Field-Fote Edelle C, Yang Jaynie F, Basso D Michele, Gorassini Monica A
1 Shepherd Center, Crawford Research Institute and Division of Physical Therapy, Emory University , Atlanta, Georgia .
2 Department of Physical Therapy, Faculty of Rehabilitation Medicine and Neuroscience and Mental Health Institute, Faculty of Medicine & Dentistry, University of Alberta , Edmonton, Alberta, Canada .
J Neurotrauma. 2017 May 1;34(9):1813-1825. doi: 10.1089/neu.2016.4565. Epub 2016 Dec 20.
Restoration of walking ability is an area of great interest in the rehabilitation of persons with spinal cord injury. Because many cortical, subcortical, and spinal neural centers contribute to locomotor function, it is important that intervention strategies be designed to target neural elements at all levels of the neuraxis that are important for walking ability. While to date most strategies have focused on activation of spinal circuits, more recent studies are investigating the value of engaging supraspinal circuits. Despite the apparent potential of pharmacological, biological, and genetic approaches, as yet none has proved more effective than physical therapeutic rehabilitation strategies. By making optimal use of the potential of the nervous system to respond to training, strategies can be developed that meet the unique needs of each person. To complement the development of optimal training interventions, it is valuable to have the ability to predict future walking function based on early clinical presentation, and to forecast responsiveness to training. A number of clinical prediction rules and association models based on common clinical measures have been developed with the intent, respectively, to predict future walking function based on early clinical presentation, and to delineate characteristics associated with responsiveness to training. Further, a number of variables that are correlated with walking function have been identified. Not surprisingly, most of these prediction rules, association models, and correlated variables incorporate measures of volitional lower extremity strength, illustrating the important influence of supraspinal centers in the production of walking behavior in humans.
恢复行走能力是脊髓损伤患者康复领域中备受关注的一个方面。由于许多皮质、皮质下和脊髓神经中枢都参与运动功能，因此设计干预策略以针对神经轴各级对行走能力至关重要的神经元件非常重要。虽然迄今为止大多数策略都集中在激活脊髓回路，但最近的研究正在探讨激活脊髓上回路的价值。尽管药理学、生物学和遗传学方法具有明显潜力，但目前尚无一种方法被证明比物理治疗康复策略更有效。通过充分利用神经系统对训练做出反应的潜力，可以制定出满足每个人独特需求的策略。为了补充最佳训练干预措施的开发，基于早期临床表现预测未来行走功能以及预测对训练的反应性具有重要价值。已经分别基于常见临床指标开发了一些临床预测规则和关联模型，目的是根据早期临床表现预测未来行走功能，并描绘与对训练的反应性相关的特征。此外，已经确定了一些与行走功能相关的变量。不出所料，这些预测规则、关联模型和相关变量大多纳入了意志性下肢力量的测量，这说明了脊髓上中枢对人类行走行为产生的重要影响。
