Physical and rehabilitation medicine, medical rehabilitationPhysical and rehabilitation medicine, medical rehabilitationФизическая и реабилитационная медицина, медицинская реабилитация2658-68432949-1436Eco-Vector11198710.36425/rehab111987CASE REPORTКЛИНИЧЕСКИЙ СЛУЧАЙResearch ArticlePost-stroke hand synergy formation variant. Clinical caseВариант формирования постинсультной синергии руки. Клинический случайhttps://orcid.org/0000-0002-4730-33383445-8770KlochkovAnton S.КлочковАнтон Сергеевич
Russian Federation

MD, Cand. Sci. (Med.)

к.м.н.

klochkov@neurology.ruhttps://orcid.org/0000-0003-1395-66454824-1240KhizhnikovaAnastasiya E.ХижниковаАнастасия Евгеньевна
Russian Federation

MD, Cand. Sci. (Med.)

к.м.н.

nastushkapal@gmail.comhttps://orcid.org/0000-0003-0716-37377756-6427BakulinIlya S.БакулинИлья Сергеевич
Russian Federation

MD, Cand. Sci. (Med.)

к.м.н.

bakulin@neurology.ruhttps://orcid.org/0000-0001-9396-60638799-8092KremnevaElena I.КремневаЕлена Игоревна
Russian Federation

MD, Cand. Sci. (Med.)

к.м.н.

kremneva@neurology.ruhttps://orcid.org/0000-0003-1841-11774040-1184PoydashevaAlexandra G.ПойдашеваАлександра Георгиевна
Russian Federation
poydasheva@neurology.ruhttps://orcid.org/0000-0002-4335-63448236-1787FuksAnna A.ФуксАнна Антоновна
Russian Federation
myfannamail@gmail.comhttps://orcid.org/0000-0002-0735-080XGorlachevDmitry V.ГорлачевДмитрий Владимирович
Russian Federation
gooorlachev@gmail.comhttps://orcid.org/0000-0001-6026-33887248-1282GnedovskayaElena V.ГнедовскаяЕлена Владимировна
Russian Federation

MD, Dr. Sci. (Med.)

д.м.н.

gnedovskaya@mail.ruhttps://orcid.org/0000-0003-3956-63623223-6006SuponevaNatalia A.СупоневаНаталья Александровна
Russian Federation

MD, Dr. Sci. (Med.), Corresponding Member of the Russian Academy of Sciences

д.м.н., чл.-корр. РАН

nasu2709@mail.ruResearch Center of NeurologyНаучный центр неврологииResearch Center of NeurologyНаучный центр неврологии2911202209122022442923031910202231102022Copyright ©; 2022, Eco-VectorCopyright ©; 2022, Эко-Вектор2022Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0https://journals.eco-vector.com/2658-6843/article/view/111987

Pathological synergies are a frequent consequence of cerebrovascular accidents and hinders further recovery. The existing concept of the formation of pathological synergies considers them as a compensatory strategy in response to damage to the pyramidal tract, which, due to paresis and increased muscle tone, has acquired a pathological character. Recent studies in primates have shown that the contralateral hemisphere, in particular the reticulospinal and rubrospinal tracts, may be involved in motor control of the hand. The current hypothesis presents the corticoreticulospinal and corticorubrospinal tracts as a back-up system for neuronal reorganization due to injury.

This clinical case describes the role of the white matter of the contralateral hemisphere in the mechanism of formation of pathological flexion synergy, based on data from the analysis of movements and neuroimaging.

Патологические двигательные синергии являются частым последствием нарушений мозгового кровообращения и препятствуют дальнейшему восстановлению активности. Существующее представление о формировании патологических синергий рассматривает их как компенсаторную стратегию в ответ на повреждение пирамидного пути, которая из-за пареза и повышения мышечного тонуса приобрела патологический характер. Последние исследования на приматах показали, что в моторном контроле руки может участвовать контралатеральное полушарие, в частности ретикулоспинальный и руброспинальный тракты. Современная гипотеза представляет кортикоретикулоспинальный и кортикоруброспинальный тракт в качестве резервной системы для нейронной реорганизации вследствие поражения.

Настоящий клинический случай описывает роль белого вещества контралатерального полушария в механизме формирования патологической сгибательной синергии, основываясь на данных анализа движений и нейровизуализации.

