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不完全性脊髓损伤后骑行过程中颈腰耦合对脊髓反射的影响。

Effect of cervicolumbar coupling on spinal reflexes during cycling after incomplete spinal cord injury.

作者信息

Zhou R, Parhizi B, Assh J, Alvarado L, Ogilvie R, Chong S L, Mushahwar V K

机构信息

Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta , Edmonton, Alberta , Canada.

Sensory Motor Adaptive Rehabilitation Technology (SMART) Network, University of Alberta , Edmonton, Alberta , Canada.

出版信息

J Neurophysiol. 2018 Dec 1;120(6):3172-3186. doi: 10.1152/jn.00509.2017. Epub 2018 Sep 12.

Abstract

Spinal networks in the cervical and lumbar cord are actively coupled during locomotion to coordinate arm and leg activity. The goals of this project were to investigate the intersegmental cervicolumbar connectivity during cycling after incomplete spinal cord injury (iSCI) and to assess the effect of rehabilitation training on improving reflex modulation mediated by cervicolumbar pathways. Two studies were conducted. In the first, 22 neurologically intact (NI) people and 10 people with chronic iSCI were recruited. The change in H-reflex amplitude in flexor carpi radialis (FCR) during leg cycling and H-reflex amplitude in soleus (SOL) during arm cycling were investigated. In the second study, two groups of participants with chronic iSCI underwent 12 wk of cycling training: one performed combined arm and leg cycling (A&L) and the other legs only cycling (Leg). The effect of training paradigm on the amplitude of the SOL H-reflex was assessed. Significant reduction in the amplitude of both FCR and SOL H-reflexes during dynamic cycling of the opposite limbs was found in NI participants but not in participants with iSCI. Nonetheless, there was a significant reduction in the SOL H-reflex during dynamic arm cycling in iSCI participants after training. Substantial improvements in SOL H-reflex properties were found in the A&L group after training. The results demonstrate that cervicolumbar modulation during rhythmic movements is disrupted in people with chronic iSCI; however, this modulation is restored after cycling training. Furthermore, involvement of the arms simultaneously with the legs during training may better regulate the leg spinal reflexes. NEW & NOTEWORTHY This work systematically demonstrates the disruptive effect of incomplete spinal cord injury on cervicolumbar coupling during rhythmic locomotor movements. It also shows that the impaired cervicolumbar coupling could be significantly restored after cycling training. Actively engaging the arms in rehabilitation paradigms for the improvement of walking substantially regulates the excitability of the lumbar spinal networks. The resulting regulation may be better than that obtained by interventions that focus on training of the legs only.

摘要

在运动过程中,颈髓和腰髓中的脊髓网络会积极耦合,以协调手臂和腿部的活动。本项目的目标是研究不完全性脊髓损伤(iSCI)后骑行过程中的节段间颈腰连接,并评估康复训练对改善颈腰通路介导的反射调制的影响。进行了两项研究。第一项研究招募了22名神经功能正常(NI)的人和10名慢性iSCI患者。研究了腿部骑行时桡侧腕屈肌(FCR)的H反射幅度变化以及手臂骑行时比目鱼肌(SOL)的H反射幅度变化。在第二项研究中,两组慢性iSCI参与者进行了12周的骑行训练:一组进行手臂和腿部联合骑行(A&L),另一组仅进行腿部骑行(Leg)。评估了训练模式对SOL H反射幅度的影响。在NI参与者中发现,对侧肢体动态骑行时FCR和SOL H反射的幅度均显著降低,但iSCI参与者中未发现。尽管如此,训练后iSCI参与者在动态手臂骑行时SOL H反射有显著降低。训练后,A&L组的SOL H反射特性有显著改善。结果表明,慢性iSCI患者在节律性运动过程中的颈腰调制受到破坏;然而,骑行训练后这种调制得以恢复。此外,训练过程中手臂与腿部同时参与可能会更好地调节腿部脊髓反射。新发现与值得注意之处 本研究系统地证明了不完全性脊髓损伤对节律性运动过程中颈腰耦合的破坏作用。还表明,颈腰耦合受损在骑行训练后可显著恢复。在康复模式中积极让手臂参与以改善步行,可显著调节腰脊髓网络的兴奋性。由此产生的调节效果可能优于仅专注于腿部训练的干预措施。

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