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PHENOTYPES OF HEMIPARESIS DUE TO VARYING SEVERITY OF THE IMPAIRMENT OF THE CORTICOSPINAL INNERVATION
S.Ye. Cherkasov
Chebotarev Institute of Gerontology, National Academy of
Medical Sciences of Ukraine, Kyiv, Ukraine
DOI: https://doi.org/10.15407/fz69.04.029
Abstract
The impairment of motor functions after stroke has a
polymorphic structure, in which a decrease in strength,
impairment of selective control of movements, and the
development of a spastic syndrome are most studied. With
partial lesions of the primary motor cortex and impairment
of corticospinal innervation, the recovery of motor control
is supported by various processes of neuroplastic reorganization. Among humans, the influence of corticospinal
innervation impairments on the functional state of motor
control and the development of spasticity syndrome remains
poorly understood. The aim of our work was to establish
the phenotypes of the functional state of motor control with
different severity of corticospinal innervation impairment
among patients after an ischemic stroke. We found that
when the corticospinal innervation is impaired on 32.9%
[31.9-28.8] the control of the distal parts of the extremities
and the synergies of the proximal parts are fractionated,
and when on 92.9% [96-80.5] the control of the distal parts
is lost and the number of synergies of proximal parts are
decreases. With complete impairment of the corticospinal
innervation, remains control of primitive synergies of only
the proximal parts of the extremities. The development
of spastic syndrome was higher in groups with increased
segmental excitability, which was not directly related to
the state of corticospinal innervation impairment. Thus,
the phenotype of hemiparesis with an increase of the corticospinal innervation impairment is characterized by the
dominance of a decrease of the strength of the distal parts
of the extremities and an impairment of proximo-distal
inter-joints coordination. Restoration of strength and control of the proximal parts of the extremities, axial muscles
of the trunk and regulation of the muscles tone indicate
the involvement of the alternative from the corticospinal,
descending cortical and subcortical motor pathways.
Keywords:
stroke; phenotype of hemiparesis; spasticity; transcranial magnetic stimulation; corticospinal innervations
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