感觉反馈对脑瘫成年人蹬离期跖屈肌激活的作用。

Contribution of sensory feedback to plantar flexor muscle activation during push-off in adults with cerebral palsy.

作者信息

Frisk Rasmus F, Jensen Peter, Kirk Henrik, Bouyer Laurent J, Lorentzen Jakob, Nielsen Jens B

机构信息

Center of Neuroscience, University of Copenhagen, Copenhagen, Denmark;

University College Zealand, Roskilde, Denmark.

出版信息

J Neurophysiol. 2017 Dec 1;118(6):3165-3174. doi: 10.1152/jn.00508.2017. Epub 2017 Sep 13.

Abstract

Exaggerated sensory activity has been assumed to contribute to functional impairment following lesion of the central motor pathway. However, recent studies have suggested that sensory contribution to muscle activity during gait is reduced in stroke patients and children with cerebral palsy (CP). We investigated whether this also occurs in CP adults and whether daily treadmill training is accompanied by alterations in sensory contribution to muscle activity. Seventeen adults with CP and 12 uninjured individuals participated. The participants walked on a treadmill while a robotized ankle-foot orthosis applied unload perturbations at the ankle, thereby removing sensory feedback naturally activated during push-off. Reduction of electromyographic (EMG) activity in the soleus muscle caused by unloads was compared and related to kinematics and ankle joint stiffness measurements. Similar measures were obtained after 6 wk of gait training. We found that sensory contribution to soleus EMG activation was reduced in CP adults compared with uninjured adults. The lowest contribution of sensory feedback was found in participants with lowest maximal gait speed. This was related to increased ankle plantar flexor stiffness. Six weeks of gait training did not alter the contribution of sensory feedback. We conclude that exaggerated sensory activity is unlikely to contribute to impaired gait in CP adults, because sensory contribution to muscle activity during gait was reduced compared with in uninjured individuals. Increased passive stiffness around the ankle joint is likely to diminish sensory feedback during gait so that a larger part of plantar flexor muscle activity must be generated by descending motor commands. Findings suggest that adults with cerebral palsy have less contribution of sensory feedback to ongoing soleus muscle activation during push-off than uninjured individuals. Increased passive stiffness around the ankle joint is likely to diminish sensory feedback during gait, and/or sensory feedback is less integrated with central motor commands in the activation of spinal motor neurons. Consequently, muscle activation must to a larger extent rely on descending drive, which is already decreased because of the cerebral lesion.

摘要

中枢运动通路损伤后的功能障碍被认为与感觉活动过度有关。然而,最近的研究表明,中风患者和脑瘫(CP)儿童在步态中感觉对肌肉活动的贡献降低。我们调查了这种情况是否也发生在成年CP患者中,以及日常跑步机训练是否伴随着感觉对肌肉活动贡献的改变。17名成年CP患者和12名未受伤个体参与了研究。参与者在跑步机上行走,同时一个机器人化的踝足矫形器在脚踝处施加卸载扰动,从而消除在蹬离期自然激活的感觉反馈。比较了卸载引起的比目鱼肌肌电图(EMG)活动的减少,并将其与运动学和踝关节僵硬度测量结果相关联。在进行6周的步态训练后获得了类似的测量结果。我们发现,与未受伤的成年人相比,成年CP患者中感觉对比目鱼肌EMG激活的贡献降低。在最大步态速度最低的参与者中发现感觉反馈的贡献最低。这与踝关节跖屈肌僵硬度增加有关。6周的步态训练并未改变感觉反馈的贡献。我们得出结论,感觉活动过度不太可能导致成年CP患者的步态受损,因为与未受伤个体相比,步态中感觉对肌肉活动的贡献降低。踝关节周围被动僵硬度的增加可能会减少步态中的感觉反馈,因此跖屈肌肌肉活动的更大一部分必须由下行运动指令产生。研究结果表明,与未受伤个体相比,成年脑瘫患者在蹬离期对正在进行的比目鱼肌肌肉激活的感觉反馈贡献较小。踝关节周围被动僵硬度的增加可能会减少步态中的感觉反馈,和/或在脊髓运动神经元的激活中感觉反馈与中枢运动指令的整合较少。因此,肌肉激活必须在更大程度上依赖下行驱动,而由于脑部病变,下行驱动已经减少。

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