Department of Biomedical Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
IEEE Trans Neural Syst Rehabil Eng. 2011 Dec;19(6):686-95. doi: 10.1109/TNSRE.2011.2170589. Epub 2011 Oct 6.
To date, research on the motor control of hand function in cerebral palsy has focused on children with hemiplegia, although many persons with diplegic cerebral palsy (dCP) have asymmetrically decreased hand function. We explored the predictive capabilities of the motor system in a simple motor task of lifting a series of virtual objects for five persons with spastic dCP and five age-matched controls. When a person lifts an object, s/he uses an expectation of the weight of the object to generate a motor command. We asked the study subjects to lift a series of increasing weights and determined whether they extrapolated from past experience to predict the next weight in the series, even though that weight had never been experienced. Planning of precision grasp was assessed by measurement of the grip force at the beginning of the lifting task and by estimating the motor command. Execution of precision grasp was assessed by measurement of the time interval between the onset of grip and the onset of movement. We found that persons with dCP demonstrated a lack of predictive feed-forward control in their lifting movements: they exhibited a significantly longer time between onset of grip and onset of movement than the control subjects and they did not predict the weight of the next object in the lifting task. In addition, for subjects with dCP, the time between the onset of grip and the onset of movement of the dominant hand correlated strongly with the outcome of a hand function test. We postulate that a higher-order motor planning deficit in addition to execution deficit are evident in the subjects with spastic diplegic.
迄今为止，脑瘫手部运动控制的研究主要集中在偏瘫儿童身上，尽管许多双瘫脑瘫（dCP）患者的手部功能存在不对称性下降。我们探索了运动系统在一个简单的提升一系列虚拟物体的运动任务中的预测能力，该任务针对五名痉挛性双瘫脑瘫患者和五名年龄匹配的对照组进行。当一个人提起一个物体时，他会根据物体的重量预期来生成一个运动指令。我们要求研究对象提升一系列递增的重量，并确定他们是否根据过去的经验进行外推，以预测该系列中的下一个重量，即使他们从未经历过该重量。通过测量提升任务开始时的握力和估计运动指令，来评估精确抓握的规划。通过测量握持开始和运动开始之间的时间间隔来评估精确抓握的执行。我们发现，dCP 患者在提升运动中表现出缺乏预测性的前馈控制：他们的握持开始和运动开始之间的时间明显长于对照组，并且他们没有预测提升任务中下一个物体的重量。此外，对于 dCP 患者，优势手的握持开始和运动开始之间的时间与手部功能测试的结果密切相关。我们假设痉挛性双瘫患者除了执行缺陷外，还存在更高层次的运动规划缺陷。
