SYNKINESES

From Big Medical Encyclopedia

SYNKINESES (grech, syn-together, with + kinesis the movement; synonym: the associated movements, the consensual movements) — the involuntary muscular contractions and the movements accompanying the active motive act.

Various S. are characteristic of normal motility, being a component of synergies — the joint coordinated reductions of various muscles and muscular groups providing implementation of the reasonable motive act (see. Movements ). They are of great importance in mechanisms of maintenance poses (see) and balances of a body (see). So, e.g., at to walking (see) each phase of a step there correspond reduction or relaxation of muscles of a neck, a shoulder girdle, a trunk thanks to what preservation of vertical position of a body is provided; reductions of muscles of extremities are followed by reductions of muscles of a trunk, to-rye are carried out in strictly certain sequence and are directed to preservation of balance. Numerous S. are observed at run (see), swimming (see). S.'s character can change depending on an initial pose, and also in the course of the training, including also development of the prof. of skills.

S.'s implementation is provided on the basis of interaction of various departments of c. N of page — pyramidal and extrapyramidal systems, a cerebellum, the segmented device of a spinal cord (see. Motor reactions , Movements ).

The research C. is conducted by sighting behind autokinesias, and also with the help electromyography (see), goniometriya (see) and other methods of studying of functions of bodies of the movement.

At a number of diseases of c. the N of page is marked out change of character and expressiveness of physiological Pages. Sharp oppression of S. is characteristic, e.g., for parkinsonism (see), and their strengthening — for a double athetosis (see. Athetosis double ).

Emergence new, patol. Page, a part from to-rykh it is characteristic of the organisms which phylogenetic are on more low level of development or of the embryonal period of development of the person, it is observed at a number of diseases of c. N of page, and also at its inborn underdevelopment; e.g., at an underdevelopment of cerebral hemispheres at the newborn cervical reflexes of Magnus — Klein come to light (see. Magnus — Klein reflexes ); at the adult such reflexes appear at damages of a brain.

Various options patol. Pages arise usually at defeat of pyramidal system in limits of both a head, and spinal cord (at vascular, inflammatory, degenerative and dystrophic diseases of a nervous system, at multiple sclerosis, etc.). Such S.' identification allows to diagnose organic lesions of a nervous system, to estimate dynamics patol. process. These S. should be considered during the holding rehabilitation actions; one S. use, others — suppress.

Pathological S. can be divided into global, koordina-even and imitating (contralateral).

Global S. — the involuntary movements of the paralyzed extremities arising at strong and rather steady stress of healthy extremities (e.g., the forced compression of a healthy brush in a fist), and also at yawning, cough, sneezing, laughter, crying, a natu-zhivaniye. Global S.'s character usually is defined by selective increase in a tone in the paralyzed extremities. On S.'s hand it is shown by bending of fingers, bending and pronation of a forearm, assignment of a shoulder, on a leg — reduction of a hip, extension of a shin, bottom bending of foot, bending of fingers.

Koordinatornye S. — involuntary reductions of one paretichny muscles in attempt of any reductions of other, functionally related muscles. Usually they are observed during recovery of autokinesias at hemiplegia (see) when there is an opportunity to carry out the nek-ry strong-willed movements, and the accompanying movements actively it is not possible to detain. E.g., at recovery of movements in a leg before all S. arise during the bending of a shin; they consist in an additional dorsiflexion of foot or extension of her thumb whereas it is not possible to execute the isolated movement of foot and a thumb (see. Shtryumpellya phenomena ). Zh. Babinsky described the combined inflection of a hip and trunk: in attempt of the patient with a hemiplegia to sit down from a dorsal decubitus there come bending of the paralyzed hip and the heel rises from a bed. During the bending of a trunk forward the leg on the party of a hemiparesis is involuntarily bent in a knee joint (Nery's phenomenon). The symptom of the combined abduction and adduction Ry-mista concerns to this group C.: at the patient lying on spin with slightly moved apart legs in attempt of the doctor to bring closer to the centerline or to take away knaruzh a healthy leg (and resistance from the patient) the sore leg is involuntarily brought or taken away. Quite often S. in the form of involuntary bending of a thumb of a hand at passive extension of the II—V fingers (Klippel's phenomenon — Feylya) or fan-shaped cultivation of fingers of the paralyzed hand meet at yawning.

Imitating S. — the involuntary movements of one extremity imitating the strong-willed movements by other extremity. Refer the replaceable, compensatory movements to imitating S., to-rye the patient makes a healthy extremity when to it suggest to execute the movements by a paretichny extremity. At first after amputation of an extremity the strong-willed impulse, e.g., for the amputated hand causes the movement of an opposite hand. Sometimes patients with paresis of a hand facilitate performance of movements by this hand by means of the identical tension of a healthy hand. At early stages of ontogenesis at the person of the movement are symmetric and bilateral, and motive impulses irradiate on both parties. In the subsequent, at the finished myelination of pyramidal and extrapyramidal fibers, and also in process of acquisition of individual motive experience becomes possible to carry out the movements separately one extremity. Acquisition of movement skills заключается^ training in ability not only quickly to make the necessary movements, but also to suppress at the same time sinkinetichesky impulses. At defeat of pyramidal system at the level of bark and a subcortex there is a disinhibition of the neural bonds which were available in the early period of development in subcrustal educations and again imitating S. renew, to-rye are pathological. It is necessary to distinguish the similar movements relating to global S., napr, compression in a fist of the paralyzed brush along with autokinesia of a healthy hand from imitating S. At global S. this effect, in the paralyzed hand comes not only during the bending, but also at extension of a healthy brush.

Inborn imitating S. occur at several members of one family, for the rest quite healthy. They are expressed in transfer of the movement from one hand on opposite that complicates formation of many movement skills of an upper extremity. Also S. at a syndrome of the Hun is inborn — lifting of an upper eyelid at active opening of a mouth or other movements of a mandible (see. Ptosis ).

The special group is made by S. of mimic muscles (vekogubny, vekolobny, vekoplatizmovy, vekoushny, lip and palpebral, etc.) in a residual stage of defeat facial nerve (see). Postnevritichesky S.' pathogeny of mimic muscles is insufficiently studied. Assume that in the place of defeat of a facial nerve in the bone channel the so-called trigger zone of Voltman with cross momentum transfer in a nerve is created that leads at any tension of certain face muscles to emergence of the accompanying movements in other muscles.

At patol. Villages carry out treatment of a basic disease. The drugs reducing a muscle tone (Mydocalmum, Cyclodolum, dopamine) are effective.



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D. K. Bogorodinsky, A. A. Skoromets.

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