Musampa Nadine K, Mathieu Pierre A, Levin Mindy F
School of Rehabilitation, University of Montreal, Montreal, QC, Canada.
Exp Brain Res. 2007 Aug;181(4):579-93. doi: 10.1007/s00221-007-0956-6. Epub 2007 May 3.
Previous studies have shown that deficits in agonist-antagonist muscle activation in the single-joint elbow system in patients with spastic hemiparesis are directly related to limitations in the range of regulation of the thresholds of muscle activation. We extended these findings to the double-joint, shoulder-elbow system in these patients. Ten non-disabled individuals and 11 stroke survivors with spasticity in upper limb muscles participated. Stroke survivors had sustained a single unilateral stroke 6-36 months previously, had full pain-free passive range of motion of the affected shoulder and elbow and had some voluntary control of the arm. EMG activity from four elbow and two shoulder muscles was recorded during quasi-static (<5 degrees /s) stretching of elbow flexors/extensors and during slow voluntary elbow flexion/extension movement through full range. Stretches and active movements were initiated from full elbow flexion or extension with the shoulder in three different initial positions (60 degrees , 90 degrees , 145 degrees horizontal abduction). SRTs were defined as the elbow angle at which EMG signals began to exceed 2SD of background noise. SRT angles obtained by passive muscle stretch were compared with the angles at which the respective muscles became activated during voluntary elbow movements. SRTs in elbow flexors were correlated with clinical spasticity scores. SRTs of elbow flexors and extensors were within the biomechanical range of the joint and varied with changes in the shoulder angle in all subjects with hemiparesis but could not be reached in this range in all healthy subjects when muscles were initially relaxed. In patients, limitations in the regulation of SRTs resulted in a subdivision of all-possible shoulder-elbow arm configurations into two areas, one in which spasticity was present ("spatial spasticity zone") and another in which it was absent. Spatial spasticity zones were different for different muscles in different patients but, taken together, for all elbow muscles, the zones occupied a large part of elbow-shoulder joint space in each patient. The shape of the boundary between the spasticity and no-spasticity zones depended on the state of reflex inter-joint interaction. SRTs in single- and double-joint flexor muscles correlated with the positions at which muscles were activated during voluntary movements, for all shoulder angles, and this effect was greater in elbow flexor muscles (brachioradialis, biceps brachii). Flexor SRTs correlated with clinical spasticity in elbow flexors only when elbow muscles were at mid-length (90 degrees ). These findings support the notion that motor impairments after CNS damage are related to deficits in the specification and regulation of SRTs, resulting in the occurrence of spasticity zones in the space of elbow-shoulder configurations. It is suggested that the presence of spatial spasticity zones might be a major cause of motor impairments in general and deficits in inter-joint coordination in particular in patients with spasticity.
先前的研究表明,痉挛性偏瘫患者单关节肘部系统中主动肌-拮抗肌激活不足与肌肉激活阈值调节范围的限制直接相关。我们将这些发现扩展到了这些患者的双关节肩肘系统。10名非残疾个体和11名上肢肌肉痉挛的中风幸存者参与了研究。中风幸存者在6至36个月前曾经历过单次单侧中风,患侧肩部和肘部的被动活动范围完全无痛,并且对上肢有一定的自主控制能力。在肘部屈肌/伸肌的准静态(<5度/秒)伸展过程中以及在缓慢的自主肘部屈伸运动至全范围过程中,记录了四块肘部肌肉和两块肩部肌肉的肌电图活动。伸展和主动运动从肘部完全屈曲或伸展开始,肩部处于三个不同的初始位置(水平外展60度、90度、145度)。将肌电图信号开始超过背景噪声2倍标准差时的肘部角度定义为起始反应阈值(SRT)。将被动肌肉伸展获得的SRT角度与相应肌肉在自主肘部运动过程中开始激活时的角度进行比较。肘部屈肌的SRT与临床痉挛评分相关。在所有偏瘫患者中,肘部屈肌和伸肌的SRT都在关节的生物力学范围内,并且随肩部角度的变化而变化,但在所有健康受试者中,当肌肉最初放松时,在这个范围内无法达到SRT。在患者中,SRT调节的限制导致所有可能的肩肘手臂配置被细分为两个区域,一个区域存在痉挛(“空间痉挛区”),另一个区域不存在痉挛。不同患者不同肌肉的空间痉挛区不同,但总体而言,对于所有肘部肌肉,这些区域在每个患者中占据了肩肘关节空间的很大一部分。痉挛区和非痉挛区之间边界的形状取决于反射性关节间相互作用的状态。对于所有肩部角度,单关节和双关节屈肌的SRT与自主运动过程中肌肉开始激活的位置相关,并且这种影响在肘部屈肌(桡侧腕长伸肌、肱二头肌)中更大。仅当肘部肌肉处于中间长度(90度)时,屈肌SRT才与肘部屈肌的临床痉挛相关。这些发现支持了这样一种观点,即中枢神经系统损伤后的运动障碍与SRT的设定和调节不足有关,导致在肩肘配置空间中出现痉挛区。有人提出,空间痉挛区的存在可能是导致运动障碍的主要原因,尤其是痉挛患者关节间协调不足的主要原因。