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经皮脊髓刺激对正常人脊髓感觉运动网络的优势激活作用及其偏侧化特征。

Preferential activation of spinal sensorimotor networks via lateralized transcutaneous spinal stimulation in neurologically intact humans.

机构信息

Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, Minnesota.

Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, Texas.

出版信息

J Neurophysiol. 2019 Nov 1;122(5):2111-2118. doi: 10.1152/jn.00454.2019. Epub 2019 Sep 25.

Abstract

Transcutaneous spinal stimulation (TSS), a noninvasive technique to modulate sensorimotor circuitry within the spinal cord, has been shown to enable a wide range of functions that were thought to be permanently impaired in humans with spinal cord injury. However, the extent to which TSS can be used to target specific mediolateral spinal cord circuitry remains undefined. We tested the hypothesis that TSS applied unilaterally to the skin ~2 cm lateral to the midline of the lumbosacral spine selectively activates ipsilateral spinal sensorimotor circuitry, resulting in ipsilateral activation of downstream lower extremity neuromusculature. TSS cathodes and anodes were positioned lateral from the midline of the spine in 15 healthy subjects while supine, and the timing of TSS pulses was synchronized to recordings of lower extremity muscle activity and force. At motor threshold, left and right TSS-evoked muscle activity was significantly higher in the ipsilateral leg compared with contralateral recordings from the same muscles. Similarly, we observed a significant increase in force production in the ipsilateral leg compared with the contralateral leg. Delivery of paired TSS pulses, during which an initial stimulus was applied to one side of the spinal cord and 50 ms later a second stimulus was applied to the contralateral side, revealed that ipsilateral leg muscle responses decreased following the initial stimulus, whereas contralateral muscle responses did not decrease, indicating side-specific activation of lateral spinal sensorimotor circuitry. Our results indicate TSS can selectively engage ipsilateral neuromusculature via lumbosacral sensorimotor networks responsible for lower extremity function in healthy humans. We demonstrate the selectivity of transcutaneous spinal stimulation (TSS), which has been shown to enable function in humans with chronic paralysis. Specifically, we demonstrate that TSS applied to locations lateral to the spinal cord can selectively activate ipsilateral spinal sensorimotor networks. We quantified lumbosacral spinal network activity by recording lower extremity muscle electromyography and force. Our results suggest lumbosacral TSS engages side-specific spinal sensorimotor networks associated with ipsilateral lower extremity function in humans.

摘要

经皮脊髓刺激(TSS)是一种非侵入性技术,可调节脊髓内的感觉运动回路,已被证明能够实现广泛的功能,而这些功能在脊髓损伤患者中被认为是永久性受损的。然而,TSS 可以在多大程度上用于靶向特定的脊髓中侧电路仍然不清楚。我们假设,TSS 单侧施加于脊柱腰骶部中线旁约 2 厘米的皮肤,可选择性地激活同侧脊髓感觉运动回路,导致下游下肢神经肌肉的同侧激活。在 15 名健康受试者仰卧位时,TSS 阴极和阳极置于脊柱中线的外侧,并且 TSS 脉冲的定时与下肢肌肉活动和力的记录同步。在运动阈值下,与来自同一肌肉的对侧记录相比,左、右侧 TSS 诱发的肌肉活动在同侧肢体明显更高。同样,我们观察到同侧肢体的力产生显著增加,与对侧肢体相比。在施加成对 TSS 脉冲时,在一侧脊髓施加初始刺激后 50 毫秒,在对侧施加第二刺激,结果表明同侧肢体肌肉反应在初始刺激后降低,而对侧肌肉反应没有降低,表明对侧脊髓中侧感觉运动回路的特异性激活。我们的结果表明,TSS 可以通过负责健康人类下肢功能的腰骶感觉运动网络选择性地激活同侧神经肌肉。我们证明了经皮脊髓刺激(TSS)的选择性,该刺激已被证明可使慢性瘫痪的人类恢复功能。具体而言,我们证明了施加于脊髓外侧的 TSS 可以选择性地激活同侧脊髓感觉运动网络。我们通过记录下肢肌肉肌电图和力来量化腰骶脊髓网络活动。我们的结果表明,腰骶部 TSS 激活了与人类同侧下肢功能相关的特异性脊髓感觉运动网络。

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