脑卒中后顶叶后部皮质损伤患者的反应性姿势控制缺陷及听觉提示的影响。
Reactive postural control deficits in patients with posterior parietal cortex lesions after stroke and the influence of auditory cueing.
机构信息
From the School and Graduate Institute of Physical Therapy, College of Medicine (Y-HL, P-FT), Graduate Institute of Brain and Mind Sciences, College of Medicine (P-FT), and School of Occupational Therapy, College of Medicine (K-CL), National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation (Y-HL, K-CL, LL), Physical Therapy Center (P-FT), Department of Medical Imaging (Y-HW), and Department of Neurology (J-SJ), National Taiwan University Hospital, Taipei, Taiwan; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada (JJE); and Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan (S-CC).
出版信息
Am J Phys Med Rehabil. 2014 Oct;93(10):849-59. doi: 10.1097/PHM.0000000000000093.
OBJECTIVE
The purpose of this study was to investigate the ways in which stroke-induced posterior parietal cortex (PPC) lesions affect reactive postural responses and whether providing auditory cues modulates these responses.
DESIGN
Seventeen hemiparetic patients after stroke, nine with PPC lesions (PPCLesion) and eight with intact PPCs (PPCSpared), and nine age-matched healthy adults completed a lateral-pull perturbation experiment under noncued and cued conditions. The activation rates of the gluteus medius muscle ipsilateral (GMi) and contralateral to the pull direction, the rates of occurrence of three types of GM activation patterns, and the GMi contraction latency were investigated.
RESULTS
In noncued pulls toward the paretic side, of the three groups, the PPCLesion group exhibited the lowest activation rate (56%) of the GMi (P < 0.05), which is the primary postural muscle involved in this task, and the highest rate of occurrence (33%) of the gluteus medius muscle contralateral-activation-only pattern (P < 0.05), which is a compensatory activation pattern. In contrast, in cued pulls toward the paretic side, the PPCLesion group was able to increase the activation rate of the GMi to a level (81%) such that there became no significant differences in activation rate of the GMi among the three groups (P > 0.05). However, there were no significant differences in the GM activation patterns and GMi contraction latency between the noncued and cued conditions for the PPCLesion group (P > 0.05).
CONCLUSIONS
The PPCLesion patients had greater deficits in recruiting paretic muscles and were more likely to use the compensatory muscle activation pattern for postural reactions than the PPCSpared patients, suggesting that PPC is part of the neural circuitry involved in reactive postural control in response to lateral perturbations. The auditory cueing used in this study, however, did not significantly modify the muscle activation patterns in the PPCLesion patients. More research is needed to explore the type and structure of cueing that could effectively improve patterns and speed of postural responses in these patients.
目的
本研究旨在探讨脑卒中后顶后皮质（PPC）损伤对反应性姿势反应的影响方式，以及提供听觉提示是否会调节这些反应。
设计
17 名脑卒中后偏瘫患者，9 名患有 PPC 损伤（PPCLesion），8 名 PPC 保留完整（PPCSpared），9 名年龄匹配的健康成年人，在无提示和有提示条件下完成侧向拉力扰动实验。研究了同侧（GMi）和对侧臀中肌（GM）的激活率、三种 GM 激活模式的发生率以及 GMi 收缩潜伏期。
结果
在向患侧的无提示拉力中，三组中，PPCLesion 组 GMi 的激活率（56%）最低（P<0.05），GMi 是该任务中主要的姿势肌，而对侧 GM 激活模式的发生率（33%）最高（P<0.05），这是一种代偿性激活模式。相反，在向患侧的有提示拉力中，PPCLesion 组能够将 GMi 的激活率提高到 81%，以至于三组 GMi 的激活率没有显著差异（P>0.05）。然而，PPCLesion 组在无提示和有提示条件下，GM 激活模式和 GMi 收缩潜伏期没有显著差异（P>0.05）。
结论
PPCLesion 患者在募集瘫痪肌肉方面存在更大的缺陷，更有可能使用代偿性肌肉激活模式来进行姿势反应，而不是 PPCSpared 患者，这表明 PPC 是参与对侧扰动的反应性姿势控制的神经回路的一部分。然而，本研究中使用的听觉提示并没有显著改变 PPCLesion 患者的肌肉激活模式。需要进一步研究以探索能够有效改善这些患者姿势反应的类型和结构的提示方式。
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