Spastic Cerebral Palsy: Possible Spinal Interneuronal Contributions

Abstract

Summary The author explores the possibility that abnormal and immature spinal interneuronal circuits play a rôle in spastic cerebral palsy. Interneuronal abnormalities could account for a number of characteristic signs: sensitivity to normally innocuous stimuli, hyperreflexia, abnormal and inappropriate co–ordination patterns, and limitations in acquiring, planning, executing and correcting skilful actions. The precise pattern of interneuronal anomalies present will depend on the original site of the lesion, age at onset, and on how central and segmental development were affected. Although the number of relevant studies is very small, there are indications that long–term training can produce changes in segmental response, both by altering descending inhibition and by producing lasting changes in spinal neuronal organisation and responsiveness. Modern recording techniques have introduced the prospect of tracing immature and abnormal segmental components and of establishing their impacts on movement control. RÉSUMÉ Infirmité motrice cérébrale spastique: possibilité d'une contribution médullaire interneurale Les auteurs envisagent la possibilité que des circuits médullaires interneuraux anormaux et immatures jouent un rôle dans la spasticité de l'IMC. Les anomalies interneurales pourraient rendre compte d'un certain nombre de signes caractéristiques: sensibilitéà des stimuli normalement inoffensifs, hyperreflexie, groupements de coordination anormaux et inappropriés, limitations dans l'acquisition, la prévision, l'execution et la correction d'actions efficaces. Le groupement précis de anomalies interneurales recontrées pourrait dépendre du site original de la lésion, de l'âge de début et de la façon dont aurait été affecté le développement central et segmentaire. Quoique le nombre d'études sur le sujet est très faible, il existe des éléments en faveur de l'efficience d'un apprentissage à long terme sur des modifications de la réponse segmentaire, à la fois en altérant les inhibitions descendantes et en produisant des changements durables de l'aptitude à répondre et de l'organisation au niveau neuronal médullaire. Les techniques d'enregistrement modernes doivent permettre de retrouver les composantes segmentaires anormales et immatures, d'établir leur impact sur le contrôle du mouvement. ZUSAMMENFASSUNG Spastische Cerebralparese: mögliche spinale interneuronale Beteiligung Der Autor untersucht die Frage, ob abnorme und unreife spinale interneuronale Verbindungen bei der spastischen Cerebralparese eine Rolle spielen. Interneuronale Anomalien könnten die Ursache für eine Reihe charakteristischer Befunde sein: Sensibilität für normalerweise harmlose Reize, Hyperreflexie, abnorme und unangepaßte Koordinationsmuster und die Einschränkungen beim Erlernen, Planen, Ausführen und Korrigieren von Geschicklichkeitsaufgaben. Das genaue Muster der vorliegenden interneuronalen Anomalien hangt ab von dem ursprünglichen Sitz der Läsion, vom Eintrittsalter und davon, wie die zentrale und segmentale Entwicklung betroffen war. Obwohl d...

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