Seelen H A, Potten Y J, Adam J J, Drukker J, Spaans F, Huson A
Institute for Rehabilitation Research, Posture and Movement Research Group, Hoensbroek, The Netherlands.
Ergonomics. 1998 Mar;41(3):302-16. doi: 10.1080/001401398187053.
One of the basic aims in the rehabilitation of thoracic spinal cord injured (SCI) patients concerns the regaining of sitting posture control. This implies the development of new postural strategies requiring the adjustment of motor programming processes. The aim of this study was to investigate the time course of postural reorganization during active, clinical rehabilitation of thoracic SCI patients with different SCI levels. Thus changes in motor programming in sitting balance control were investigated in two groups of complete low or high thoracic SCI patients. At several stages during the rehabilitation process an experiment was held in which sitting posture was perturbed systematically using submaximal reaching movements over four reaching distances. This bimanual reaching task was presented as a visual precue choice reaction time (RT) task in which reaching distance (i.e. grade of postural perturbation) was precued. Results indicated that in both high and low thoracic SCI patients RTs in movements involving postural perturbation became shorter during the course of the rehabilitation period. However, low thoracic SCI patients were generally slower in the programming of balance perturbing movements than high thoracic SCI patients, a phenomenon that did not change over time. Furthermore, initial differences in RTs as a function of grade of postural perturbation disappeared in both groups in the course of the rehabilitation phase. Precue benefit, equally large for both groups, did not change as a function of rehabilitation time. It is concluded that the observed phenomena signify the gradual development of new central postural control processes in both SCI groups during rehabilitation. Low thoracic SCI patients, having more residual sensorimotor functions, seem to adopt more complex strategies in maintaining and restoring sitting balance that take longer to specify and to programme. High thoracic SCI patients seem to rely on simpler strategies using more passive postural support.
胸段脊髓损伤（SCI）患者康复的基本目标之一是重新获得坐姿控制能力。这意味着要开发新的姿势策略，这需要调整运动编程过程。本研究的目的是调查不同SCI水平的胸段SCI患者在积极的临床康复过程中姿势重组的时间进程。因此，在两组完全性低位或高位胸段SCI患者中研究了坐姿平衡控制中运动编程的变化。在康复过程的几个阶段进行了一项实验，其中通过在四个伸展距离上进行次最大伸展运动来系统地干扰坐姿。这个双手伸展任务被呈现为一个视觉预提示选择反应时间（RT）任务，其中伸展距离（即姿势干扰程度）是预先提示的。结果表明，在高位和低位胸段SCI患者中，涉及姿势干扰的运动的反应时间在康复期间都变短了。然而，低位胸段SCI患者在平衡干扰运动的编程方面通常比高位胸段SCI患者慢，这一现象不会随时间变化。此外，在康复阶段，两组中作为姿势干扰程度函数的反应时间的初始差异都消失了。两组的预提示益处同样大，并且不会随康复时间而变化。得出的结论是，观察到的现象表明在康复过程中，两个SCI组都逐渐发展出新的中枢姿势控制过程。低位胸段SCI患者具有更多的残余感觉运动功能，似乎在维持和恢复坐姿平衡时采用了更复杂但需要更长时间来确定和编程的策略。高位胸段SCI患者似乎依赖于使用更多被动姿势支撑的更简单策略。
