PDF(Pubmed)
Abstract：
Introduction Cerebral palsy (CP) is a neurodevelopmental condition that results from an injury to a developing brain. Children with CP fail to execute precise, well-coordinated movements, and excessive muscular co-contraction or co-activation is a prominent attribute of CP. The normal reciprocal relationship between agonists and antagonists during voluntary movements is altered in patients with CP. H-reflex, which is often regarded as the electrical equivalent of the spinal stretch reflex, can be used to examine the overall reflex arc, including the Ia sensory afferent strength and the spinal motoneuron excitability state. Furthermore, neuromodulatory influence of vibration on H-reflex has been found, which has been increasingly investigated to ascertain its potential use as an intervention in patients with increased spinal reflex excitability. Our goal was to identify the brain mechanism underlying the motor deficits by studying Soleus H-reflex changes during voluntary movement (dorsiflexion) and also to determine the role of vibration in H-reflex modulation in children with spastic CP. Methods Soleus H-reflex was recorded in 12 children with spastic CP (10-16 years) and 15 age-matched controls. Recordings were obtained at rest, during dorsiflexion, and during vibratory stimulation for each subject. H-responses (Hmax amplitudes and Hmax-to-Mmax ratio) were compared among the controls and the cases (CP), for the experiments performed, by the Wilcoxon signed-rank test. The recruitment curves depicting the distribution of mean H-response amplitudes with stimulus intensity increment, for dorsiflexion and vibration were compared among controls and cases by the two-sample Kolmogorov-Smirnov (KS) test. p-value <0.05 was considered as statistically significant. Results Hmax amplitudes and the Hmax-to-Mmax ratio increased (15 % and 12.2 % increment, respectively) from the resting values in the children with CP (p<0.05), while controls exhibited a decrease (reduction of 62% and 57 %, respectively) during dorsiflexion (p<0.05). Vibratory stimulation produced a decreasing trend in H-response measures in both the groups. There was about 15 % and 16 % reduction respectively among children with CP while that of 24 % and 21 % respectively among the controls. The differences in the recruitment curves (distribution of average H-response amplitudes with stimulation intensity) recorded during dorsiflexion and vibration experiments among controls compared with those with CP were found to be statistically significant by the two-sample KS test (p<0.0001). Conclusion The failure of H-reflex suppression during voluntary antagonist muscle activation suggests the presence of impaired reciprocal inhibition in spastic CP. The relatively modest H-response reduction caused by vibratory stimulation in children with CP provides limited evidence of vibratory regulation of the H-reflex in CP. More research into the mechanisms driving motor abnormalities in children with CP is needed, which could aid in therapy planning.
摘要：
背景技术脑性瘫痪(CP)是由发育中的大脑的损伤引起的神经发育病症。儿童CP无法执行精确，协调良好的运动，过度的肌肉共收缩或共激活是CP的一个突出属性。CP患者在自愿运动期间激动剂和拮抗剂之间的正常相互关系发生了改变。H反射,通常被认为是脊柱拉伸反射的电等效物，可用于检查整体的Re-ex弧，包括Ia感觉强度和脊髓运动神经元兴奋性状态。此外，已经发现振动对H反射的神经调节影响，越来越多的研究，以确定其作为脊髓反射兴奋性增强患者干预的潜在用途。我们的目标是通过研究自主运动（背屈）期间的SoleusH反射变化来确定运动缺陷的大脑机制，并确定振动在痉挛型CP儿童中H反射调节中的作用。方法对12例痉挛型CP患儿（10-16岁）和15例年龄匹配的对照组进行比目鱼H反射记录。录音是在休息时获得的，在背屈期间，以及在每个受试者的振动刺激期间。在对照组和病例（CP）之间比较H反应（Hmax振幅和Hmax与Mmax之比）。对于进行的实验，通过Wilcoxon符号秩检验.募集曲线描绘了平均H响应振幅随刺激强度增量的分布，通过两个样本的Kolmogorov-Smirnov（KS）检验，比较了对照组和病例之间的背屈和振动。P值<0.05被认为是统计学上显著的。结果Hmax振幅和Hmax与Mmax之比增加(增加15%和12.2%，分别)来自CP患儿的静息值(p<0.05)，而对照组表现出下降(减少了62%和57%，分别)在背屈期间(p<0.05)。振动刺激在两组中的H反应测量值均呈下降趋势。CP儿童分别减少了约15％和16％，而对照组分别减少了24％和21％。通过双样本KS检验发现，在背屈和振动实验期间，对照组与CP相比，记录的募集曲线（平均H响应幅度与刺激强度的分布）差异具有统计学意义（p<0.0001）。结论自愿性拮抗肌激活过程中H-反射抑制的失败表明在痉挛型CP中存在受损的相互抑制。CP儿童中由振动刺激引起的相对适度的H反应降低提供了有限的证据证明CP中H反射的振动调节。需要对CP儿童运动异常的机制进行更多的研究，这可以帮助制定治疗计划。
