Neural Rehabilitation Group, Cajal Institute, CSIC, 28002, Madrid, Spain.
Sensorimotor Function Group, Hospital Nacional de Parapléjicos, 45072, Toledo, Spain.
Med Biol Eng Comput. 2018 Aug;56(8):1425-1434. doi: 10.1007/s11517-018-1787-2. Epub 2018 Jan 17.
Several studies have examined spinal reflex modulation during leg cycling in healthy and spinal cord injury (SCI) subjects. However, the effect of cutaneous plantar afferent input on spinal excitability during leg cycling after SCI has not been characterised. The aim of the study was to test the feasibility of using controlled leg cycling in combination with plantar cutaneous electrical stimulation (ES) cycling to assess lower limb spinal sensorimotor excitability in subjects with motor complete or incomplete SCI. Spinal sensorimotor excitability was estimated by measuring cutaneomuscular-conditioned soleus H-reflex activity. Reflex excitability was tested before and after a 10-min ES cycling session in 13 non-injured subjects, 6 subjects with motor incomplete SCI (iSCI) who had moderately impaired gait function, 4 subjects with motor iSCI who had severely impaired gait function, and 5 subjects with motor complete SCI (cSCI). No modulation of soleus H-reflex with plantar cutaneous stimuli was observed after either iSCI or cSCI when compared to non-injured subjects. However, after ES cycling, reflex excitability significantly increased in subjects with iSCI and moderately impaired gait function. ES cycling facilitated spinal sensorimotor excitability only in subjects with motor iSCI with residual gait function. Increased spinal excitability induced with a combination of exercise and afferent stimulation could be adopted with diagnostic and prognostic purposes to reveal the activity-based neurorehabilitation profile of individual subjects with motor iSCI.
ISRCTN 26172500 ; retrospectively registered on 15 July 2016 Graphical abstract ᅟ.
已有多项研究检查了健康人和脊髓损伤（SCI）受试者在腿部循环时的脊髓反射调节。然而，SCI 后腿部循环时皮肤足底传入输入对脊髓兴奋性的影响尚未得到描述。本研究的目的是测试使用受控腿部循环结合足底皮肤电刺激（ES）循环来评估运动完全或不完全 SCI 受试者下肢脊髓感觉运动兴奋性的可行性。通过测量皮肌条件性比目鱼肌 H 反射活动来估计脊髓感觉运动兴奋性。在 13 名未受伤的受试者、6 名运动不完全 SCI（iSCI）受试者（步态功能中度受损）、4 名运动不完全 SCI 受试者（步态功能严重受损）和 5 名运动完全 SCI（cSCI）受试者中，在 10 分钟 ES 循环后，在 10 分钟 ES 循环前和之后测试反射兴奋性。与未受伤的受试者相比，在 iSCI 或 cSCI 后，足底皮肤刺激对比目鱼肌 H 反射没有调制。然而，在 ES 循环后，具有中度受损步态功能的 iSCI 受试者的反射兴奋性显著增加。ES 循环仅在具有残留步态功能的运动 iSCI 受试者中促进脊髓感觉运动兴奋性。结合运动和传入刺激诱导的脊髓兴奋性增加，可以用于诊断和预后目的，以揭示具有运动 iSCI 的个体受试者的基于活动的神经康复特征。
ISRCTN26172500；2016 年 7 月 15 日回顾性注册
