Wittenberg George F
Baltimore VA Medical Center Geriatric Research, Education and Clinical Center, Baltimore, MD, USA.
Dev Med Child Neurol. 2009 Oct;51 Suppl 4:134-9. doi: 10.1111/j.1469-8749.2009.03426.x.
The measurement of motor deficits in individuals with cerebral palsy (CP) has been largely based on clinical criteria. Yet functional imaging and non-invasive stimulation methods provide a means to measure directly abnormalities of the motor system. The size and location of muscles and movement representations can be determined with transcranial magnetic stimulation (TMS) and functional magnetics resonance imaging. Thus the homunculus can be individually mapped in children with CP. Because size of representation within the homunculus relates to quality of motor control, measurement of the distance between body parts provides a metric that may be useful in classifying deficits. Bilateral motor control in one hemisphere, while normal in neonates, persists variably in CP, providing another physiological metric. In this study, we used TMS to measure hand and ankle representations in a convenience sample of children with spastic CP. Overlapping thumb and ankle maps were found in children with both hemiplegia and diplegia, and these maps may be from either side of the body. While more participants are required to make conclusions about disability and compression/bilaterality of the homunculus, it appears as if TMS-derived metrics relate to motor abnormalities. These abnormal motor maps also are a therapeutic target, as stimulation methods are being developed as adjuncts to physical means of rehabilitation.
对脑瘫（CP）患者运动功能障碍的测量很大程度上基于临床标准。然而，功能成像和非侵入性刺激方法提供了一种直接测量运动系统异常的手段。肌肉和运动表征的大小及位置可通过经颅磁刺激（TMS）和功能磁共振成像来确定。因此，可以为患有CP的儿童个体绘制运动小人图。由于运动小人图中的表征大小与运动控制质量相关，测量身体各部位之间的距离提供了一个可能有助于对功能障碍进行分类的指标。一个半球的双侧运动控制在新生儿中是正常的，但在CP患者中会有不同程度的持续存在，这提供了另一个生理指标。在本研究中，我们使用TMS对一组痉挛型CP儿童的手部和脚踝表征进行了测量。在偏瘫和双瘫儿童中均发现了重叠的拇指和脚踝图谱，这些图谱可能来自身体的任何一侧。虽然需要更多参与者才能得出关于运动小人图的残疾情况以及压缩/双侧性的结论，但似乎TMS得出的指标与运动异常有关。这些异常的运动图谱也是一个治疗靶点，因为刺激方法正在被开发作为物理康复手段的辅助方法。
