Gerasimenko Yury, Gorodnichev Ruslan, Moshonkina Tatiana, Sayenko Dimitry, Gad Parag, Reggie Edgerton V
Pavlov Institute of Physiology, 199034 St. Petersburg, Russia; Department of Integrative Biology and Physiology, University of California, Terasaki Life Sciences Building, 610, Charles E. Young Drive East, Los Angeles, CA 90095-1527 USA.
Velikie Luky State Academy of Physical Education and Sport, 182100 Velikie Luky, Russia.
Ann Phys Rehabil Med. 2015 Sep;58(4):225-231. doi: 10.1016/j.rehab.2015.05.003. Epub 2015 Jul 20.
Locomotor behavior is controlled by specific neural circuits called central pattern generators primarily located at the lumbosacral spinal cord. These locomotor-related neuronal circuits have a high level of automaticity; that is, they can produce a "stepping" movement pattern also seen on electromyography (EMG) in the absence of supraspinal and/or peripheral afferent inputs. These circuits can be modulated by epidural spinal-cord stimulation and/or pharmacological intervention. Such interventions have been used to neuromodulate the neuronal circuits in patients with motor-complete spinal-cord injury (SCI) to facilitate postural and locomotor adjustments and to regain voluntary motor control. Here, we describe a novel non-invasive stimulation strategy of painless transcutaneous electrical enabling motor control (pcEmc) to neuromodulate the physiological state of the spinal cord. The technique can facilitate a stepping performance in non-injured subjects with legs placed in a gravity-neutral position. The stepping movements were induced more effectively with multi-site than single-site spinal-cord stimulation. From these results, a multielectrode surface array technology was developed. Our preliminary data indicate that use of the multielectrode surface array can fine-tune the control of the locomotor behavior. As well, the pcEmc strategy combined with exoskeleton technology is effective for improving motor function in paralyzed patients with SCI. The potential impact of using pcEmc to neuromodulate the spinal circuitry has significant implications for furthering our understanding of the mechanisms controlling locomotion and for rehabilitating sensorimotor function even after severe SCI.
运动行为由主要位于腰骶脊髓的称为中枢模式发生器的特定神经回路控制。这些与运动相关的神经元回路具有高度的自主性；也就是说，在没有脊髓上和/或外周传入输入的情况下，它们也能产生在肌电图（EMG）上也能看到的“踏步”运动模式。这些回路可以通过硬膜外脊髓刺激和/或药物干预进行调节。这种干预已被用于对运动完全性脊髓损伤（SCI）患者的神经元回路进行神经调节，以促进姿势和运动调整，并恢复自主运动控制。在这里，我们描述了一种新的无创刺激策略——无痛经皮电刺激实现运动控制（pcEmc），以调节脊髓的生理状态。该技术可以促进腿部处于重力中性位置的未受伤受试者的踏步表现。与单部位脊髓刺激相比，多部位刺激能更有效地诱发踏步运动。基于这些结果，开发了一种多电极表面阵列技术。我们的初步数据表明，使用多电极表面阵列可以微调对运动行为的控制。此外，pcEmc策略与外骨骼技术相结合对于改善SCI瘫痪患者的运动功能是有效的。使用pcEmc调节脊髓回路的潜在影响对于进一步理解控制运动的机制以及即使在严重SCI后恢复感觉运动功能具有重要意义。
