Rodionov Andrei, Savolainen Sarianna, Kirveskari Erika, Mäkelä Jyrki P, Shulga Anastasia
BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Clinical Neurosciences, Clinical Neurophysiology, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Front Neurol. 2020 May 20;11:397. doi: 10.3389/fneur.2020.00397. eCollection 2020.
Recovery of lower-limb function after spinal cord injury (SCI) is dependent on the extent of remaining neural transmission in the corticospinal pathway. The aim of this proof-of-concept pilot study was to explore the effects of long-term paired associative stimulation (PAS) on leg muscle strength and walking in people with SCI. Five individuals with traumatic incomplete chronic tetraplegia (>34 months post-injury, motor incomplete, 3 females, mean age 60 years) with no contraindications to transcranial magnetic stimulation (TMS) received PAS to one or both legs for 2 months (28 sessions in total, 5 times a week for the first 2 weeks and 3 times a week thereafter). The participants were evaluated with the Manual Muscle Test (MMT), AIS motor and sensory examination, Modified Asworth Scale (MAS), and the Spinal Cord Independence Measure (SCIM) prior to the intervention, after 1 and 2 months of PAS, and after a 1-month follow-up. The study was registered at clinicaltrials.gov (NCT03459885). During the intervention, MMT scores and AIS motor scores increased significantly ( = 0.014 and = 0.033, respectively). Improvements were stable in follow-up. AIS sensory scores, MAS, and SCIM were not modified significantly. MMT score prior to intervention was a good predictor of changes in walking speed ( = 0.962). The results of this proof-of-concept pilot study justify a larger trial on the effect of long-term PAS on leg muscle strength and walking in people with chronic incomplete SCI.
脊髓损伤（SCI）后下肢功能的恢复取决于皮质脊髓通路中剩余神经传递的程度。本概念验证性初步研究的目的是探讨长期配对联想刺激（PAS）对SCI患者腿部肌肉力量和步行能力的影响。五名创伤性不完全性慢性四肢瘫痪患者（损伤后>34个月，运动不完全性，3名女性，平均年龄60岁），无经颅磁刺激（TMS）禁忌证，接受单腿或双腿PAS治疗2个月（共28次治疗，前2周每周5次，此后每周3次）。在干预前、PAS治疗1个月和2个月后以及1个月随访后，对参与者进行徒手肌力测试（MMT）、美国脊髓损伤协会（AIS）运动和感觉检查、改良Ashworth量表（MAS）以及脊髓独立测量（SCIM）评估。该研究已在ClinicalTrials.gov注册（NCT03459885）。干预期间，MMT评分和AIS运动评分显著提高（分别为P = 0.014和P = 0.033）。随访期间改善情况稳定。AIS感觉评分、MAS和SCIM无显著变化。干预前的MMT评分是步行速度变化的良好预测指标（r = 0.962）。本概念验证性初步研究的结果证明有必要开展一项更大规模的试验，以研究长期PAS对慢性不完全性SCI患者腿部肌肉力量和步行能力的影响。
