Les maladies du sytème nerveux
FMR Walshe
Roth & Masson Ed
1948 p27
Lorsque le malade bâille, le bras paralysé accuse un spasme et s'étend partiellement de même que le poignet et les doigts; lorsque le bâillement est passé le membre reprend sa position première

mise à jour du
19 décembre 2002
  Brain, 1923, 46, 1-37
 On certain tonic or postural reflexes in hemiplegia with special reference to the so called "associated movements"
Walshe FMR , London


In earlier papers the writer bas endeavoured to analyse in physiological terms the spasticity resulting from pyramidal system lesions and also the reflex movements in the lower limbs in the two clinical forms of paraplegia, the extended and the flexed. These phenomena were identified with certain tonic and phasic reflex reactions described by Sherrington. A similar detailed analysis of the familiar associated movements of the paralysed limbs in hemiplegia remains to be undertaken on the same lines. In the papers referred to above some preliminary considerations on the subject were stated. Thus, these movements were described as tome or postural reactions, that is, as reflex variations in muscle tone, rather than as movements in the strict physiological sense. This conclusion was based upon the following considerations.
Neurolocists are learning froui Sherrington to regard muscle tone as the basis of posture, and decerebrate rigidity as a form of reflex standing. In the earlier analysis of spasticity, as it occurs in hemiplegia and in the extended form of spastic paraplegia, reasons were given for regarding it as physiologically identical with experimentally produced decerebrate rigidity. It was pointed out that all voluntary purposive movements are accompanied by an appropriate postural adjustment of the rest of the skeletal musculature, and that in forceful movements this adjustment or adaptation is necessarily bilateral and widespread. Although carried out under voluntary control, postural adaptation is a function of reflex mechanisms situated in the brain-stem, which are not put out of action by the lesion which produces hemiplegia and abolishes voluntary control of the musculature on the affected side of the body.
In these circumstances, we should still expect postural reactions to occur when forceful voluntary motor activities are carried out by the musculature of the sound half of the body. Now, however, deprived of cortical control, they would occur in exaggerated intensity and deprived of that fineness of adaptation which that control ensures. It was concluded that the associated movements of hemiplegia are phenomena of this order, appearing in the muscles of the affected side on certain voluntary movements of the normal limbs, or on such semi-voluntary movements as yawning. In other words, associated movements, or, as we shall call thein, " associated reactions," are released postural reactions in muscles deprived of voluntary control. [...]
We have chosen tonic voluntary activity of the normal limbs as the type of stimulus most effective in eliciting an associated reaction but is not suggested that voluntary contraction of other muscles may have a similar, if less pronouneed, effect. Firm clenching of the stiffening of the neck muscles, and such quasi-involuntary activities yawning and stretching and coughing, also produce associated reaction. Further, voluntary contraction of one of the limbs on the hemiplegicside may be productive of an associated reaction in the other. It is possible also that the elevation of the shoulder, abduction of the .. and flexion of the forearm, which may accompany the attempt patient voluntarily to extend his clenched fingers in the affected may be of the nature of an associated reaction. In this case, how as we shall see when discussing Marie and Foix's classificati on syncinésies, another type of movement may be in question every instance the voluntary contraction which constitutes the stimuli for an associated reaction, whether it be in the limb or trunk- must be forceful and maintained.

The form of the associated reaction.- As Riddoch have pointed out, the associated reaction may be very widespread it is with the limb reaction that we shall mainly deal, because more readily capable of accurate observation and recording than contraction in trunk muscles, and is therefore better adapted for determination of the nature of associated reactions as a whole. It shall see later, it is essential in studying associated reactions the conditions of examination shall be constant. The folowing description applies to the reactions obtained from a patient his back with the head in the median position. The normal are extended and supported on the bed at the patient's side. The h then held by the observer and the patient commanded to give a sfeady, and maintained grasp. No excursion of the arm occur in these circumstances the paralysed arm as it lies resting, semi across the patient's body, is seen to go into strong tonic cont after a short interval. In this contraction every muscle of the and limb girdle may be both felt and seen to contract. In the of instanced the flexors of the forearm are most affected, a slow movment of flexion at the elbow results, and the new posture taken maintained more or less steadily until the patient is told to re voluntary grasp. In addition to flexion of the elbow there is free some elevation of the shoulder and either adduction or abduction upper arm. In the former case the forearm and hand pass across body toward.the sound side, in the latter the forearm is lift the body and moved away from the normal side. [...]

In this connection it is interesting to note the form of associated reaction in the paralysed arni which accompanies yawning and stretching. It is exceptional to find a subject with residual spastic lierniplegia from whom a history of spontaneous movement of the paralysed arm or hand on yawning cannot be obtained. In many cases, coughing is also accompanied by such a reaction. Every patient whom the writer has questioned on this point, with a single exception, has stated that the movement of the hand and digits in these circumstances is one of extension. This is often complete and is accompanied by fanning of the fingers. The forearm may be extended, but more commonly flexes and is raised up in front of the patient. Whenever the writer has observed this reaction to yawning, extension and separation of the digits have occurred. Moreover, two patients volunteered the statement that when the fingers are extended and abducted during a yawn they are able to flex and extend them rapidly, a thing they were unable to do at any other time. Indeed, one man added that he always waited for a yawn so that he might exercise his fingers in this way. In an earlier reference to this detail, the general inference was suggested that unilateral muscular contraction evoked an associated flexion, while such bilateral muscular acte as yawning evoked associated extensior. In the light of the more recent observations recorded here, this generalization must be abandoned, yet it remains a striking fact that the force of muscular activity most commonly producing associated extension the digits is bilateral. In this case, the stimulus may be tonic contration of the diaphragm.......
Comprendre avec l'aide de K Ezure la coordination respiration - marche
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