对多发性硬化症患者静态姿势控制功能障碍的高级特征分析及其相关神经机制。
Advanced characterization of static postural control dysfunction in persons with multiple sclerosis and associated neural mechanisms.
机构信息
College of Health and Human Sciences, Department of Health and Exercise Science, Colorado State University, 951 Plum St, Fort Collins, CO, 80523, USA.
College of Health and Human Sciences, Department of Health and Exercise Science, Colorado State University, 951 Plum St, Fort Collins, CO, 80523, USA.
出版信息
Gait Posture. 2021 Jan;83:114-120. doi: 10.1016/j.gaitpost.2020.10.015. Epub 2020 Oct 16.
BACKGROUND
Multiple sclerosis (MS) is an autoimmune-based chronic inflammatory disease characterized by the neurodegeneration of the central nervous system and produces postural dysfunction. Quiet or static standing is a complex task carried out through afferent sensory inputs and efferent postural corrective outputs. Currently the mechanisms underlying these outputs remain largely unknown.
RESEARCH QUESTION
Assess the relationship between multi-dimensional measures of postural control and microstructural integrity of the cortical sensorimotor pathway (CSP) in persons with MS (PwMS) and neurotypical adults.
METHODS
Postural control performance was assessed by both overall and directional time-to-boundary measures across four manipulated sensory stance conditions (eyes open/closed; stance firm/foam) in twenty-nine neurotypical and twenty-seven PwMS. These postural outcomes were evaluated with mixed-model repeated measures analysis of variance across group (MS and control) and stance condition. Postural performance was also correlated with magnetic resonance imaging diffusion tensor-derived measures of microstructural integrity of the CSP.
RESULTS
PwMS displayed significantly (p = 0.026) worse anterior-posterior postural control compared to their neurotypical counterparts across sensory testing conditions and poorer CSP microstructural integrity in comparison to neurotypical adults (p = 0.008). Additionally, PwMS displayed a significant association (2D (rho = -0.384, p = 0.048), AP (rho = -0.355, p = 0.035), and ML (rho = -0.365, p = 0.030) between integrity of the CSP and postural control performance during proprioceptive-based balance, such that those with worse cortical structure had poorer balance control.
SIGNIFICANCE
This is the first study to establish connections between the microstructural integrity of the CSP and multi-dimensional postural control performance. Results indicate that a reduction in the CSP microstructural integrity is associated with poorer postural control in PwMS. These outcomes identify neural underpinnings of postural control dysfunction in PwMS and provide new avenues for evaluating the efficacy of postural rehabilitation strategies in PwMS that express proprioceptive-based postural deficits.
背景
多发性硬化症（MS）是一种基于自身免疫的慢性炎症性疾病，其特征是中枢神经系统的神经退行性变，并产生姿势功能障碍。安静或静态站立是一项通过传入感觉输入和传出姿势校正输出来完成的复杂任务。目前，这些输出的机制在很大程度上仍然未知。
研究问题
评估多发性硬化症患者（PwMS）和神经典型成年人的姿势控制多维测量与皮质感觉运动通路（CSP）的微观结构完整性之间的关系。
方法
通过在四个受控制的感觉站立条件（睁眼/闭眼；站立牢固/泡沫）下，对 29 名神经典型和 27 名 PwMS 的整体和方向到达边界时间进行测量，评估姿势控制性能。这些姿势结果通过混合模型重复测量方差分析进行评估，包括组（MS 和对照组）和站立条件。姿势表现也与磁共振成像扩散张量衍生的 CSP 微观结构完整性测量值相关。
结果
与神经典型对照组相比，PwMS 在所有感觉测试条件下的前后向姿势控制明显（p=0.026）更差，与神经典型成年人相比，CSP 微观结构完整性更差（p=0.008）。此外，PwMS 显示出与姿势控制性能之间存在显著关联（2D（rho=-0.384，p=0.048），AP（rho=-0.355，p=0.035）和 ML（rho=-0.365，p=0.030））在基于本体感觉的平衡中，CSP 的完整性与姿势控制性能之间存在关联，即皮质结构越差，平衡控制越差。
意义
这是第一项建立 CSP 微观结构完整性与多维姿势控制性能之间联系的研究。结果表明，CSP 微观结构完整性的降低与 PwMS 中姿势控制不佳有关。这些结果确定了 PwMS 中姿势控制功能障碍的神经基础，并为评估表达本体感觉性姿势缺陷的 PwMS 中姿势康复策略的疗效提供了新的途径。
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