Chandrasekaran Subhalakshmi, Davis John, Bersch Ines, Goldberg Gary, Gorgey Ashraf S
Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA.
Swiss Paraplegic Centre, Nottwil, Switzerland; Institute of Clinical Sciences, Department of Orthopedics at the University of Gothenburg, Gothenburg, Sweden.
Neural Regen Res. 2020 Aug;15(8):1397-1407. doi: 10.4103/1673-5374.274326.
Spinal cord injury (SCI) population with injury below T10 or injury to the cauda equina region is characterized by denervated muscles, extensive muscle atrophy, infiltration of intramuscular fat and formation of fibrous tissue. These morphological changes may put individuals with SCI at higher risk for developing other diseases such as various cardiovascular diseases, diabetes, obesity and osteoporosis. Currently, there is no available rehabilitation intervention to rescue the muscles or restore muscle size in SCI individuals with lower motor neuron denervation. We, hereby, performed a review of the available evidence that supports the use of electrical stimulation in restoration of denervated muscle following SCI. Long pulse width stimulation (LPWS) technique is an upcoming method of stimulating denervated muscles. Our primary objective is to explore the best stimulation paradigms (stimulation parameters, stimulation technique and stimulation wave) to achieve restoration of the denervated muscle. Stimulation parameters, such as the pulse duration, need to be 100-1000 times longer than in innervated muscles to achieve desirable excitability and contraction. The use of electrical stimulation in animal and human models induces muscle hypertrophy. Findings in animal models indicate that electrical stimulation, with a combination of exercise and pharmacological interventions, have proven to be effective in improving various aspects like relative muscle weight, muscle cross sectional area, number of myelinated regenerated fibers, and restoring some level of muscle function. Human studies have shown similar outcomes, identifying the use of LPWS as an effective strategy in increasing muscle cross sectional area, the size of muscle fibers, and improving muscle function. Therefore, displaying promise is an effective future stimulation intervention. In summary, LPWS is a novel stimulation technique for denervated muscles in humans with SCI. Successful studies on LPWS of denervated muscles will help in translating this stimulation technique to the clinical level as a rehabilitation intervention after SCI.
胸10以下脊髓损伤（SCI）或马尾神经区域损伤的人群，其特征为肌肉失神经支配、广泛的肌肉萎缩、肌内脂肪浸润以及纤维组织形成。这些形态学变化可能使SCI患者患其他疾病的风险更高，如各种心血管疾病、糖尿病、肥胖症和骨质疏松症。目前，尚无有效的康复干预措施来挽救SCI伴下运动神经元失神经支配患者的肌肉或恢复肌肉大小。在此，我们对支持在SCI后使用电刺激恢复失神经支配肌肉的现有证据进行了综述。长脉冲宽度刺激（LPWS）技术是一种新兴的刺激失神经支配肌肉的方法。我们的主要目标是探索最佳刺激模式（刺激参数、刺激技术和刺激波形）以实现失神经支配肌肉的恢复。刺激参数，如脉冲持续时间，需要比支配正常肌肉时长100 - 1000倍，以达到理想的兴奋性和收缩。在动物和人体模型中使用电刺激可诱导肌肉肥大。动物模型的研究结果表明，电刺激与运动和药物干预相结合，已被证明在改善诸如相对肌肉重量、肌肉横截面积、有髓再生纤维数量等多个方面以及恢复一定程度的肌肉功能方面是有效的。人体研究也显示了类似的结果，确定LPWS是增加肌肉横截面积、肌肉纤维大小以及改善肌肉功能的有效策略。因此，作为一种有效的未来刺激干预措施具有前景。总之，LPWS是一种针对SCI患者失神经支配肌肉的新型刺激技术。关于失神经支配肌肉LPWS的成功研究将有助于将这种刺激技术转化为SCI后的临床康复干预措施。