strokeabnormal synergyrehabilitationcase reportmotor controlинсультпатологическая синергияреабилитацияклинический случайрегуляция движенийThe paper was prepared as a part of fundamental research of the Research center of neurology.Статья подготовлена в рамках фундаментальной НИР ФГБНУ «Научный центр неврологии».Knutsson E, Martensson A. Dynamic motor capacity in spastic paresis and its relation to prime mover dysfunction, spastic reflexes and antagonist co-activation. Scand J Rehabil Med. 1980;12(3):93–106.Knutsson E., Martensson A. Dynamic motor capacity in spastic paresis and its relation to prime mover dysfunction, spastic reflexes and antagonist co-activation // Scand J Rehabil Med. 1980. Vol. 12, N 3. Р. 93–106.Knutsson E, Dewalde PJ, Younge RR. Studies of gait control in patients with spastic paresis. Clinical Neurophysiology in Spasticity. New York: Elsevier; 1985. Р. 175–184.Knutsson E., Dewalde P.J., Younge R.R. Studies of gait control in patients with spastic paresis. Clinical Neurophysiology in Spasticity. New York: Elsevier, 1985. Р. 175–184.Chen J, Friesen WO, Iwasaki T. Mechanisms underlying rhythmic locomotion: interactions between activation, tension and body curvature waves. J Exp Biol. 2012;215(2):211–219. doi: 10.1242/jeb.058669Chen J., Friesen W.O., Iwasaki T. Mechanisms underlying rhythmic locomotion: interactions between activation, tension and body curvature waves // J Exp Biol. 2012. Vol. 215, N 2. Р. 211–219. doi: 10.1242/jeb.058669Owen M, Ingo C, Dewald JP. Upper extremity motor impairments and microstructural changes in bulbospinal pathways in chronic hemiparetic stroke. Front Neurol. 2017;13(8):257. doi: 10.3389/fneur.2017.00257Owen M., Ingo C., Dewald J.P. Upper extremity motor impairments and microstructural changes in bulbospinal pathways in chronic hemiparetic stroke // Front Neurol. 2017. Vol. 13, N 8. Р. 257. doi: 10.3389/fneur.2017.00257Mori S, Matsuyama K, Mori F, Nakajima K. Supraspinal sites that induce locomotion in the vertebrate central nervous system. Adv Neurol. 2001;(87):25–40.Mori S., Matsuyama K., Mori F., Nakajima K. Supraspinal sites that induce locomotion in the vertebrate central nervous system // Adv Neurol. 2001. Vol. 87. Р. 25–40.Schepens B, Stapley P, Drew T. Neurons in the pontomedullary reticular formation signal posture and movement both as an integrated behavior and independently. J Neurophysiol. 2008;100(4):2235–2253. doi: 10.1152/jn.01381.2007Schepens B., Stapley P., Drew T. Neurons in the pontomedullary reticular formation signal posture and movement both as an integrated behavior and independently // J Neurophysiol. 2008. Vol. 100, N 4. Р. 2235–2253. doi: 10.1152/jn.01381.2007Drew T, Dubuc R, Rossignol S. Discharge patterns of reticulospinal and other reticular neurons in chronic, unrestrained cats walking on a treadmill. J Neurophysiol. 1986;55(2):375–401. doi: 10.1152/jn.1986.55.2.375Drew T., Dubuc R., Rossignol S. Discharge patterns of reticulospinal and other reticular neurons in chronic, unrestrained cats walking on a treadmill // J Neurophysiol. 1986. Vol. 55, N 2. Р. 375–401. doi: 10.1152/jn.1986.55.2.375Matsuyama K, Drew T. Vestibulospinal and reticulospinal neuronal activity during locomotion in the intact cat. I. Walking on a level surface. J Neurophysiol. 2000;84(5):2237–2256. doi: 10.1152/jn.2000.84.5.2237Matsuyama K., Drew T. Vestibulospinal and reticulospinal neuronal activity during locomotion in the intact cat. I. Walking on a level surface // J Neurophysiol. 2000. Vol. 84, N 5. Р. 2237–2256. doi: 10.1152/jn.2000.84.5.2237Prentice SD, Drew T. Contributions of the reticulospinal system to the postural adjustments occurring during voluntary gait modifications. J Neurophysiol. 2001;85(2):679–698. doi: 10.1152/jn.2001.85.2.679Prentice S.D., Drew T. Contributions of the reticulospinal system to the postural adjustments occurring during voluntary gait modifications // J Neurophysiol. 2001. Vol. 85, N 2. Р. 679–698. doi: 10.1152/jn.2001.85.2.679Schepens B, Drew T. Independent and convergent signals from the pontomedullary reticular formation contribute to the control of posture and movement during reaching in the cat. J Neurophysiol. 2004;92(4):2217–2238. doi: 10.1152/jn.01189.2003Schepens B., Drew T. Independent and convergent signals from the pontomedullary reticular formation contribute to the control of posture and movement during reaching in the cat // J Neurophysiol. 2004. Vol. 92, N 4. Р. 2217–2238. doi: 10.1152/jn.01189.2003Riddle CN, Edgley SA, Baker SN. Direct and indirect connections with upper limb motoneurons from the primate reticulospinal tract. J Neurosci. 2009;29(15):4993–4999. doi: 10.1523/JNEUROSCI.3720-08.2009Riddle C.N., Edgley S.A., Baker S.N. Direct and indirect connections with upper limb motoneurons from the primate reticulospinal tract // J Neurosci. 