Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA, USA; Motion & Gait Analysis Laboratory, Lucile Packard Children's Hospital, Palo Alto, CA, USA; Department of Bioengineering, Stanford University, Stanford, CA, USA.
Dev Med Child Neurol. 2014 Jun;56(6):522-8. doi: 10.1111/dmcn.12355. Epub 2013 Dec 21.
Selective motor control (SMC) impairment involves movement patterns dominated by flexor or extensor synergies that interfere with functional movements in children with cerebral palsy (CP). Emerging evidence on neural correlates of impaired SMC has important implications for etiology and for the treatment for children with CP. Early evidence on the microstructure of brain white matter assessed with diffusion tensor imaging in adult patients after stroke suggests that the rubrospinal tract may compensate for injury to the corticospinal tract. Furthermore, the observed changes on diffusion tensor imaging corresponded to the degree of SMC impairment. The rubrospinal tract may provide imperfect compensation in response to corticospinal tract injury, resulting in diminished SMC. Cortical mapping evidence in stroke patients indicates that loss of SMC is also associated with increased overlap of joint representation in the sensorimotor cortices. The severity of SMC impairment can be assessed with the recently developed Selective Control Assessment of the Lower Extremity, a validated observation-based measure designed for children with spastic CP. Recent advances in neuroimaging and assessment of SMC provide an opportunity to better understand the etiology and impact of impaired SMC, which may ultimately guide strategic treatment for children with CP.
选择性运动控制（SMC）障碍涉及由屈肌或伸肌协同作用主导的运动模式，这些模式会干扰脑瘫儿童的功能性运动。关于 SMC 受损的神经相关的新证据对脑瘫儿童的病因和治疗具有重要意义。早期对中风后成年患者大脑白质微观结构的研究使用扩散张量成像表明，红核脊髓束可能对皮质脊髓束损伤起到代偿作用。此外，观察到的扩散张量成像上的变化与 SMC 受损的程度相关。红核脊髓束可能会对皮质脊髓束损伤做出不完善的代偿，从而导致 SMC 下降。中风患者的皮质映射证据表明，SMC 的丧失也与感觉运动皮质中关节代表区域的重叠增加有关。最近开发的下肢选择性控制评估（Selective Control Assessment of the Lower Extremity）可用于评估 SMC 受损的严重程度，这是一种针对痉挛型脑瘫儿童的经过验证的基于观察的测量方法。SMC 的神经影像学和评估的新进展为更好地理解 SMC 受损的病因和影响提供了机会，这可能最终为脑瘫儿童的治疗提供指导。
