Schalow G, Jaigma P, Belle V K
Institute of Exercise Biology and Physiotherapy, Centre of Behavioural and Health Sciences, University of Tartu, 5 Jakobi Street, Tartu 51014, Estonia.
Electromyogr Clin Neurophysiol. 2009 Mar-Apr;49(2-3):67-91.
The present paper explains how an 18 year-old boy, who suffered an incomplete spinal cord injury (SCI) at the Cervical 5/6 levels, could achieve a near-complete recovery within 3 years of coordination dynamics therapy (CDT). The anatomically incomplete SCI was evident on MRI (Magnetic Resonance Imaging) which showed that 50% of the cord tissue was destroyed at the injury site. The administered CDT included the training of crawling, walking, running, jumping, and exercising on special CDT devices. Now 21 years old, this chronically injured young man cannot only walk independently, but he can also run and jump. He has attained full bladder control and is off all medications. The underlying mechanism contributing to this excellent recovery will have to be explained in the framework of the System Theory of Pattern Formation. In this framework the clinical improvement can be quantified in terms of coordination dynamics values, behavioural description of movement performance, analysis of motor patterns, and surface electromyography (sEMG) recorded during the movements. The impaired ability of the injured nervous system to self-organize is evidenced by deteriorated motor programs recorded with sEMG, unstable movement performances, and asymmetric attractor layouts in coordination dynamics recordings. On the other hand, the improvement of motor programs after CDT could also be measured by surface EMG, including measurements of antagonistic action of muscles and also by the improvement of the mean stability of motor patterns. These indicators of improving motor programs could be correlated with clinical improvement in certain motor performances like running and jumping. The recovery could mainly be achieved through a functional reorganisation as was indicated by the absence of significant improvement in the power of the quadriceps femoris muscles. The performances of turning on the special CDT device against high loads were diagnostic for the extent of repair of the integrative functions of the CNS. The cure of urinary bladder function is probably attributable to learning transfer from stereotyped, coordinated, integrative movements to the neural networks involved in bladder control. Since the patient received sub-optimal CDT, it took more than 3 years for the recovery. It appears that the repair of the integrative functions of the CNS need longer periods of time. But training such integrative movements is pivotal in inducing learning transfer from motor patterns to autonomic functions that resulted in the cure of urinary bladder function.
本文阐述了一名18岁男孩，在颈5/6水平遭受不完全性脊髓损伤（SCI）后，如何在3年的协调动力学疗法（CDT）治疗内实现近乎完全康复。MRI（磁共振成像）显示解剖学上的不完全性脊髓损伤，损伤部位50%的脊髓组织被破坏。所实施的CDT包括在特殊CDT设备上进行爬行、行走、跑步、跳跃和锻炼训练。现在这名21岁的长期受伤青年不仅能够独立行走，还能跑步和跳跃。他已实现膀胱完全控制，且不再服用任何药物。促成这一优异康复效果的潜在机制必须在模式形成系统理论的框架内加以解释。在此框架下，临床改善可通过协调动力学值、运动表现的行为描述、运动模式分析以及运动过程中记录的表面肌电图（sEMG）来量化。受伤神经系统自组织能力受损表现为sEMG记录的运动程序恶化、运动表现不稳定以及协调动力学记录中吸引子布局不对称。另一方面，CDT后运动程序的改善也可通过表面肌电图测量，包括肌肉拮抗作用的测量以及运动模式平均稳定性的提高。这些运动程序改善的指标可与跑步和跳跃等特定运动表现的临床改善相关联。康复主要通过功能重组实现，这一点从股四头肌力量无显著改善可以看出。在特殊CDT设备上承受高负荷开启时的表现可诊断中枢神经系统整合功能的修复程度。膀胱功能的治愈可能归因于从定型、协调、整合运动到参与膀胱控制的神经网络的学习迁移。由于患者接受的CDT并非最佳，康复花费了3年多时间。看来中枢神经系统整合功能的修复需要更长时间。但训练这种整合运动对于诱导从运动模式到自主功能的学习迁移至关重要，而正是这种迁移导致了膀胱功能的治愈。
