Spastic movement disorder: should we forget hyperexcitable stretch reflexes and start talking about inappropriate prediction of sensory consequences of movement?
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Spastic movement disorder : should we forget hyperexcitable stretch reflexes and start talking about inappropriate prediction of sensory consequences of movement? / Nielsen, Jens Bo; Christensen, Mark Schram; Farmer, Simon Francis; Lorentzen, Jakob.
In: Experimental Brain Research, Vol. 238, 2020, p. 1627-1636.Research output: Contribution to journal › Review › Research › peer-review
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TY - JOUR
T1 - Spastic movement disorder
T2 - should we forget hyperexcitable stretch reflexes and start talking about inappropriate prediction of sensory consequences of movement?
AU - Nielsen, Jens Bo
AU - Christensen, Mark Schram
AU - Farmer, Simon Francis
AU - Lorentzen, Jakob
PY - 2020
Y1 - 2020
N2 - Spastic movement disorder is characterized by reduced ability to selectively activate muscles with significant co-activation of antagonist muscles. It has traditionally been thought that hyperexcitable stretch reflexes have a central role in the pathophysiology and the clinical manifestations of the disorder. Here we argue that the main functional challenges for persons with spastic movement disorder are related to contractures, paresis, weak muscles and inappropriate central motor commands, whereas hyperexcitable reflexes play no or only an insignificant functional role. Co-activation of antagonist muscles and stiff posture and gait may rather be adaptations that aim to ensure joint and postural stability due to insufficient muscle strength. Aberrant (involuntary) muscle activity is likely related to an inadequate prediction of the sensory consequences of movement and a resulting impairment of muscle coordination. We argue that improvement of functional muscle strength and muscle coordination following central motor lesions may be achieved by optimizing integration of somatosensory information into central feedforward motor programs, whereas anti-spastic therapy that aims to reduce reflex activity may be less efficient. This opens for novel investigations into new treatment strategies that may improve functional control of movement and prevent reduced joint mobility in people with brain lesions.
AB - Spastic movement disorder is characterized by reduced ability to selectively activate muscles with significant co-activation of antagonist muscles. It has traditionally been thought that hyperexcitable stretch reflexes have a central role in the pathophysiology and the clinical manifestations of the disorder. Here we argue that the main functional challenges for persons with spastic movement disorder are related to contractures, paresis, weak muscles and inappropriate central motor commands, whereas hyperexcitable reflexes play no or only an insignificant functional role. Co-activation of antagonist muscles and stiff posture and gait may rather be adaptations that aim to ensure joint and postural stability due to insufficient muscle strength. Aberrant (involuntary) muscle activity is likely related to an inadequate prediction of the sensory consequences of movement and a resulting impairment of muscle coordination. We argue that improvement of functional muscle strength and muscle coordination following central motor lesions may be achieved by optimizing integration of somatosensory information into central feedforward motor programs, whereas anti-spastic therapy that aims to reduce reflex activity may be less efficient. This opens for novel investigations into new treatment strategies that may improve functional control of movement and prevent reduced joint mobility in people with brain lesions.
U2 - 10.1007/s00221-020-05792-0
DO - 10.1007/s00221-020-05792-0
M3 - Review
C2 - 32382862
VL - 238
SP - 1627
EP - 1636
JO - Experimental Brain Research
JF - Experimental Brain Research
SN - 0014-4819
ER -
ID: 240978100