Fundamental theory and clinical application of central pathway and postural control technique_West China Medical Journal

Authors：

JIANG Hanhong ^1,2 , WEI Qingchuan ^1,2 , YE Saiqing ^1,2 , MENG Lijiao ^1,2 , ZHANG Jing ^1,2 , HE Lin ^1,2 , CHEN Yi ^1,2 ,  GAO Qiang ^1,2

1. Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan 610041,P. R. China;

Corresponding author：

GAO Qiang, Email: gaoqiang_hxkf@163.com

Keywords：

Stroke; balance; postural control; central pathway and postural control

DOI：

10.7507/1002-0179.202204046

Video：

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Abstract Full text Figures/Tables Video References Cited by

Central pathway and postural control (CPPC) technique is a neurorehabilitation physiotherapy technique developed by the Department of Rehabilitation Medicine of West China Hospital of Sichuan University. The technique focuses on the internal mechanism and external manifestation of the central nervous conduction pathway of postural control, and uses neuroscience theory to explain and analyze the dysfunction of patients. Clinical practice and research results show that CPPC technique has good curative effect and application prospect. This paper mainly introduces the basic principles and core concepts of CPPC technique, commonly used evaluation and treatment methods, achievements and application promotion in recent years, and aims to provide a theoretical reference and guidance for further application and in-depth research of this technique.

Citation： JIANG Hanhong, WEI Qingchuan, YE Saiqing, MENG Lijiao, ZHANG Jing, HE Lin, CHEN Yi, GAO Qiang. Fundamental theory and clinical application of central pathway and postural control technique. West China Medical Journal, 2022, 37(5): 680-687. doi: 10.7507/1002-0179.202204046 Copy

