Frenkel-Toledo Silvi, Ofir-Geva Shay, Mansano Lihi, Granot Osnat, Soroker Nachum
Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel.
Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel.
Front Hum Neurosci. 2021 Feb 1;15:592975. doi: 10.3389/fnhum.2021.592975. eCollection 2021.
The impact of stroke on motor functioning is analyzed at different levels. 'Impairment' denotes the loss of basic characteristics of voluntary movement. 'Activity limitation' denotes the loss of normal capacity for independent execution of daily activities. Recovery from impairment is accomplished by 'restitution' and recovery from activity limitation is accomplished by the combined effect of 'restitution' and 'compensation.' We aimed to unravel the long-term effects of variation in lesion topography on motor impairment of the hemiparetic lower limb (HLL), and gait capacity as a measure of related activity limitation. Gait was assessed by the 3 m walk test (3MWT) in 67 first-event chronic stroke patients, at their homes. Enduring impairment of the HLL was assessed by the Fugl-Meyer Lower Extremity (FMA-LE) test. The impact of variation in lesion topography on HLL impairment and on walking was analyzed separately for left and right hemispheric damage (LHD, RHD) by voxel-based lesion-symptom mapping (VLSM). In the LHD group, HLL impairment tended to be affected by damage to the posterior limb of the internal capsule (PLIC). Walking capacity tended to be affected by a larger array of structures: PLIC and corona radiata, external capsule and caudate nucleus. In the RHD group, both HLL impairment and walking capacity were sensitive to damage in a much larger number of brain voxels. HLL impairment was affected by damage to the corona radiata, superior longitudinal fasciculus and insula. Walking was affected by damage to the same areas, plus the internal and external capsules, putamen, thalamus and parts of the perisylvian cortex. In both groups, voxel clusters have been found where damage affected FMA-LE and also 3MWT, along with voxels where damage affected only one of the measures (mainly 3MWT). In stroke, enduring 'activity limitation' is affected by damage to a much larger array of brain structures and voxels within specific structures, compared to enduring 'impairment.' Differences between the effects of left and right hemisphere damage are likely to reflect variation in motor-network organization and post-stroke re-organization related to hemispheric dominance. Further studies with larger sample size are required for the validation of these results.
中风对运动功能的影响在不同层面进行了分析。“损伤”指的是自主运动基本特征的丧失。“活动受限”指的是独立执行日常活动的正常能力的丧失。从损伤中恢复是通过“复原”实现的,而从活动受限中恢复则是通过“复原”和“代偿”的综合作用实现的。我们旨在揭示病变部位差异对偏瘫下肢(HLL)运动损伤以及作为相关活动受限衡量指标的步态能力的长期影响。在67例首次发病的慢性中风患者家中,通过3米步行试验(3MWT)对步态进行评估。通过Fugl - Meyer下肢(FMA - LE)测试评估HLL的持续性损伤。通过基于体素的病变 - 症状映射(VLSM)分别分析病变部位差异对左、右半球损伤(LHD、RHD)患者HLL损伤和步行的影响。在LHD组中,HLL损伤往往受内囊后肢(PLIC)损伤的影响。步行能力往往受更多结构的影响:PLIC和放射冠、外囊和尾状核。在RHD组中,HLL损伤和步行能力对更多脑体素的损伤都很敏感。HLL损伤受放射冠、上纵束和岛叶损伤的影响。步行受相同区域损伤的影响,此外还有内囊和外囊、壳核、丘脑以及部分外侧裂周皮质。在两组中,都发现了一些体素簇,在这些体素簇中损伤既影响FMA - LE也影响3MWT,还有一些体素中损伤仅影响其中一项指标(主要是3MWT)。在中风中,与持续性“损伤”相比,持续性“活动受限”受更多脑结构以及特定结构内更多体素损伤的影响。左、右半球损伤影响的差异可能反映了运动网络组织的差异以及与半球优势相关的中风后重组。需要进一步进行更大样本量的研究来验证这些结果。
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