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半球特化以及同侧损伤在运动协调和准确性方面的功能影响。

Hemispheric specialization and functional impact of ipsilesional deficits in movement coordination and accuracy.

作者信息

Schaefer Sydney Y, Haaland Kathleen Y, Sainburg Robert L

机构信息

Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802, USA.

出版信息

Neuropsychologia. 2009 Nov;47(13):2953-66. doi: 10.1016/j.neuropsychologia.2009.06.025. Epub 2009 Jun 30.

Abstract

Previous studies have demonstrated that following unilateral stroke, motor impairment occurs both contralateral, as well as ipsilateral, to the lesion. Although ipsilesional impairments can be functionally limiting, they can also provide important insight into the role of the ipsilateral hemisphere in controlling movement and the lateralization of specific motor control mechanisms, given that unilateral arm movements are thought to recruit processes in each hemisphere. The purpose of this study was to examine whether left and right hemisphere damage following stroke produces different ipsilesional deficits, and whether our dynamic dominance model of motor lateralization can predict such deficits. Specifically, the dynamic dominance model attributes control of multijoint dynamics to the left hemisphere, and control of steady-state position to the right hemisphere. Chronic stroke patients with either left or right hemisphere damage (LHD or RHD) used their ipsilesional arm, and the control subjects used either their left or right arm (LHC or RHC), to perform targeted reaching movements in different directions within the workspace ipsilateral to their reaching arm. We found that the LHD group showed deficits in controlling the arm's trajectory due to impaired multijoint coordination, but no deficits in achieving accurate final positions. In contrast, the RHD group showed deficits in final position accuracy but not in the ability to coordinate multiple joints during movement, thereby providing additional evidence for the hemisphere-specific nature of motor deficits. Furthermore, while both the LHD and RHD groups were functionally impaired to the same degree on the Jebsen Hand Function Test (JHFT), our results suggest that the underlying mechanisms for such impairment may be hemisphere-dependent.

摘要

以往的研究表明,单侧中风后,运动功能障碍不仅出现在损伤对侧,也出现在同侧。尽管同侧功能障碍在功能上可能具有局限性,但鉴于单侧手臂运动被认为会调动每个半球的相关过程,它们也能为同侧半球在控制运动及特定运动控制机制的偏侧化方面所起的作用提供重要见解。本研究的目的是检验中风后左、右半球损伤是否会产生不同的同侧缺陷,以及我们的运动偏侧化动态优势模型是否能够预测这些缺陷。具体而言,动态优势模型将多关节动力学的控制归因于左半球,而将稳态位置的控制归因于右半球。患有左半球或右半球损伤(LHD或RHD)的慢性中风患者使用其同侧手臂,而对照组受试者使用其左或右臂(LHC或RHC),在其伸展手臂同侧的工作区内沿不同方向进行目标性伸展运动。我们发现,LHD组由于多关节协调受损而在控制手臂轨迹方面存在缺陷,但在达到精确的最终位置方面没有缺陷。相比之下,RHD组在最终位置准确性方面存在缺陷,但在运动过程中协调多个关节的能力方面没有缺陷,从而为运动缺陷的半球特异性本质提供了额外证据。此外,虽然LHD组和RHD组在Jebsen手功能测试(JHFT)中的功能受损程度相同,但我们的结果表明,这种损伤的潜在机制可能与半球有关。

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