Yozbatiran Nuray, Keser Zafer, Hasan Khader, Stampas Argyrios, Korupolu Radha, Kim Sam, O'Malley Marcia K, Fregni Felipe, Francisco Gerard E
Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, UTHealth NeuroRecovery Research Center at TIRR Memorial Hermann, Houston, TX, USA.
Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center, Houston, TX, USA.
Spinal Cord Ser Cases. 2017 Jun 15;3:17028. doi: 10.1038/scsandc.2017.28. eCollection 2017.
This is a prospective clinical pilot case series. Improvement of arm and hand functions after spinal cord injury (SCI) is one of the major rehabilitation goals. Electrical stimulation of the primary motor cortex via transcranial direct current stimulation (tDCS) coupled with high-intensity repetitive motor training may have potential to facilitate improvement in motor function in chronic, incomplete cervical SCI. We investigated the relationship between motor recovery and changes in white matter integrity in response to treatment intervention. This study was conducted in The Institute for Rehabilitation and Research Memorial Hermann, Houston, USA.
Four right-handed adults with chronic, incomplete cervical SCI (age, 36-63 years, American Spinal Injury Association Impairment Scale grade C-D) were enrolled in 10 sessions of anodal tDCS at 2 mA versus sham tDCS followed by 1 h of robotic-assisted arm training. Changes in arm and hand function were measured with Jebsen-Taylor Hand Function Test and Motor Activity Log-Amount of Use. Diffusion tension imaging was used to measure changes in fractional anisotropy (FA) of corticospinal tracts (CSTs).
After 10 sessions of treatment, we found greater improvement in hand function and hand usage in patients who received active tDCS treatment versus sham treatment. There was an overall positive change in FA values across all patients. We show changes in arm and hand function associated with changes in CST tractographic mapping to quantify the motor system components in chronic incomplete cervical SCI.
这是一个前瞻性临床试点病例系列。脊髓损伤（SCI）后上肢和手部功能的改善是主要的康复目标之一。通过经颅直流电刺激（tDCS）对初级运动皮层进行电刺激并结合高强度重复运动训练，可能有助于改善慢性不完全性颈髓损伤患者的运动功能。我们研究了治疗干预后运动恢复与白质完整性变化之间的关系。本研究在美国休斯顿纪念赫尔曼康复与研究所进行。
4名右利手的慢性不完全性颈髓损伤成年患者（年龄36 - 63岁，美国脊髓损伤协会损伤分级C - D级）参加了为期10次的阳极tDCS治疗（2 mA）与假tDCS治疗，随后进行1小时的机器人辅助手臂训练。使用Jebsen - Taylor手部功能测试和运动活动日志 - 使用量来测量上肢和手部功能的变化。弥散张量成像用于测量皮质脊髓束（CST）的分数各向异性（FA）变化。
经过10次治疗后，我们发现接受主动tDCS治疗的患者与接受假治疗的患者相比，手部功能和手部使用情况有更大改善。所有患者的FA值总体呈正向变化。我们展示了上肢和手部功能的变化与CST束描记图变化相关，以量化慢性不完全性颈髓损伤中的运动系统成分。