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1. Persson CU, Kjellberg S, Lernfelt B, et al. Risk of falling in a stroke unit after acute stroke: The Fall Study of Gothenburg (FallsGOT). Clin Rehabil, 2018, 32(3): 398-409.
2. Park SJ, Cho KH, Kim SH. The effect of chest expansion exercise with TENS on gait ability and trunk control in chronic stroke patients. J Phys Ther Sci, 2018, 30(5): 697-699.
3. Van Criekinge T, Truijen S, Schröder J, et al. The effectiveness of trunk training on trunk control, sitting and standing balance and mobility post-stroke: a systematic review and meta-analysis. Clin Rehabil, 2019, 33(6): 992-1002.
4. Kang N, Lee RD, Lee JH, et al. Functional balance and postural control improvements in patients with stroke after noninvasive brain stimulation: a meta-analysis. Arch Phys Med Rehabil, 2020, 101(1): 141-153.
5. Matthis JS, Yates JL, Hayhoe MM. Gaze and the control of foot placement when walking in natural terrain. Curr Biol, 2018, 28(8): 1224-1233.e5.
6. 江汉宏, 叶赛青, 高强. 脑卒中后姿势控制机制与训练的研究进展. 中国康复医学杂志, 2021, 36(8): 1020-1025.
7. Cruz TL, Pérez SM, Chiappe ME. Fast tuning of posture control by visual feedback underlies gaze stabilization in walking Drosophila. Curr Biol, 2021, 31(20): 4596-4607.e5.
8. 尹群辉, 张皓. 脑卒中偏瘫患者预期性姿势调节的研究进展. 中国康复理论与实践, 2017, 23(11): 1250-1253.
9. Cavallari P, Bolzoni F, Bruttini C, et al. The organization and control of intra-limb anticipatory postural adjustments and their role in movement performance. Front Hum Neurosci, 2016, 10: 525.
10. 陈意, 谢运娟, 高强. 预期性姿势调节的神经调控网络研究进展. 中国康复理论与实践, 2020, 26(5): 568-571.
11. Piscitelli D, Falaki A, Solnik S, et al. Anticipatory postural adjustments and anticipatory synergy adjustments: preparing to a postural perturbation with predictable and unpredictable direction. Exp Brain Res, 2017, 235(3): 713-730.
12. Chiou SY, Hurry M, Reed T, et al. Cortical contributions to anticipatory postural adjustments in the trunk. J Physiol, 2018, 596(7): 1295-1306.
13. Bastian AJ. Learning to predict the future: the cerebellum adapts feedforward movement control. Curr Opin Neurobiol, 2006, 16(6): 645-649.
14. Deane JA, Lim AKP, Phillips ATM, et al. Symptomatic individuals with Lumbar Disc Degeneration use different anticipatory and compensatory kinematic strategies to asymptomatic controls in response to postural perturbation. Gait Posture, 2022, 94: 222-229.
15. Cheung TCK, Schmuckler MA. Multisensory postural control in adults: variation in visual, haptic, and proprioceptive inputs. Hum Mov Sci, 2021, 79: 102845.
16. Dideriksen J, Negro F. Feedforward modulation of gamma motor neuron activity can improve motor command accuracy. J Neural Eng, 2021, 18(4): 046068.
17. Bax AM, Johnson KJ, Watson AM, et al. The effects of perturbation type and direction on threat-related changes in anticipatory postural control. Hum Mov Sci, 2020, 73: 102674.
18. Blumenfeld H. Neuroanatomy through clinical cases. Sunderland:Sinauer Associates, 2010: 698-734.
19. Lam CK, Tokuno CD, Staines WR, et al. The direction of the postural response to a vestibular perturbation is mediated by the cerebellar vermis. Exp Brain Res, 2016, 234(12): 3689-3697.
20. Stoodley CJ, Schmahmann JD. Functional topography of the human cerebellum. Handb Clin Neurol, 2018, 154: 59-70.
21. Santos MJ, Kanekar N, Aruin AS. The role of anticipatory postural adjustments in compensatory control of posture: 1. Electromyographic analysis. J Electromyogr Kinesiol, 2010, 20(3): 388-397.
22. Takahata K, Kato M. Neural mechanism underlying autistic savant and acquired savant syndrome. Brain Nerve, 2008, 60(7): 861-869.
23. Fujimoto H, Mihara M, Hattori N, et al. Cortical changes underlying balance recovery in patients with hemiplegic stroke. Neuroimage, 2014, 85(1): 547-554.
24. Mihara M, Miyai I, Hattori N, et al. Cortical control of postural balance in patients with hemiplegic stroke. Neuroreport, 2012, 23(5): 314-319.
25. Kaulmann D, Hermsdörfer J, Johannsen L. Disruption of right posterior parietal cortex by continuous theta burst stimulation alters the control of body balance in quiet stance. Eur J Neurosci, 2017, 45(5): 671-678.
26. Mierau A, Pester B, Hülsdünker T, et al. Cortical correlates of human balance control. Brain Topogr, 2017, 30(4): 434-446.
27. 高强, 江汉宏, 魏清川, 等. 中枢传导通路与姿势控制技术研究进展与应用推广. 中国科技成果, 2021, 22(10): 58-59.
28. Shumway-Cook A, Woollacott MH. Motor control: translating research into clinical practice. Philadelphia: Lippincott Williams & Wilkins, 2017: 22-43.
29. Karthikbabu S, Verheyden G. Relationship between trunk control, core muscle strength and balance confidence in community-dwelling patients with chronic stroke. Top Stroke Rehabil, 2021, 28(2): 88-95.
30. Jijimol G, Fayaz RK, Vijesh PV. Correlation of trunk impairment with balance in patients with chronic stroke. NeuroRehabilitation, 2013, 32(2): 323-325.
31. Sorrentino G, Sale P, Solaro C, et al. Clinical measurement tools to assess trunk performance after stroke: a systematic review. Eur J Phys Rehabil Med, 2018, 54(5): 772-784.
32. Verheyden G, Kersten P. Investigating the internal validity of the Trunk Impairment Scale (TIS) using Rasch analysis: the TIS 2.0. Disabil Rehabil, 2010, 32(25): 2127-2137.
33. Hernández ED, Galeano CP, Barbosa NE, et al. Intra- and inter-rater reliability of Fugl-Meyer assessment of upper extremity in stroke. J Rehabil Med, 2019, 51(9): 652-659.
34. Rech KD, Salazar AP, Marchese RR, et al. Fugl-Meyer assessment scores are related with kinematic measures in people with chronic hemiparesis after stroke. J Stroke Cerebrovasc Dis, 2020, 29(1): 104463.
35. Tsang RC, Chau RM, Cheuk TH, et al. The measurement properties of modified Rivermead mobility index and modified functional ambulation classification as outcome measures for Chinese stroke patients. Physiother Theory Pract, 2014, 30(5): 353-359.
36. Lascano AM, Lalive PH, Hardmeier M, et al. Clinical evoked potentials in neurology: a review of techniques and indications. J Neurol Neurosurg Psychiatry, 2017, 88(8): 688-696.
37. Niso G, Tjepkema-Cloostermans MC, Lenders MWPM, et al. Modulation of the somatosensory evoked potential by attention and spinal cord stimulation. Front Neurol, 2021, 12: 694310.
38. Lee SY, Lim JY, Kang EK, et al. Prediction of good functional recovery after stroke based on combined motor and somatosensory evoked potential findings. J Rehabil Med, 2010, 42(1): 16-20.
39. 张伟东, 寇丽, 王幸丽, 等. 脑干听觉诱发电位、脑电图、MRI 及 MSCT 在诊断重症病毒性脑炎患儿中的应用. 中国 CT 和 MRI 杂志, 2020, 18(5): 75-78.
40. 曹成龙, 宋健, 杜浩, 等. 基于事件相关电位技术的情绪能力障碍研究进展. 中国临床神经外科杂志, 2017, 22(4): 276-278.
41. Paulus W, Classen J, Cohen LG, et al. State of the art: pharmacologic effects on cortical excitability measures tested by transcranial magnetic stimulation. Brain Stimul, 2008, 1(3): 151-163.
42. Li JY, Chen R. Increased intracortical inhibition in hyperglycemic hemichorea-hemiballism. Mov Disord, 2015, 30(2): 198-205.
43. Keser Z, Buchl SC, Seven NA, et al. Electroencephalogram (EEG) with or without transcranial magnetic stimulation (TMS) as biomarkers for post-stroke recovery: a narrative review. Front Neurol, 2022, 13: 827866.
44. Quaresima V, Ferrari M. Functional near-infrared spectroscopy (fNIRS) for assessing cerebral cortex function during human behavior in natural/social situations: a concise review. Organ Res Met, 2016, 1: 46-68.
45. Khan H, Naseer N, Yazidi A, et al. Analysis of human gait using hybrid EEG-fNIRS-based BCI system: a review. Front Hum Neurosci, 2021, 14: 613254.
46. Amyot F, Kenney K, Spessert E, et al. Assessment of cerebrovascular dysfunction after traumatic brain injury with fMRI and fNIRS. Neuroimage Clin, 2020, 25: 102086.
47. 吴毅. 脑卒中患者的脑功能检测及脑刺激新技术. 中华物理医学与康复杂志, 2019, 41(2): 81-83.
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Fundamental theory and clinical application of central pathway and postural control technique

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