Viallet F, Massion J, Bonnefoi-Kyriacou B, Aurenty R, Obadia A, Khalil R
Service de Neurologie, CHG Aix-en-Provence, Marseille.
Rev Neurol (Paris). 1994;150(1):55-60.
In his original description of cerebellar asynergia, Babinski, in 1899, presented a patient with cerebellar dysfunction performing a backward upper trunk bending. When the patient tried to bend his head and trunk, his lower limbs stayed almost motionless, because the associated flexion of the knee and hip, usually observed in a normal subject, did not take place. To reassess the possibility that asynergia may actually be a symptom of cerebellar dysfunction, a combined kinematic and electromyographic (EMG) analysis of the upper-trunk bending was performed on 3 patients suffering from progressive cerebellar ataxia of late onset and showing a significant atrophy of the vermis on MRI examination. Compared with 3 age and sex-matched control subjects, a significant slowing down of the upper-trunk displacement and a marked reduction of the associated displacement of hip and knee was observed. EMG recordings of three pairs of antagonistic muscles at trunk level (rectus abdominis, erectores spinae), at thigh level (vastus lateralis, semi membranosus), and at leg level (tibialis anterior, gastrocnemius lateralis), showed that the reciprocal activation pattern characteristic of a normal fast movement was absent at the thigh level in the cerebellar patients. This lack of reciprocal activation of the thigh muscles during the upper-trunk bending might explain the reduction of the compensatory displacement of the hip and knee. It might also represent an essential feature of cerebellar dysfunction in provoking axial asynergia between the upper-trunk, which is the moving segment, and the leg, which is the supporting segment during equilibrium control and during whole body displacement.
1899年，巴宾斯基在其对小脑协同不能的最初描述中，展示了一名患有小脑功能障碍的患者进行上躯干向后弯曲的情况。当患者试图弯曲头部和躯干时，其下肢几乎保持不动，因为正常受试者中通常会出现的膝关节和髋关节的相关屈曲并未发生。为了重新评估协同不能实际上可能是小脑功能障碍症状的可能性，对3名患有迟发性进行性小脑共济失调且MRI检查显示蚓部明显萎缩的患者进行了上躯干弯曲的运动学和肌电图（EMG）联合分析。与3名年龄和性别匹配的对照受试者相比，观察到上躯干位移明显减慢，以及髋部和膝部相关位移显著减少。在躯干水平（腹直肌、竖脊肌）、大腿水平（股外侧肌、半膜肌）和小腿水平（胫骨前肌、外侧腓肠肌）对三对拮抗肌的肌电图记录显示，小脑患者在大腿水平缺乏正常快速运动特有的相互激活模式。在上躯干弯曲过程中大腿肌肉缺乏相互激活可能解释了髋部和膝部代偿性位移的减少。它也可能代表了小脑功能障碍的一个基本特征，即在平衡控制和全身位移过程中，作为运动节段的上躯干与作为支撑节段的腿部之间引发轴向协同不能。
