Wirth Brigitte, van Hedel Hubertus J A, Curt Armin
Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, Zurich, Switzerland.
J Neurol. 2008 Feb;255(2):273-9. doi: 10.1007/s00415-008-0724-y. Epub 2008 Jan 22.
Motor assessment after incomplete spinal cord injury (iSCI) currently consists of tests for muscle strength (manual muscle testing) and gait. The ability to adequately time a movement, an aspect of dexterity, is not tested. Thus, this study assessed the timing of ankle dorsiflexion in iSCI patients in the supine position and during gait and examined its relation to measures for muscle strength, corticospinal conductivity and gait speed.
In 12 subjects with iSCI and 12 matched controls, timing of ankle dorsiflexion was tested by means of auditory-paced dorsi- and plantar-flexion movements at three frequencies in the supine position and by determining initiation and termination of dorsiflexion in swing during gait. In addition, maximal movement velocity (MMV) in the ankle task, maximal voluntary contraction (MVC), corticospinal conductivity (motor evoked potentials (MEP)) and gait speed (10 Meter Walk Test) were assessed.
The groups did not significantly differ in timing of ankle dorsiflexion, neither in the supine position nor in gait. However, they significantly differed in MMV at all frequencies, MEP latency, MEP amplitude and gait speed. In contrast to ankle timing in the supine position, the onset of dorsiflexion in swing during gait significantly correlated to the dynamic MEP parameters.
Although MMV and gait speed were significantly reduced, timing of ankle dorsiflexion, both in the supine position and during gait,was less impaired in iSCI patients. This indicates that the loss of strength, particularly of dynamic strength, is the major motor impairment in iSCI, which might be considered when assessing treatment interventions.
目前，不完全性脊髓损伤（iSCI）后的运动评估包括肌肉力量测试（徒手肌力测试）和步态测试。然而，尚未对动作计时能力（灵活性的一个方面）进行测试。因此，本研究评估了iSCI患者在仰卧位和步态期间踝关节背屈的计时情况，并研究了其与肌肉力量、皮质脊髓传导性和步态速度测量指标之间的关系。
选取12例iSCI患者和12例匹配的对照组，通过在仰卧位以三种频率进行听觉节奏引导的背屈和跖屈运动，以及在步态期间确定摆动期背屈的起始和终止，来测试踝关节背屈的计时情况。此外，还评估了踝关节任务中的最大运动速度（MMV）、最大自主收缩（MVC）、皮质脊髓传导性（运动诱发电位（MEP））和步态速度（10米步行测试）。
两组在仰卧位和步态中踝关节背屈的计时方面均无显著差异。然而，在所有频率下的MMV、MEP潜伏期、MEP波幅和步态速度方面，两组存在显著差异。与仰卧位时的踝关节计时不同，步态摆动期背屈的起始与动态MEP参数显著相关。
尽管MMV和步态速度显著降低，但iSCI患者在仰卧位和步态期间的踝关节背屈计时受损较轻。这表明力量丧失，尤其是动态力量丧失，是iSCI的主要运动障碍，在评估治疗干预措施时可能需要考虑这一点。
