Grunt Sebastian, Newman Christopher J, Saxer Stefanie, Steinlin Maja, Weisstanner Christian, Kaelin-Lang Alain
1 Division of Neuropaediatrics, Development and Rehabilitation, University Children's Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Switzerland.
2 Paediatric Neurology and Neurorehabilitation Unit, Lausanne University Hospital, Lausanne, Switzerland.
Neurorehabil Neural Repair. 2017 Mar;31(3):280-289. doi: 10.1177/1545968316680483. Epub 2016 Dec 13.
Mirror therapy provides a visual illusion of a normal moving limb by using the mirror reflection of the unaffected arm instead of viewing the paretic limb and is used in rehabilitation to improve hand function. Little is known about the mechanism underlying its effect in children with hemiparesis.
To investigate the effect of the mirror illusion (MI) on the excitability of the primary motor cortex (M1) in children and adolescents.
Twelve patients with hemiparesis (10-20 years) and 8 typically developing subjects (8-17 years) participated. Corticospinal reorganization was classified as contralateral (projection from contralateral hemisphere to affected hand) or ipsilateral (projection from ipsilateral hemisphere to affected hand). M1 excitability of the hemisphere projecting to the affected (nondominant in typically developing subjects) hand was obtained during 2 different conditions using single-pulse transcranial magnetic stimulation (TMS). Each condition (without/with mirror) consisted of a unimanual and a bimanual task. Motor-evoked potentials (MEPs) were recorded from the abductor pollicis brevis and flexor digitorum superficialis muscles.
MEP amplitudes were significantly increased during the mirror condition ( P = .005) in typically developing subjects and in patients with contralateral reorganization. No significant effect of MI was found in subjects with ipsilateral reorganization. MI increased M1 excitability during active movements only. This increase was not correlated to hand function.
MI increases the excitability of M1 in hemiparetic patients with contralateral corticospinal organization and in typically developing subjects. This finding provides neurophysiological evidence supporting the application of mirror therapy in selected children and adolescents with hemiparesis.
镜像疗法通过使用未受影响手臂的镜像反射来提供正常运动肢体的视觉错觉，而不是观察麻痹的肢体，用于康复治疗以改善手部功能。关于其对偏瘫儿童疗效的潜在机制知之甚少。
研究镜像错觉（MI）对儿童和青少年初级运动皮层（M1）兴奋性的影响。
12例偏瘫患者（10 - 20岁）和8例发育正常的受试者（8 - 17岁）参与研究。皮质脊髓重组分为对侧（从对侧半球投射到患手）或同侧（从同侧半球投射到患手）。在两种不同条件下，使用单脉冲经颅磁刺激（TMS）获取投射到患手（在发育正常的受试者中非优势手）的半球的M1兴奋性。每种条件（无镜像/有镜像）包括单手任务和双手任务。从拇短展肌和指浅屈肌记录运动诱发电位（MEP）。
在发育正常的受试者和对侧重组的患者中，镜像条件下MEP波幅显著增加（P = 0.005）。在同侧重组的受试者中未发现MI有显著影响。MI仅在主动运动期间增加M1兴奋性。这种增加与手部功能无关。
MI增加了对侧皮质脊髓组织的偏瘫患者和发育正常受试者的M1兴奋性。这一发现提供了神经生理学证据，支持在部分偏瘫儿童和青少年中应用镜像疗法。
