Spastic movement disorder is characterized by reduced ability to selectively activate muscles with significant co-activation of antagonist muscles. It has traditionally been thought that hyperexcitable stretch reflexes have a central role in the pathophysiology and the clinical manifestations of the disorder. Here we argue that the main functional challenges for persons with spastic movement disorder are related to contractures, paresis, weak muscles and inappropriate central motor commands, whereas hyperexcitable reflexes play no or only an insignificant functional role. Co-activation of antagonist muscles and stiff posture and gait may rather be adaptations that aim to ensure joint and postural stability due to insufficient muscle strength. Aberrant (involuntary) muscle activity is likely related to an inadequate prediction of the sensory consequences of movement and a resulting impairment of muscle coordination. We argue that improvement of functional muscle strength and muscle coordination following central motor lesions may be achieved by optimizing integration of somatosensory information into central feedforward motor programs, whereas anti-spastic therapy that aims to reduce reflex activity may be less efficient. This opens for novel investigations into new treatment strategies that may improve functional control of movement and prevent reduced joint mobility in people with brain lesions.

中文翻译：

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痉挛性运动障碍：我们是否应该忘记过度兴奋的伸展反射并开始谈论运动的感觉后果的不恰当预测？

痉挛性运动障碍的特征在于选择性地激活肌肉的能力降低，而拮抗肌的显着共激活。传统上认为，过度兴奋的伸展反射在该疾病的病理生理和临床表现中起着中心作用。在这里，我们认为痉挛性运动障碍患者的主要功能挑战与挛缩，轻瘫，肌肉无力和不适当的中央运动命令有关，而过度兴奋的反射则不起作用或仅起不重要的作用。拮抗肌肉以及僵硬的姿势和步态的共激活可能是旨在确保由于肌肉力量不足而引起的关节和姿势稳定性的适应。异常（非自愿​​）肌肉活动很可能与运动感觉结果的预测不足以及由此导致的肌肉协调性受损有关。我们认为，通过将体感信息整合到中央前馈运动程序中，可以优化整合体感信息，从而实现功能性肌肉力量和肌肉协调性的改善，而旨在减少反射活动的抗痉挛疗法可能效率较低。这为新型治疗策略的新颖研究打开了大门，这些策略可能会改善运动功能控制并防止脑部病变患者的关节活动性降低。我们认为，通过将体感信息整合到中央前馈运动程序中，可以优化整合体感信息，从而实现功能性肌肉力量和肌肉协调性的改善，而旨在减少反射活动的抗痉挛疗法可能效率较低。这为新颖的治疗策略的新颖研究打开了大门，这些策略可能会改善运动功能控制并防止大脑病变患者的关节活动性降低。我们认为，通过将体感信息整合到中央前馈运动程序中，可以优化整合体感信息，从而实现功能性肌肉力量和肌肉协调性的改善，而旨在减少反射活动的抗痉挛疗法可能效率较低。这为新型治疗策略的新颖研究打开了大门，这些策略可能会改善运动功能控制并防止脑部病变患者的关节活动性降低。