Leconte Patricia, Orban de Xivry Jean-Jacques, Stoquart Gaëtan, Lejeune Thierry, Ronsse Renaud
Institute of Mechanics, Materials and Civil Engineering, Université catholique de Louvain, Place du Levant 2, 1348, Louvain-la-Neuve, Belgium.
Louvain Bionics, Université catholique de Louvain, 1348, Louvain-la-Neuve, Belgium.
Exp Brain Res. 2016 Jun;234(6):1403-17. doi: 10.1007/s00221-015-4543-y. Epub 2016 Jan 9.
Recent reports indicate that rhythmic and discrete upper-limb movements are two different motor primitives which recruit, at least partially, distinct neural circuitries. In particular, rhythmic movements recruit a smaller cortical network than discrete movements. The goal of this paper is to compare the levels of disability in performing rhythmic and discrete movements after a stroke. More precisely, we tested the hypothesis that rhythmic movements should be less affected than discrete ones, because they recruit neural circuitries that are less likely to be damaged by the stroke. Eleven stroke patients and eleven age-matched control subjects performed discrete and rhythmic movements using an end-effector robot (REAplan). The rhythmic movement condition was performed with and without visual targets to further decrease cortical recruitment. Movement kinematics was analyzed through specific metrics, capturing the degree of smoothness and harmonicity. We reported three main observations: (1) the movement smoothness of the paretic arm was more severely degraded for discrete movements than rhythmic movements; (2) most of the patients performed rhythmic movements with a lower harmonicity than controls; and (3) visually guided rhythmic movements were more altered than non-visually guided rhythmic movements. These results suggest a hierarchy in the levels of impairment: Discrete movements are more affected than rhythmic ones, which are more affected if they are visually guided. These results are a new illustration that discrete and rhythmic movements are two fundamental primitives in upper-limb movements. Moreover, this hierarchy of impairment opens new post-stroke rehabilitation perspectives.
最近的报告表明，有节奏的和离散的上肢运动是两种不同的运动原基，它们至少部分地募集不同的神经回路。特别是，有节奏的运动比离散运动募集的皮质网络更小。本文的目的是比较中风后进行有节奏运动和离散运动时的残疾程度。更确切地说，我们检验了这样一个假设，即有节奏的运动应该比离散运动受影响更小，因为它们募集的神经回路不太可能因中风而受损。11名中风患者和11名年龄匹配的对照受试者使用末端执行器机器人（REAplan）进行离散和有节奏的运动。有节奏的运动在有视觉目标和无视觉目标的情况下进行，以进一步减少皮质募集。通过特定指标分析运动运动学，捕捉平滑度和协调性的程度。我们报告了三个主要观察结果：（1）患侧手臂进行离散运动时的运动平滑度比有节奏运动时更严重地下降；（2）大多数患者进行有节奏运动时的协调性低于对照组；（3）视觉引导的有节奏运动比非视觉引导的有节奏运动改变更大。这些结果表明了损伤程度的等级关系：离散运动比有节奏运动受影响更大，而有节奏运动如果是视觉引导的则受影响更大。这些结果再次表明离散运动和有节奏运动是上肢运动中的两种基本原基。此外，这种损伤等级关系为中风后康复开辟了新的前景。
