Abstract
The process of learning to produce voluntary changes in the position of the center of pressures using biological feedback was studied by stabilography in patients with hemipareses due to cerebrovascular lesions in the zone supplied by the middle cerebral artery. There were significant impairments to learning in all groups of patients, who had lesions in different sites, demonstrating that cortical mechanisms are involved in learning to control posture voluntarily. These studies showed that patients with lesions in the right hemisphere had rather greater deficits in performing the task than those with lesions in the left hemisphere. There were significant differences in the initial deficit in performing the task on the first day of training depending on the side of the lesion. All groups of patients differed from healthy subjects in that significant learning occurred only at the initial stages of training (the first five days). Learning at the initial stage in patients with concomitant lesions of the parietal-temporal area and with combined lesions with motor, premotor, and parietal-temporal involvement was significantly worse and the level of task performance at the end of the initial stage was significantly worse than in patient with local lesions of the motor cortex. The level of learning was independent of the severity of the motor deficit (paresis, spasticity), but was associated with the severity of impairment of the proprioceptive sense and the severity of disruption to the upright posture (asymmetry in the distribution of support pressures, amplitude of variation in the position of the center of pressures). The learning process had positive effects on the severity of motor impairment and on the asymmetry of the distribution of support pressures in the standing posture. Reorganization of posture during bodily movements occurred mainly because of impairment to the developed “non-use” stereotype of the paralyzed lower limb.
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REFERENCES
N. A. Bernshtein, The Physiology of Movements and Activity [in Russian], Nauka, Moscow (1990).
A. M. Zimkina, "The neurophysiological bases of the compensation of external functions," in: Clinical Neurophysiology [in Russian], Leningrad (1972), p. 343.
M. E. Ioffe, Mechanisms of Movement Learning [in Russian], Nauka, Moscow (1991).
N. V. Konovalov, "Basic concepts in the question of functional recovery after stroke," Zh. Nevropatol. Psikhiatr., 55, No. 6, 401 (1955).
A. R Luriya, Higher Cortical Functions in Humans [in Russian], Moscow State University Press, Moscow (1969).
Zh. Massion, "Central coordination of pose and movement," in: Associative Systems of the Brain [in Russian], Nauka, Leningrad (1985), p. 18.
Yu. S. Sliva, I. V. Kondrat'ev, and O. V. Orlov, Medical Information Systems [in Russian], Taganrog (1993), Vol. 4, p. 120.
L. A. Chernikova, Optimization of the Recovery Process in Patients following Stroke: Clinical and Neuropsychological Aspects of Functional Bioregulation [in Russian], Author's abstract of thesis for doctorate in medical sciences, Science Research Institute of Neurology, Russian Academy of Medical Sciences, Moscow (1998).
K. B. Shapovalova, I. V. Yakunin, and M. I. Boiko, "Involvement of the head of the caudate nucleus in the mechanisms of conditioned reflex rearrangement of pose," Zh. Vyssh. Nerv. Deyat., 34, No. 4, 669 (1984).
V. N. Shmel'kov, Restoration of Movement Potential in Patients with Post-Stoke Paralyses and Pareses and Focal Lesions in Different Cortical Hemispheres [in Russian], Author's abstract of thesis for doctorate in medical sciences, Science Research Institute of Neurology, Russian Academy of Medical Sciences, Moscow (1979).
A. I. Shumilina, "The involvement of the pyramidal and extrapyramidal systems in motor activity in deafferented limbs," in: Questions in Higher Nervous Activity [in Russian], P. K. Anokhin (ed.), Academy of Medical Sciences of the USSR Press, Moscow (1949), p. 174.
J. Armand, O. Olivier, S. A. Edgley, and R. N. Lemon, "The structure and function of the developing corticospinal tract: some key issues," in: Hand and Brain, A. M. Wing, P. Haggard, and G. R. Flanagan (eds.), Academic Press, New York (1996), p. 125.
M. B. Badke and P. W. Duncan, "Patterns of rapid motor responses during postural adjustments when standing in healthy subjects and hemiplegic patients," Phys. Ther., 63, 13 (1983).
E. V. Birjukova, M. Dufosse, A. A. Frolov, et al., "Role of the sensorimotor cortex in postural adjustment accompanying a conditioned paw lift in the standing cat," Exptl. Brain Res., 78, 588 (1989).
R. W. Bohannon and P. A. Larkin, "Lower extremity weight bearing under various standing conditions in independently ambulatory patients with hemiparesis," Phys. Ther., 65, No. 9, 1323 (1985).
A. Brodal, "Self-observations and neuro-anatomical considerations after stroke," Brain, 93, 664 (1973).
V. B. Brooks, The Neural Basis of Motor Control, Oxford University Press, New York (1986).
N. I. Burlachkova and M. E. Ioffe, "The analysis of the postural adjustment accompanying a local movement," Aggressologie, 20B, 141 (1979).
W. W. Chambers, C. N. Liu, and G. P. McGough, "Anatomical and physiological correlates of plasticity in the central nervous system," Brain Behav. Evol., 8, 675 (1973).
M. E. Ioffe, N. G. Ivanova, A. A. Frolov, et al., "On the role of motor cortex in the learned rearrangement of postural coordinations," in: Stance and Motion. Facts and Concepts,V. S. Gurfinkel, et al. (eds.), Plenum Press, New York (1988), p. 213.
R. G. Hamman, I. Mekjavic, A. L. Mallinson, and N. S. Longridge, "Training effects during repeated therapy sessions of balance training using visual feedback," Arch. Physiol. Med. Rehab.,73, No. 8, 738 (1992).
F. B. Horak, "Clinical measurements of postural control in adults," Phys. Ther., 67, 1881 (1987).
D. G. Lawrence and H. G. J. M. Kuypers, "The functional organization of the motor system in the monkey," Brain, 91, 1 (1968).
J. Massion, "Role of the motor cortex in the postural adjustment associated with movements," in: Integration in the Nervous System, H. Asanuma and V. J. Wilson (eds.), Igaku-Shoin, Tokyo (1979), p. 239.
A. M. Wong, M.. Y. Lee, J. K. Kuo, and F. T. Tang, "The development and clinical evaluation of a standing biofeedback trainer," J. Rehab. Res. Dev., 34, No. 7, 322 (1997).
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Ustinova, K.I., Chernikova, L.A., Ioffe, M.E. et al. Impairment of Learning the Voluntary Control of Posture in Patients with Cortical Lesions of Different Locations: the Cortical Mechanisms of Pose Regulation. Neurosci Behav Physiol 31, 259–267 (2001). https://doi.org/10.1023/A:1010326332751
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DOI: https://doi.org/10.1023/A:1010326332751