Characteristics of learning voluntary control of posture in lesions of the pyramidal and nigrostriatal systems.

The aim of the study reported here was to investigate impairments on the learning of voluntary control of the center of pressures using visual feedback in patients with lesions of the corticospinal and nigrostriatal systems. Participants were 33 patients with Parkinson's disease and 20 patients with hemipareses due to circulatory lesions in the basin of the middle cerebral artery. Subjects stood on a stabilometric platform and used two computer games over 10 days to learn to shift the body relative to the foot to move the centre of pressures, indicated by the position of a cursor on the screen, with the target and to move the target to a specified part of the screen. The games differed in terms of the postural tasks. In one, the direction of movement of the center of pressures was not known to the subjects, and subjects learned a general strategy for posture control; the other formed a strictly defined postural coordination. Both groups of patients were found to have impairments of voluntary control of the position of the center of pressures. There were no differences between groups of patients, in terms of the severity of the initial performance deficit in the task involving shifts of the center of pressures in different directions (the general strategy for controlling the center of pressures), while learning of this task was more difficult for patients with Parkinson's disease. The initial deficit in the fine postural coordination task was more marked in patients with Parkinsonism, though learning in these patients was significantly better than in patients with hemipareses. It is suggested that the mechanisms of involvement of the nigrostriatal and corticospinal systems in learning the voluntary control of posture have elements in common as well as unique elements.

[Voluntary postural control learning with a use of visual bio-feedback in patients with spinocerebellar degenerations]. / Obuchenie proizvol'nomu kontroliu pozy s ispol'zovaniem zritel'noi obratnoi sviazi u bol'nykh spinotserebelliarnymi degeneratsiiami.

The study aimed at evaluation of possibility and features of voluntary postural control learning using biofeedback from a force platform in patients with spinocerebellar ataxias. Thirty-seven patients with different forms of spinocerebellar degenerations and 13 age-matched healthy subjects were trained to shift the center of pressure (CP) during several stabilographic computer games which tested an ability to learn 2 different types of voluntary postural control: general strategy and precise coordination of CP shifting. Despite the disturbances of static posture and ability for voluntary control of CP position, patients with spinocerebellar degenerations can learn to control a vertical posture using biofeedback on stabilogram. In contrast to healthy subjects, improvement of coordination in the training process does not exert a significant influence on the static posture characteristics, in particular on lateral CP oscillations. The results obtained suggest involvement of the cerebellum in both types of postural control that distinguishes them from pathology caused by motor cortex and nigro-striatal system involved only in one type of postural control.

[Features of learning voluntary control of posture after pyramidal and nigrostriatal lesions]. / Osobennosti obucheniia proizvol'nomu kontroliu pozy pri porazheniiakh piramidnoi i nigro-striarnoi sistem.

The study was aimed at investigation of a deficit of learning the center-of-pressure voluntary control in patients with lesions of corticospinal and nigrostriatal systems. Thirty three patients with Parkinson's disease and 20 patients with hemiparesis after cerebrovascular accidents in the MCA participated in the investigation. The subjects stood on a force platform and in the form of a computer game were trained to match the projection of the center of pressure (a cursor) with a target on the screen under the visual feedback control. Two different postural tasks were presented. In the first task the direction of the center-of-pressure shift was not known before, so the subject learned the general strategy of the center-pressure control. In the other task a precise postural coordination should be formed. The voluntary control of the center-of-pressure position was found to be impaired in both groups of patients. In the task of moving the center of pressure in various directions (general strategy), no differences in the initial deficit of the task performance were found between the groups, but the learning was more efficient in the group of hemiparetic patients. However, in the task with precise postural coordination, despite the greater initial deficit in the parkinsonian patients, the learning in this group of patients was substantially more efficient than in hemiparetic patients. The results suggest both common and different features of the involvement of the corticospinal and nigrostriatal systems in learning voluntary control of posture.

[Deficit of learning of posture voluntary control in patients with cortical lesions of various locations: cortical mechanisms of posture regulation]. / Narusheniie obucheniia proizvol'nomu kontroliu pozy pri korkovykh porazheniiakh razlichnoi lokalizatsii: k voprosu o korkovykh mekhanizmakh reguliatsii pozy.

Forty two hemiparetic patients after cerebrovascular accidents were trained to change the position of the center of pressure according to a target on the screen with the visual feedback control. The learning was substantially impaired in comparison with the group of healthy subjects. Patients with the right-hemispheric lesions showed somewhat greater learning deficit than patients with lesions in the left hemisphere. Lesion localization also affected the process of learning. The learning was disturbed to a greater extent in patients with lesions involving not only motor but also premotor and parietal cortical areas. In patients with parieto-temporal lesions the learning reached a very low level after three initial days of training, possibly, because of the deficit of sensory integration and of body scheme in the extra-personal space. Patients with combined lesions of the motor, premotor, and parietal areas showed the lowest results. The learning was shown to depend on the deficit of proprioception and extent of postural disturbances (asymmetry of body weight distribution and amplitude of the center of pressure oscillations) rather than on the extent of motor deficit (paresis and spasticity). However, the learning itself improved some motor disturbances.