Charalambous Charalambos C, Bowden Mark G, Adkins DeAnna L
Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA.
Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA Ralph H. Johnson VA Medical Center, Charleston, SC, USA.
Neurorehabil Neural Repair. 2016 Jan;30(1):94-102. doi: 10.1177/1545968315581418. Epub 2015 Apr 15.
Despite the plethora of human neurophysiological research, the bilateral involvement of the leg motor cortical areas and their interhemispheric interaction during both normal and impaired human walking is poorly understood. Using transcranial magnetic stimulation (TMS), we have expanded our understanding of the role upper-extremity motor cortical areas play in normal movements and how stroke alters this role, and probed the efficacy of interventions to improve post-stroke arm function. However, similar investigations of the legs have lagged behind, in part, due to the anatomical difficulty in using TMS to stimulate the leg motor cortical areas. Additionally, leg movements are predominately bilaterally controlled and require interlimb coordination that may involve both hemispheres. The sensitive, but invasive, tools used in animal models of locomotion hold great potential for increasing our understanding of the bihemispheric motor cortical control of walking. In this review, we discuss 3 themes associated with the bihemispheric motor cortical control of walking after stroke: (a) what is known about the role of the bihemispheric motor cortical control in healthy and poststroke leg movements, (b) how the neural remodeling of the contralesional hemisphere can affect walking recovery after a stroke, and (c) what is the effect of behavioral rehabilitation training of walking on the neural remodeling of the motor cortical areas bilaterally. For each theme, we discuss how rodent models can enhance the present knowledge on human walking by testing hypotheses that cannot be investigated in humans, and how these findings can then be back-translated into the neurorehabilitation of poststroke walking.
尽管有大量关于人类神经生理学的研究，但在正常和受损的人类行走过程中，腿部运动皮层区域的双侧参与及其半球间的相互作用仍知之甚少。利用经颅磁刺激（TMS），我们扩展了对上肢运动皮层区域在正常运动中所起作用的理解，以及中风如何改变这一作用，并探究了改善中风后手臂功能的干预措施的效果。然而，对腿部的类似研究却滞后了，部分原因是使用TMS刺激腿部运动皮层区域存在解剖学上的困难。此外，腿部运动主要由双侧控制，需要双侧肢体协调，这可能涉及两个半球。在运动的动物模型中使用的敏感但具有侵入性的工具，对于增进我们对行走的双侧半球运动皮层控制的理解具有巨大潜力。在这篇综述中，我们讨论了与中风后行走的双侧半球运动皮层控制相关的三个主题：（a）关于双侧半球运动皮层控制在健康和中风后腿部运动中的作用已知的情况；（b）对侧半球的神经重塑如何影响中风后的行走恢复；（c）行走的行为康复训练对双侧运动皮层区域神经重塑的影响。对于每个主题，我们讨论了啮齿动物模型如何通过测试无法在人类中进行研究的假设来增强目前对人类行走的认识，以及这些发现如何随后被反向转化为中风后行走的神经康复。
