1 Department of Integrative Biology and Physiology, University of California, Los Angeles, California.
2 Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, Texas.
J Neurotrauma. 2019 May 1;36(9):1435-1450. doi: 10.1089/neu.2018.5956. Epub 2018 Dec 15.
Neuromodulation of spinal networks can improve motor control after spinal cord injury (SCI). The objectives of this study were to (1) determine whether individuals with chronic paralysis can stand with the aid of non-invasive electrical spinal stimulation with their knees and hips extended without trainer assistance, and (2) investigate whether postural control can be further improved following repeated sessions of stand training. Using a double-blind, balanced, within-subject cross-over, and sham-controlled study design, 15 individuals with SCI of various severity received transcutaneous electrical spinal stimulation to regain self-assisted standing. The primary outcomes included qualitative comparison of need of external assistance for knee and hip extension provided by trainers during standing without and in the presence of stimulation in the same participants, as well as quantitative measures, such as the level of knee assistance and amount of time spent standing without trainer assistance. None of the participants could stand unassisted without stimulation or in the presence of sham stimulation. With stimulation all participants could maintain upright standing with minimum and some ( = 7) without external assistance applied to the knees or hips, using their hands for upper body balance as needed. Quality of balance control was practice-dependent, and improved with subsequent training. During self-initiated body-weight displacements in standing enabled by spinal stimulation, high levels of leg muscle activity emerged, and depended on the amount of muscle loading. Our findings indicate that the lumbosacral spinal networks can be modulated transcutaneously using electrical spinal stimulation to facilitate self-assisted standing after chronic motor and sensory complete paralysis.
脊髓网络的神经调节可以改善脊髓损伤后的运动控制。本研究的目的是：（1）确定慢性瘫痪的个体是否可以在膝关节和髋关节伸展的情况下，在没有训练师帮助的情况下，借助非侵入性的脊髓电刺激站立，（2）研究在重复站立训练后，姿势控制是否可以进一步改善。采用双盲、平衡、自身交叉和假对照研究设计，15 名不同严重程度的脊髓损伤患者接受经皮脊髓电刺激以恢复自我辅助站立。主要结果包括在同一参与者中，定性比较站立时无刺激和有刺激情况下训练师提供的膝关节和髋关节伸展所需的外部辅助程度，以及定量测量，如膝关节辅助水平和无训练师辅助站立的时间。在没有刺激或假刺激的情况下，没有参与者可以独立站立。有了刺激，所有参与者都可以用手保持上半身平衡，用最小的力和一些（ = 7）不需要外部辅助来保持膝关节或髋关节伸直，从而站立。平衡控制的质量是依赖于练习的，并且随着后续训练而提高。在脊髓刺激允许的自我发起的身体重量位移期间，腿部肌肉出现高水平的活动，并且取决于肌肉负荷量。我们的发现表明，使用脊髓电刺激可以对腰骶部脊髓网络进行经皮调节，以促进慢性运动和感觉完全瘫痪后的自我辅助站立。
