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亚急性脑卒中患者比目鱼肌H反射的激活后抑制随下肢运动功能的恢复而增加。

Postactivation depression of soleus H-reflex increase with recovery of lower extremities motor functions in patients with subacute stroke.

作者信息

Kawaishi Yu, Matsumoto Naoki, Nishiwaki Toshiya, Hirano Tatsuro

机构信息

Department of Rehabilitation, Kobe Rehabilitation Hospital: 14-1 Nakaichiriyama, Shimotanigami-Aza, Ymada-cho, Kita-ku, Kobe-shi, Hyogo 651-1102, Japan.

出版信息

J Phys Ther Sci. 2017 Sep;29(9):1539-1542. doi: 10.1589/jpts.29.1539. Epub 2017 Sep 15.

Abstract

[Purpose] The soleus H-reflex is depressed at stimulation rates greater than 0.1 Hz. This reflex depression is referred to as postactivation depression. Postactivation depression reflects the reduced efficacy of the Ia-motoneurons synapses when they are evaluated after a previous activation. The aim of this study was to determine whether the recovery of motor functions in the lower extremities affects the PAD of the soleus H-reflex in patients with subacute stroke undergoing rehabilitation. [Subjects and Methods] Eight patients with subacute stroke patients were recruited. Postactivation depression, Fugl-Meyer score (lower-limb portion), walking velocity, the Modified Ashworth Scale, and center of pressure sway during standing were measured within three days of admission to rehabilitation and 50 days later. [Results] After rehabilitation, Fugl-Meyer scores, center of pressure path length, and walking velocity were significantly improved, and postactivation depression had significantly increased. There was a significant positive correlation between the rates of change of postactivation depression and center of pressure path length. [Conclusion] The results demonstrated that postactivation depression is partially normalized after rehabilitation in patients with subacute stroke, and suggested that the recovery in lower extremity function after stroke particularly standing stability is affected by spinal synaptic plasticity.

摘要

[目的]比目鱼肌Hoffmann反射(H反射)在刺激频率大于0.1Hz时会受到抑制。这种反射抑制被称为激活后抑制。激活后抑制反映了Ia运动神经元突触在前一次激活后接受评估时其效能的降低。本研究的目的是确定正在接受康复治疗的亚急性中风患者下肢运动功能的恢复是否会影响比目鱼肌H反射的激活后抑制。[对象与方法]招募了8例亚急性中风患者。在康复入院3天内及50天后测量激活后抑制、Fugl-Meyer评分(下肢部分)、步行速度、改良Ashworth量表以及站立时的压力中心摆动情况。[结果]康复后,Fugl-Meyer评分、压力中心路径长度和步行速度显著改善,激活后抑制显著增加。激活后抑制的变化率与压力中心路径长度之间存在显著正相关。[结论]结果表明,亚急性中风患者康复后激活后抑制部分恢复正常,提示中风后下肢功能的恢复,尤其是站立稳定性,受脊髓突触可塑性的影响。

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