Estes Stephen P, Iddings Jennifer A, Field-Fote Edelle C
Shepherd Center, Crawford Research Institute , Atlanta, GA , USA.
Shepherd Center, Crawford Research Institute, Atlanta, GA, USA; School of Medicine, Emory University, Division of Physical Therapy, Atlanta, GA, USA.
Front Neurol. 2017 Feb 3;8:17. doi: 10.3389/fneur.2017.00017. eCollection 2017.
While priming is most often thought of as a strategy for modulating neural excitability to facilitate voluntary motor control, priming stimulation can also be utilized to target spinal reflex excitability. In this application, priming can be used to modulate the involuntary motor output that often follows central nervous system injury. Individuals with spinal cord injury (SCI) often experience spasticity, for which antispasmodic medications are the most common treatment. Physical therapeutic/electroceutic interventions offer an alternative treatment for spasticity, without the deleterious side effects that can accompany pharmacological interventions. While studies of physical therapeutic/electroceutic interventions have been published, a systematic comparison of these approaches has not been performed. The purpose of this study was to compare four non-pharmacological interventions to a sham-control intervention to assess their efficacy for spasticity reduction. Participants were individuals ( = 10) with chronic SCI (≥1 year) who exhibited stretch-induced quadriceps spasticity. Spasticity was quantified using the pendulum test before and at two time points after (immediate, 45 min delayed) each of four different physical therapeutic/electroceutic interventions, plus a sham-control intervention. Interventions included stretching, cyclic passive movement (CPM), transcutaneous spinal cord stimulation (tcSCS), and transcranial direct current stimulation (tDCS). The sham-control intervention consisted of a brief ramp-up and ramp-down of knee and ankle stimulation while reclined with legs extended. The order of interventions was randomized, and each was tested on a separate day with at least 48 h between sessions. Compared to the sham-control intervention, stretching, CPM, and tcSCS were associated with a significantly greater reduction in spasticity immediately after treatment. While the immediate effect was largest for stretching, the reduction persisted for 45 min only for the CPM and tcSCS interventions. tDCS had no immediate or delayed effects on spasticity when compared to sham-control. Interestingly, the sham-control intervention was associated with significant within-session increases in spasticity, indicating that spasticity increases with immobility. These findings suggest that stretching, CPM, and tcSCS are viable non-pharmacological alternatives for reducing spasticity, and that CPM and tcSCS have prolonged effects. Given that the observed effects were from a single-session intervention, future studies should determine the most efficacious dosing and timing strategies.
虽然启动通常被认为是一种调节神经兴奋性以促进自主运动控制的策略，但启动刺激也可用于针对脊髓反射兴奋性。在这种应用中，启动可用于调节中枢神经系统损伤后常出现的非自主运动输出。脊髓损伤（SCI）患者常经历痉挛，抗痉挛药物是最常见的治疗方法。物理治疗/电治疗干预为痉挛提供了一种替代治疗方法，没有药物干预可能伴随的有害副作用。虽然已经发表了关于物理治疗/电治疗干预的研究，但尚未对这些方法进行系统比较。本研究的目的是将四种非药物干预与假对照干预进行比较，以评估它们减轻痉挛的效果。参与者为患有慢性SCI（≥1年）且表现出牵张诱导股四头肌痉挛的个体（n = 10）。在四种不同的物理治疗/电治疗干预以及假对照干预中的每一种之后（即时、延迟45分钟）的两个时间点以及之前，使用摆锤试验对痉挛进行量化。干预措施包括拉伸、循环被动运动（CPM）、经皮脊髓刺激（tcSCS）和经颅直流电刺激（tDCS）。假对照干预包括在腿部伸展平卧时对膝盖和脚踝刺激进行短暂的逐渐增强和逐渐减弱。干预顺序是随机的，并且每种干预在单独的一天进行测试，各次测试之间至少间隔48小时。与假对照干预相比，拉伸、CPM和tcSCS在治疗后立即与痉挛的显著更大减轻相关。虽然拉伸的即时效果最大，但只有CPM和tcSCS干预的减轻持续了45分钟。与假对照相比，tDCS对痉挛没有即时或延迟影响。有趣的是，假对照干预与疗程内痉挛的显著增加相关，表明痉挛随不动而增加。这些发现表明，拉伸、CPM和tcSCS是减轻痉挛的可行非药物替代方法，并且CPM和tcSCS具有持久效果。鉴于观察到的效果来自单次干预，未来的研究应确定最有效的给药和时间策略。
