Corticospinal Excitability and Neuromuscular Performance in Individuals with Functional Ankle Instability

功能性踝關節不穩定之大腦皮質脊髓興奮性與神經肌肉表現之研究

游翔婷(Hsiang-Ting Yu) ； 林秀真(Hsiu-Chen Lin) ； 施怡芬(Yi-Fen Shih)

《物理治療》 42卷1期 (2017/03) Pp. 32-41

https://doi.org/10.6215/FJPT.PTS1463649333

摘要

Background and purpose: Corticospinal pathways are important in movement control, yet these pathways have not been evaluated in people with functional ankle instability (FAI). _ e purpose of our study was to determine whether corticospinal excitability, neuromuscular performance and dorsiflexion range of the ankle joint differed between people with and without FAI. Methods: Eleven subjects with functional ankle instability (5 males, 26.90 ± 5.90 yr, 64.39 ± 13.51 kg, 170.64 ± 9.18 cm) and 11 matched controls (5 males, 23.53 ± 0.95 yr, 60.5 ± 11.11 kg, 165.44 ± 10.02 cm) were recruited in this study. Mean electromyography data from the peroneus longus (PL), tibialis anterior (TA), and soleus (SOL) were collected during the Y balance test. Single pulse transcranial magnetic stimulation was performed, and the active motor threshold (AMT), motor evoked potential (MEP) and the cortical silent period of the PL and SOL were recorded. Mann-Whitney U test was used for statistical analysis. The level of significance was set at α = 0.05. Results: Compared to the healthy controls, the FAI group showed altered TA activation in the anterior (p = 0.047) and posterolateral direction (p = 0.031) and less PL in the anterior (p = 0.023) and posterolateral directions (p = 0.013) during the balance test. Individuals with FAI revealed significantly lower MEP of the PL (401.83 ± 220.37 uV vs. 222.70 ± 79.24 uV, p = 0.017) and SOL (382.04 ± 219.33 uV vs. 221.76 ± 63.12 uV, p = 0.022). Conclusion and clinical relevance: Our findings indicated that individuals with FAI had a poorer TA and PL muscle performance and impaired corticospinal excitability of the PL and SOL, which should be addressed when managing patients with FAI.

關鍵字

Corticospinal excitability ； Functional ankle instability ； Neuromuscular performance ； Balance

並列摘要

背景與目的：大腦皮質脊髓控制是動作調節重要的一環，然而對於功能性踝關節不穩定患者的相關機制研究仍有限。本實驗的目的在探討健康受測者與功能性踝關節不穩定受測者在大腦皮質脊髓興奮性、神經肌肉表現、以及踝關節之主動與被動活動度之差異。方法：本研究共招募11 位功能性踝關節不穩定受測者(5 男，26.90 ± 5.90 歲，64.39 ± 13.51 公斤，170.64 ± 9.18 公分) 以及11 位配對之健康受測者(5 男，23.53 ± 0.95 歲，60.5 ± 11.11 公斤，165.44 ± 10.02 公分)。受測者進行Y 字動態平衡測試中紀錄腓骨長肌、脛前肌、以及比目魚肌平均肌電圖訊號，並以經顱磁刺激給予單刺激同時記錄腓骨長肌及比目魚肌的動作閾值、動作誘發電位與皮質靜止期。統計分析：以曼惠特尼U 測試(Mann-Whitney U test) 進行統計分析。顯著水平α 值定於0.05。結果：研究結果顯示，相較於健康受測者，功能性踝關節不穩定受測者在執行Y 字動態平衡測試時，脛前肌活性在往前方(p = 0.047) 與後外側(p = 0.031) 延伸時有顯著差異，而腓骨長肌在向前方(p = 0.023) 與後外側(p =0.013) 延伸時則有顯著較少的活性表現。在經顱磁刺激的參數上，功能性踝關節不穩定受測者之腓骨長肌與比目魚肌之動作誘發電位顯著較健康受測者低(401.83 ± 220.37 uV vs. 222.70 ± 79.24 uV, p = 0.017；382.04 ± 219.33uV vs. 221.76 ± 63.12 uV, p = 0.022)。結論與臨床意義：本研究顯示功能性踝關節不穩定受測者有顯著較差之脛前肌與腓骨長肌之肌肉表現，且腓骨長肌與比目魚肌之大腦皮質脊髓興奮性較健康受測者也有顯著較差之表現，因此未來在評估治療功能性踝關節不穩定者時也需著重其神經肌肉表現，並給予適當之治療。

並列關鍵字

大腦皮質脊髓興奮性 ； 功能性踝關節不穩定 ； 神經肌肉表現 ； 平衡