长期硬膜外电刺激辅助任务特异性训练对 2 例慢性截瘫患者继发状况的影响。
Impact of long-term epidural electrical stimulation enabled task-specific training on secondary conditions of chronic paraplegia in two humans.
机构信息
Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota, USA.
Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, Minnesota, USA.
出版信息
J Spinal Cord Med. 2021 Sep;44(5):800-805. doi: 10.1080/10790268.2020.1739894. Epub 2020 Mar 23.
Spinal cord injury (SCI) often results in chronic secondary health conditions related to autonomic and metabolic dysfunction. Epidural electrical stimulation (EES) combined with task-specific training has been shown to enable motor function in individuals with chronic paralysis. The reported effects of EES on secondary health conditions, such as bladder function and body composition, are limited. We report the impact of EES on SCI-related secondary health changes in bladder function and body composition. Two participants with motor and sensory complete SCI performed 6 months of rehabilitation without EES followed by 12 months of task-specific training with EES after implantation of a 16-electrode array on the surface of the lumbosacral spinal cord. Participants performed three days of training per week in the laboratory, and additionally performed task-specific activities with EES at home during this time frame. Changes in bladder and body composition were recorded via clinically-available testing of neurogenic bladder functionality and dual-energy X-ray absorptiometry, respectively. In one participant, we observed an increase in episodes of urinary incontinence with worsening bladder compliance and pressures at the end of the study. Bone mineral density changes were insignificant in both participants; however, one participant showed a substantial increase in lean mass (+9.1 kg; 6 months of training) via redistribution of body fat through an android/gynoid ratio reduction (-0.15; 6 months of training). EES optimized for standing and stepping may negatively impact neurogenic bladder functionality. Close monitoring of bladder health is imperative to prevent undesirable bladder compliance, which can lead to upper urinary tract deteriorations. Conversely, EES may serve as an adjunct tool with regular exercise modalities to improve body composition through activation of musculature innervated by spinal segments that are below the SCI.
脊髓损伤(SCI)常导致与自主和代谢功能障碍相关的慢性继发性健康状况。硬膜外电刺激(EES)结合特定任务训练已被证明能使慢性瘫痪患者恢复运动功能。EES 对膀胱功能和身体成分等继发性健康状况的影响有限。我们报告了 EES 对与 SCI 相关的继发性健康变化(包括膀胱功能和身体成分)的影响。两名运动和感觉完全性 SCI 患者在接受 EES 植入 16 电极阵列之前,首先进行了 6 个月的康复治疗(无 EES),然后进行了 12 个月的特定任务训练。患者每周在实验室进行三天训练,在此期间还在家中使用 EES 进行特定任务活动。通过神经原性膀胱功能的临床可用测试和双能 X 射线吸收法分别记录膀胱和身体成分的变化。在一名参与者中,我们观察到随着研究的进行,尿失禁发作次数增加,膀胱顺应性和压力变差。两名参与者的骨矿物质密度变化均不显著;然而,一名参与者通过身体脂肪分布的改变(android/gynoid 比率降低 -0.15;6 个月的训练),使瘦体重显著增加(+9.1kg;6 个月的训练)。优化用于站立和行走的 EES 可能会对神经原性膀胱功能产生负面影响。密切监测膀胱健康对于防止不理想的膀胱顺应性至关重要,因为这可能导致上尿路恶化。相反,EES 可以作为一种辅助工具,与常规运动方式相结合,通过激活脊髓损伤以下节段支配的肌肉来改善身体成分。