Сенсомоторная интеграция в норме и после перенесенного инсульта

Дамулин И.В. Сенсомоторная интеграция в норме и после перенесенного инсульта. Consilium Medicum. 2018; 20 (2): 63–68. DOI: 10.26442/2075-1753_2018.2.63-68

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Damulin I.V. Sensorimotor integration in health and after stroke. Consilium Medicum. 2018; 20 (2): 63–68. DOI: 10.26442/2075-1753_2018.2.63-68

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Аннотация

В статье рассматриваются современные представления о структурной и функциональной организации соматосенсорной системы. Подчеркивается, что обязательным условием для выполнения тонких движений является не только наличие обратной связи, обеспечиваемой сенсорной импульсацией, но также сохранность возможности сенсомоторной интеграции. При этом сами по себе процессы сенсомоторной интеграции основаны на феномене предугадывания/предвосхищения последствий той или иной двигательной программы. В свою очередь существующая двигательная система предвосхищения/предугадывания событий модулирует сенсорную систему, афферентация которой влияет на точность исполнения движений. Неврологический дефицит, связанный с инсультом, обусловлен поврежденной зоной и проводящими путями, проходящими поблизости от нее, а также нарушением нейронных сетей за пределами очага ишемии. Остро возникший ишемический инсульт приводит не только к нарушению функциональных и эффективных связей, составляющих коннектом, но и существенно меняет динамические характеристики (силу, частоту) связанных нейронной сетью зон корковых осцилляций, что приводит к их десинхронизации. В основе восстановления после инсульта лежат нормализация церебральной перфузии, активация путей, располагающихся как около ишемического очага, так и на расстоянии от него, а также изменение возбудимости корковых структур. Восстановление после перенесенного инсульта в значительной мере определяется возможностями центральной нервной системы к мультимодальной интеграции, а не ограничивается только сенсомоторной интеграцией. Понимание структурно-функциональной основы сенсомоторной интеграции, ее динамичности открывает новые возможности воздействия, в частности, с целью лучшего восстановления после перенесенного инсульта.

Ключевые слова: соматосенсорная система, сенсомоторная интеграция, активность головного мозга в состоянии покоя после инсульта, восстановление после инсульта.

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In the article a modern view on structural and functional somatosensory system organization is discussed. It is outlined that not only a feedback mechanism based on sensory impulsation is an essential condition for fine motor movements, but also sensorimotor integration is involved. The processes of sensorimotor integration are based on lookahead/forestalling phenomena of the movement results. Whereas an existing movement program of lookahead/forestalling modulates the sensory system, afferent activity of which influences movement accuracy. The neurological deficit associated with stroke is determined by the involved area and adjacent conduction tracts and also by neural networks damage outside the ischemic area. Acute ischemic stroke not only results in functional and effective connections of connectome damage, but also changes dynamical characteristics (amplitude and frequency) of cortical oscillations that results in desynchronization. Cerebral perfusion normalization, activation of tracts close to the ischemic area and distant from it, and cortical excitability change are the basis for recovery after stroke. Stroke recovery is considerably determined by central nervous system multimodal integration and is not limited only by sensorimotor integration. Understanding of structural and functional basis for sensorimotor integration and its dynamic properties opens up new possibilities of interventions that will result in better recovery after stroke.

Key words: somatosensory system, sensorimotor integration, brain activity at rest after stroke, stroke recovery.

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