Wernig A, Müller S
Department of Physiology, University of Bonn, FRG.
Paraplegia. 1992 Apr;30(4):229-38. doi: 10.1038/sc.1992.61.
After low transection of the spinal cord mammalian quadrupeds can be trained to walk on a driven surface indicating that coordinating neuronal circuits persist in the spinal cord segments caudal to the lesion. We trained 8 persons with incomplete spinal cord lesion on a Laufband (driven treadmill) for 1 1/2 to 7 months (5 days a week, 30-60 minutes daily) starting 5 to 20 months after injury and found significant improvement in the utilisation of the paralysed limbs during locomotion. Locomotion is described in one additional patient who had trained independently on parallel bars for several years. Five patients had complete functional paralysis in one lower limb when tested in a resting position. In EMG recordings voluntary activity (ie activity induced upon command) was absent or residual in the main flexor and extensor muscles of this limb. In contrast, during locomotion flexion and extension movements were performed and phasic EMG activity was present. In these 5 patients, and in all others reported here, skin sensibility and proprioception are preserved to different degrees in all limbs. In the course of locomotive training of 4 severely paralysed patients the initially habituating flexion reflexes could be entrained in the paralysed limbs as was the case for knee extension during stance. Subsequently, initial body weight support (BWS) of 40% could be reduced to 0%. The distance covered on the Laufband (0-104 m in the first week) increased significantly (200-410 m) in the last week of training as did speed (0-10 to 14-23 m/min). More importantly, this training subsequently allowed patients to walk on a static surface for 100 to 200 meters while voluntary activity remained absent in the paralysed limb when tested at rest. Similar progress was achieved in the 4 less severely paralysed patients. The one patient who had trained independently on parallel bars for several years is described walking on a static surface for 40 meters with the help of a walker, though he had one completely and one near completely paralysed lower limb. It appears that bipedal stepping with consequent knee extension and stabilisation can be taught after unilateral complete or near complete loss of voluntary activity, suggesting the manifestation of complex reflex motor patterns at the spinal level.
在对哺乳动物四足动物进行脊髓低位横断后，可以训练它们在驱动表面上行走，这表明协调神经回路在损伤部位尾侧的脊髓节段中仍然存在。我们对8例不完全性脊髓损伤患者在Laufband（驱动跑步机）上进行了1个半月至7个月的训练（每周5天，每天30 - 60分钟），训练从受伤后5至20个月开始，结果发现患者在运动过程中对瘫痪肢体的利用有显著改善。另外还描述了1例在双杠上自主训练数年的患者的运动情况。5例患者在静息状态下测试时，一侧下肢完全功能性瘫痪。在肌电图记录中，该肢体的主要屈肌和伸肌没有或仅有残余的自主活动（即根据指令诱发的活动）。相反，在运动过程中，该肢体进行了屈伸运动，并且出现了肌电图的相位活动。在这5例患者以及本文报道的所有其他患者中，所有肢体的皮肤感觉和本体感觉都有不同程度的保留。在对4例严重瘫痪患者进行运动训练的过程中，最初出现的适应性屈曲反射可以在瘫痪肢体中被诱发出来，就像站立时膝关节伸展的情况一样。随后，最初40%的体重支撑（BWS）可以降至0%。在训练的最后一周，在Laufband上行走的距离（第一周为0 - 104米）显著增加（200 - 410米），速度也从0 - 10米/分钟增加到14 - 23米/分钟。更重要的是，这种训练随后使患者能够在静止表面上行走100至200米，而在静息状态下测试时，瘫痪肢体仍然没有自主活动。4例瘫痪程度较轻的患者也取得了类似的进展。文中描述了1例在双杠上自主训练数年的患者，尽管他一侧下肢完全瘫痪，另一侧几乎完全瘫痪，但在助行器的帮助下能够在静止表面上行走40米。似乎在单侧完全或几乎完全丧失自主活动后，可以教会患者进行双足迈步以及随之而来的膝关节伸展和稳定，这表明在脊髓水平出现了复杂的反射运动模式。
