Zhou Rui, Alvarado Laura, Ogilvie Robert, Chong Su Ling, Shaw Oriana, Mushahwar Vivian K
Neuroscience & Mental Health Institute, Faculty of Medicine & Dentistry, University of Alberta , Edmonton, Alberta , Canada.
Sensory Motor Adaptive Rehabilitation Technology (SMART) Network, University of Alberta , Edmonton, Alberta , Canada.
J Neurophysiol. 2018 Jun 1;119(6):2194-2211. doi: 10.1152/jn.00569.2017. Epub 2018 Jan 24.
Arm movements modulate leg activity and improve gait efficiency; however, current rehabilitation interventions focus on improving walking through gait-specific training and do not actively involve the arms. The goal of this project was to assess the effect of a rehabilitation strategy involving simultaneous arm and leg cycling on improving walking after incomplete spinal cord injury (iSCI). We investigated the effect of 1) non-gait-specific training and 2) active arm involvement during training on changes in over ground walking capacity. Participants with iSCI were assigned to simultaneous arm-leg cycling (A&L) or legs only cycling (Leg) training paradigms, and cycling movements were assisted with electrical stimulation. Overground walking speed significantly increased by 0.092 ± 0.022 m/s in the Leg group and 0.27 ± 0.072m/s in the A&L group after training. Whereas the increases in the Leg group were similar to those seen after current locomotor training strategies, increases in the A&L group were significantly larger than those in the Leg group. Walking distance also significantly increased by 32.12 ± 8.74 m in the Leg and 91.58 ± 36.24 m in the A&L group. Muscle strength, sensation, and balance improved in both groups; however, the A&L group had significant improvements in most gait measures and had more regulated joint kinematics and muscle activity after training compared with the Leg group. We conclude that electrical stimulation-assisted cycling training can produce significant improvements in walking after SCI. Furthermore, active arm involvement during training can produce greater improvements in walking performance. This strategy may also be effective in people with other neural disorders or diseases. NEW & NOTEWORTHY This work challenges concepts of task-specific training for the rehabilitation of walking and encourages coordinated training of the arms and legs after spinal cord injury. Cycling of the legs produced significant improvements in walking that were similar in magnitude to those reported with gait-specific training. Moreover, active engagement of the arms simultaneously with the legs generated nearly double the improvements obtained by leg training only. The cervico-lumbar networks are critical for the improvement of walking.
手臂运动可调节腿部活动并提高步态效率;然而,目前的康复干预措施侧重于通过特定步态训练来改善行走能力,并未积极调动手臂。本项目的目标是评估一种涉及手臂和腿部同时进行循环训练的康复策略对不完全性脊髓损伤(iSCI)后改善行走能力的效果。我们研究了1)非特定步态训练和2)训练过程中手臂的主动参与对地面行走能力变化的影响。患有iSCI的参与者被分配到手臂 - 腿部同时循环训练(A&L)或仅腿部循环训练(Leg)范式,并且通过电刺激辅助循环运动。训练后,Leg组的地面行走速度显著提高了0.092±0.022米/秒,A&L组提高了0.27±0.072米/秒。虽然Leg组的增加幅度与当前运动训练策略后的增加幅度相似,但A&L组的增加幅度明显大于Leg组。Leg组的行走距离也显著增加了32.12±8.74米,A&L组增加了91.58±36.24米。两组的肌肉力量、感觉和平衡都有所改善;然而,与Leg组相比,A&L组在大多数步态指标上有显著改善,并且训练后关节运动学和肌肉活动更加规律。我们得出结论,电刺激辅助循环训练可以显著改善脊髓损伤后的行走能力。此外,训练过程中手臂的主动参与可以在行走表现上产生更大的改善。这种策略可能对患有其他神经障碍或疾病的人也有效。新发现与值得注意之处 这项工作挑战了用于行走康复的特定任务训练的概念,并鼓励脊髓损伤后手臂和腿部的协调训练。腿部循环训练在行走方面产生了显著改善,其幅度与特定步态训练报告的幅度相似。此外,手臂与腿部同时积极参与所产生的改善几乎是仅腿部训练所获得改善的两倍。颈腰网络对于行走能力的改善至关重要。