Momeni Kamyar, Ramanujam Arvind, Ravi Manikandan, Garbarini Erica, Forrest Gail F
Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ, United States.
Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States.
Front Hum Neurosci. 2020 Sep 25;14:549965. doi: 10.3389/fnhum.2020.549965. eCollection 2020.
The objective of this study was to evaluate the biomechanical, neural, and functional outcomes during a 10-min treadmill stepping trial before and after two independent interventions with neuromuscular electrical stimulation (ES) in an individual with spinal cord injury (SCI). In this longitudinal study, a 34-year-old male with sensory- and motor-complete SCI (C5/C6) underwent two consecutive interventions: 61 h of supine lower limb ES (ES-alone) followed by 51 h of ES combined with stand training (ST) using an overhead body-weight support (BWS) system (ST + ES). In post ES-alone (unloaded), compared to baseline, the majority (∼60%) of lower extremity muscles decreased their peak surface electromyography (sEMG) amplitude, while in post ST + ES (loaded), compared to post ES-alone, there was a restoration in muscle activation that endured the continuous 10-min stepping. Temporal α-motor neuron activity patterns were observed for the SCI participant. In post ST + ES, there were increases in spinal activity patterns during mid-stance at spinal levels L5-S2 for the right and left limbs. Moreover, in post ES-alone, trunk stability increased with excursions from the midline of the base-of-support (50%) to the left (44.2%; Baseline: 54.2%) and right (66.4%; baseline: 77.5%). The least amount of trunk excursion observed post ST + ES, from midline to left (43%; AB: 22%) and right (64%; AB: 64%). Overall, in post ES-alone, there were gains in trunk independence with a decrease in lower limb muscle activation, whereas in post ST + ES, there were gains in trunk independence and increased muscle activation in both bilateral trunk muscles as well as lower limb muscles during the treadmill stepping paradigm. The results of the study illustrate the importance of loading during the stimulation for neural and mechanical gains.
本研究的目的是评估在一名脊髓损伤（SCI）个体中，在接受两次独立的神经肌肉电刺激（ES）干预前后，进行10分钟跑步机踏步试验期间的生物力学、神经和功能结果。在这项纵向研究中，一名34岁的感觉和运动完全性SCI（C5/C6）男性接受了两次连续干预：61小时的仰卧位下肢ES（仅ES），随后是51小时的ES结合使用头顶体重支持（BWS）系统的站立训练（ST）（ST + ES）。在单独ES后（无负荷），与基线相比，大多数（约60%）下肢肌肉的表面肌电图（sEMG）峰值幅度降低，而在ST + ES后（有负荷），与单独ES后相比，肌肉激活恢复，且持续了连续10分钟的踏步。观察了SCI参与者的颞α运动神经元活动模式。在ST + ES后，左右下肢在脊髓L5 - S2水平的站立中期脊髓活动模式增加。此外，在单独ES后，随着支撑面中心（50%）向左侧（44.2%；基线：54.2%）和右侧（66.4%；基线：77.5%）偏移，躯干稳定性增加。在ST + ES后观察到的躯干偏移量最少，从中心到左侧（43%；AB：22%）和右侧（64%；AB：64%）。总体而言，在单独ES后，躯干独立性增加，下肢肌肉激活减少，而在ST + ES后，在跑步机踏步模式下，躯干独立性增加，双侧躯干肌肉以及下肢肌肉的肌肉激活增加。研究结果说明了刺激期间负荷对于神经和机械增益的重要性。