2009. Vol. 29, N 15. Р. 4993–4999. doi: 10.1523/JNEUROSCI.3720-08.2009Owen M, Ingo C, Dewald JP. Upper extremity motor impairments and microstructural changes in bulbospinal pathways in chronic hemiparetic stroke. Front Neurol. 2017;(8):257. doi: 10.3389/fneur.2017.00257Owen M., Ingo C., Dewald J.P. Upper extremity motor impairments and microstructural changes in bulbospinal pathways in chronic hemiparetic stroke // Front Neurol. 2017. Vol. 8. Р. 257. doi: 10.3389/fneur.2017.00257Davidson AG, Buford JA. Bilateral actions of the reticulospinal tract on arm and shoulder muscles in the monkey: stimulus triggered averaging. Exp Brain Res. 2006;173(1):25–39. doi: 10.1007/s00221-006-0374-1Davidson A.G., Buford J.A. Bilateral actions of the reticulospinal tract on arm and shoulder muscles in the monkey: stimulus triggered averaging // Exp Brain Res. 2006. Vol. 173, N 1. Р. 25–39. doi: 10.1007/s00221-006-0374-1Baker SN. The primate reticulospinal tract, hand function and functional recovery. J Physiol. 2011;589(23):5603–5612. doi: 10.1113/jphysiol.2011.215160Baker S.N. The primate reticulospinal tract, hand function and functional recovery // J Physiol. 2011. Vol. 589, N 23. Р. 5603–5612. doi: 10.1113/jphysiol.2011.215160Zaaimi B, Edgley SA, Soteropoulos DS, Baker SN. Changes in descending motor pathway connectivity after corticospinal tract lesion in macaque monkey. Brain. 2012;135(7):2277–2289. doi: 10.1093/brain/aws115Zaaimi B., Edgley S.A., Soteropoulos D.S., Baker S.N. Changes in descending motor pathway connectivity after corticospinal tract lesion in macaque monkey // Brain. 2012. Vol. 135, N 7. Р. 2277–2289. doi: 10.1093/brain/aws115Khizhnikova AE, Klochkov AS, Kotov-Smolensky AM, et al. Dynamics of the kinematic portrait of post-stroke paresis of the hand against the background of rehabilitation. Bulletin of Russian state medical university. 2019(4):34–41. (In Russ). doi: 10.24075/vrgmu.2019.056Хижникова А.Е., Клочков А.С., Котов-Смоленский А.М., и др. Динамика кинематического портрета постинсультного пареза руки на фоне реабилитации // Вестник российского государственного медицинского университета. 2019. № 4. С. 34–41. doi: 10.24075/vrgmu.2019.056Suponeva NA, Yusupova DG, Ilyina KA, et al Validation of the Modified Ashworth scale in Russia. Annals of clinical and experimental neurology. 2020;14(1):89–96. (In Russ). doi: 10.25692/ACEN.2020.1.10Супонева Н.А., Юсупова Д.Г., Ильина К.А., и др. Валидация Модифицированной шкалы Эшворта (Modified Ashworth Scale) в России // Анналы клинической и экспериментальной неврологии. 2020. Т. 14, № 1. С. 89–96. doi: 10.25692/ACEN.2020.1.10Suponeva NA, Yusupova DG, Zimin AA, et al. Validation of the Russian version of the Fugl-Meyer Assessment of Physical Performance for assessment of patients with post-stroke paresis. Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2021; 121(8-2):86–90. (In Russ).Супонева Н.А., Юсупова Д.Г., Зимин А.А., и др. Валидация русскоязычной версии шкалы Фугл-Мейера для оценки состояния пациентов с постинсультным парезом // Журнал неврологии и психиатрии им. С.С. Корсакова. 2021. Т. 121, № 8-2. С. 86–90. doi: 10.17116/jnevro202112108286Stinear C. Prediction of recovery of motor function after stroke. Lancet Neurol. 2010;9(12):1228–1232. doi: 10.1016/S1474-4422(10)70247-7Stinear C. Prediction of recovery of motor function after stroke // Lancet Neurol. 2010. Vol. 9, N 12. Р. 1228–1232. doi: 10.1016/S1474-4422(10)70247-7Stinear CM, Barber PA, Petoe M, et al. D.The PREP algorithm predicts potential for upper limb recovery after stroke. Brain. 2012;135(8):2527–2535. doi: 10.1093/brain/aws146Stinear C.M., Barber P.A., Petoe M., et al. The PREP algorithm predicts potential for upper limb recovery after stroke // Brain. 2012. Vol. 135, N 8. Р. 2527–2535. doi: 10.1093/brain/aws146Ziemann U, Ishii K, Borgheresi A, et al. Dissociation of the pathways mediating ipsilateral and contralateral motor-evoked potentials in human hand and arm muscles. J Physiol. 1999;1(518):895–906. doi: 10.1111/j.1469-7793.1999.0895p.xZiemann U., Ishii K., Borgheresi A., et al. Dissociation of the pathways mediating ipsilateral and contralateral motor-evoked potentials in human hand and arm muscles // J Physiol. 1999. Vol. 1, N 518. Р. 895–906. doi: 10.1111/j.1469-7793.1999.0895p.xXu J, Ejaz N, Hertler B, et al. Separable systems for recovery of finger strength and control after stroke. J Neurophysiol. 2017;118(2):1151–1163. doi: 10.1152/jn.00123.2017Xu J., Ejaz N., Hertler B., et al. Separable systems for recovery of finger strength and control after stroke // J Neurophysiol. 2017. Vol. 118, N 2. Р. 1151–1163. doi: 10.1152/jn.00123.2017