在未受影响肢体的强直性收缩过程中，受损运动皮层的易化与中风后的运动状态相关。

Facilitation of the Lesioned Motor Cortex During Tonic Contraction of the Unaffected Limb Corresponds to Motor Status After Stroke.

作者信息

Chiou Shin-Yi, Wang Ray-Yau, Liao Kwong-Kum, Yang Yea-Ru

机构信息

Department of Physical Therapy and Assistive Technology (S.Y.C, R.Y.W, Y.R.Y), National Yang-Ming University, Taipei, Taiwan; and Department of Neurology (K.K.L), Taipei Veterans General Hospital, Taipei, Taiwan.

出版信息

J Neurol Phys Ther. 2016 Jan;40(1):15-21. doi: 10.1097/NPT.0000000000000109.

DOI:10.1097/NPT.0000000000000109

PMID:26569095

Abstract

BACKGROUND AND PURPOSE

Contraction of the muscles of the unaffected hand is associated with enhanced activation of lesioned motor cortex (ie, crossed facilitation) in some individuals after stroke. However, the association between crossed facilitation and motor function status remains unclear. We investigated whether existence of crossed facilitation corresponds to motor status of the affected upper limb after stroke.

METHODS

Data were collected from 58 participants with unilateral stroke. The Fugl-Meyer assessment of upper extremity (FMA-UE) was used to evaluate motor status. Motor-evoked potentials (MEPs) were elicited from the abductor pollicis brevis (ABP) of the affected side under 3 conditions: rest, tonic contraction of the ABP of the unaffected side, or tonic contraction of the tibialis anterior of the unaffected side.

RESULTS

In 28 of the 58 participants, MEPs could be elicited from the affected ABP at rest; these participants also exhibited crossed facilitation during contraction on the unaffected side. Participants with MEPs at rest exhibited higher FMA-UE scores (53.04 ± 2.59) compared with participants with absent MEP (19.83 ± 1.60; Z = -6.21). Seven participants with no MEPs at rest had MEPs with crossed facilitation; their FMA-UE scores were higher compared with the 23 who had no ABP MEP under any condition (Z = -2.66). FMA-UE scores were positively correlated with the amount of crossed facilitation during the APB task (r = 0.68) and the tibialis anterior task (r = 0.54).

DISCUSSION AND CONCLUSIONS

In some participants, MEPs in the affected hand muscle were enhanced by tonic contraction of the muscles on the unaffected side even if no MEP could be evoked at rest. The degree of crossed facilitation in the affected hand muscle was correlated with the level of motor function of the affected upper limb, and the FMA-UE score could classify the presence/absence of crossed facilitation.Video abstract available for more insights from the authors (Supplemental Digital Content 1, http://links.lww.com/JNPT/A117).

摘要

背景与目的

在一些中风后的个体中，未受影响手的肌肉收缩与受损运动皮层的激活增强（即交叉易化）有关。然而，交叉易化与运动功能状态之间的关联仍不明确。我们研究了交叉易化的存在是否与中风后受影响上肢的运动状态相对应。

方法

收集了58名单侧中风参与者的数据。使用上肢Fugl-Meyer评估量表（FMA-UE）来评估运动状态。在三种条件下从受影响侧的拇短展肌（ABP）引出运动诱发电位（MEP）：静息、未受影响侧ABP的强直收缩或未受影响侧胫前肌的强直收缩。

结果

58名参与者中有28名在静息时可从受影响的ABP引出MEP；这些参与者在未受影响侧收缩时也表现出交叉易化。与未引出MEP的参与者（19.83±1.60；Z=-6.21）相比，静息时引出MEP的参与者FMA-UE评分更高（53.04±2.59）。7名静息时未引出MEP的参与者在交叉易化时引出了MEP；与23名在任何条件下均未引出ABP MEP的参与者相比，他们的FMA-UE评分更高（Z=-2.66）。FMA-UE评分与APB任务期间（r=0.68）和胫前肌任务期间（r=0.54）的交叉易化量呈正相关。

讨论与结论

在一些参与者中，即使静息时无法引出MEP，未受影响侧肌肉的强直收缩也会增强受影响手部肌肉的MEP。受影响手部肌肉的交叉易化程度与受影响上肢的运动功能水平相关，且FMA-UE评分可对交叉易化的存在与否进行分类。作者提供视频摘要以获取更多见解（补充数字内容1，http://links.lww.com/JNPT/A117）。