能性策略。
