Dietz V
Balgrist University Hospital, Zürich, Switzerland.
Handb Clin Neurol. 2013;110:133-43. doi: 10.1016/B978-0-444-52901-5.00012-5.
This chapter deals with the neuronal mechanisms underlying impaired gait. The aim is, first, a better understanding of the underlying pathophysiology and, second, the selection of an adequate treatment. One of the first symptoms of a lesion within the central motor system perceived by patients is a movement disorder, which is most characteristic during locomotion, e.g. in patients suffering spasticity after stroke or a spinal cord injury or Parkinson disease. By the recording and analysis of electrophysiological and biomechanical signals during a movement, the significance of impaired reflex behavior or muscle tone and its contribution to the movement disorder can reliably be assessed. Adequate treatment should not be restricted to the correction of an isolated clinical sign but should be based on the mechanisms underlying the movement disorder that impairs the patient. Therapy should be directed toward functional training, which takes advantage of the plasticity of the nervous system. In the future a combination of repair and functional training will further improve the mobility of disabled patients.
本章探讨步态受损背后的神经元机制。目的一是更好地理解潜在的病理生理学，二是选择适当的治疗方法。患者察觉到的中枢运动系统损伤的首要症状之一是运动障碍，这在运动过程中最为典型，例如中风、脊髓损伤或帕金森病后出现痉挛的患者。通过记录和分析运动过程中的电生理和生物力学信号，可以可靠地评估反射行为受损或肌肉张力及其对运动障碍的影响。适当的治疗不应局限于纠正单一的临床症状，而应基于损害患者的运动障碍的潜在机制。治疗应针对功能训练，利用神经系统的可塑性。未来，修复与功能训练相结合将进一步改善残疾患者的活动能力。
