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Deficits in corticospinal control of stretch reflex thresholds in stroke: implications for motor impairment
Clinical Neurophysiology ( IF 4.7 ) Pub Date : 2020-09-01 , DOI: 10.1016/j.clinph.2020.05.030
Daniele Piscitelli 1 , Nicolas A Turpin 2 , Sandeep K Subramanian 3 , Anatol G Feldman 4 , Mindy F Levin 1
Affiliation  

OBJECTIVES The corticospinal system (CS) regulates muscle activation through shifts in muscle-level tonic stretch-reflex thresholds (TSRT). This ability is impaired in stroke and contributes to sensorimotor impairments such as spasticity. We determined the role of CS in elbow flexor activity regulation in healthy and post-stroke subjects. We also determined whether CS modulation deficits were related to sensorimotor impairment intensity in post-stroke individuals. METHODS Seventeen healthy (59.8 ± 12.2 yr) and 27 stroke subjects (58.7 ± 10.1 yr) had transcranial magnetic stimulation (TMS) applied over the primary motor cortex (M1) flexor representation to elicit motor-evoked potentials (MEPs) in elbow flexors in different angular positions. In a subset of post-stroke subjects (n = 12), flexor TSRTs were measured in passive and active conditions, and TSRT modulation was determined. RESULTS Position-related MEP amplitude modulation was similar in healthy and mild stroke subjects, while subjects with more severe stroke exhibited less consistent modulation. MEP modulation in stroke was related to clinical upper limb motor impairment, spasticity, and the ability to modulate TSRTs between passive and active elbow movements. CONCLUSIONS CS output was closely related to TSRT modulation. Impairments in TSRT regulation may underlie motor deficits in moderate-to-severe post-stroke individuals. SIGNIFICANCE Translation of these neurophysiological findings to clinical applications may enhance post-stroke motor recovery.

中文翻译:

中风牵张反射阈值的皮质脊髓控制缺陷:对运动障碍的影响

目的 皮质脊髓系统 (CS) 通过改变肌肉水平强直牵张反射阈值 (TSRT) 来调节肌肉激活。这种能力在中风中受损,并导致感觉运动障碍,如痉挛。我们确定了 CS 在健康和中风后受试者肘屈肌活动调节中的作用。我们还确定 CS 调制缺陷是否与中风后个体的感觉运动障碍强度有关。方法 17 名健康 (59.8 ± 12.2 岁) 和 27 名中风受试者 (58.7 ± 10.1 岁) 在初级运动皮层 (M1) 屈肌表征上施加经颅磁刺激 (TMS),以在肘部屈肌中引发运动诱发电位 (MEP)。不同的角度位置。在中风后受试者的子集中(n = 12),在被动和主动条件下测量屈肌 TSRT,并确定了 TSRT 调制。结果 与位置相关的 MEP 幅度调制在健康和轻度中风受试者中相似,而更严重的中风受试者表现出不太一致的调制。中风中的 MEP 调节与临床上肢运动障碍、痉挛以及在被动和主动肘部运动之间调节 TSRT 的能力有关。结论 CS 输出与 TSRT 调制密切相关。TSRT 调节受损可能是中度至重度卒中后个体运动缺陷的基础。意义将这些神经生理学发现转化为临床应用可能会增强中风后运动恢复。而中风更严重的受试者则表现出不太一致的调制。中风中的 MEP 调节与临床上肢运动障碍、痉挛以及在被动和主动肘部运动之间调节 TSRT 的能力有关。结论 CS 输出与 TSRT 调制密切相关。TSRT 调节受损可能是中度至重度卒中后个体运动缺陷的基础。意义将这些神经生理学发现转化为临床应用可能会增强中风后运动恢复。而中风更严重的受试者则表现出不太一致的调制。中风中的 MEP 调节与临床上肢运动障碍、痉挛以及在被动和主动肘部运动之间调节 TSRT 的能力有关。结论 CS 输出与 TSRT 调制密切相关。TSRT 调节受损可能是中度至重度卒中后个体运动缺陷的基础。意义将这些神经生理学发现转化为临床应用可能会增强中风后运动恢复。TSRT 调节受损可能是中度至重度卒中后个体运动缺陷的基础。意义将这些神经生理学发现转化为临床应用可能会增强中风后运动恢复。TSRT 调节受损可能是中度至重度卒中后个体运动缺陷的基础。意义将这些神经生理学发现转化为临床应用可能会增强中风后运动恢复。
更新日期:2020-09-01
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