IEEE Trans Neural Syst Rehabil Eng. 2021;29:310-319. doi: 10.1109/TNSRE.2021.3049133. Epub 2021 Mar 2.
Paralysis of the upper extremity severely restricts independence and quality of life after spinal cord injury. Regaining control of hand and arm movements is the highest treatment priority for people with paralysis, 6-fold higher than restoring walking ability. Nevertheless, current approaches to improve upper extremity function typically do not restore independence. Spinal cord stimulation is an emerging neuromodulation strategy to restore motor function. Recent studies using surgically implanted electrodes demonstrate impressive improvements in voluntary control of standing and stepping. Here we show that transcutaneous electrical stimulation of the spinal cord leads to rapid and sustained recovery of hand and arm function, even after complete paralysis. Notably, the magnitude of these improvements matched or exceeded previously reported results from surgically implanted stimulation. Additionally, muscle spasticity was reduced and autonomic functions including heart rate, thermoregulation, and bladder function improved. Perhaps most striking is that all six participants maintained their gains for at least three to six months beyond stimulation, indicating functional recovery mediated by long-term neuroplasticity. Several participants resumed their hobbies that require fine motor control, such as playing the guitar and oil painting, for the first time in up to 12 years since their injuries. Our findings demonstrate that non-invasive transcutaneous electrical stimulation of the spinal networks restores movement and function of the hands and arm for people with both complete paralysis and long-term spinal cord injury.
上肢瘫痪严重限制了脊髓损伤后的独立性和生活质量。对于瘫痪患者来说，恢复手部和手臂运动的控制是最高的治疗重点，这比恢复行走能力的优先级高 6 倍。然而，目前改善上肢功能的方法通常无法恢复独立性。脊髓刺激是一种新兴的神经调节策略，可以恢复运动功能。最近使用手术植入电极的研究表明，在站立和行走方面的自愿控制方面取得了令人印象深刻的改善。在这里，我们表明，经皮脊髓电刺激可快速且持续地恢复手和手臂的功能，即使是在完全瘫痪的情况下。值得注意的是，这些改善的幅度与之前报道的手术植入刺激的结果相匹配或超过。此外，肌肉痉挛减少，自主功能（包括心率、体温调节和膀胱功能）得到改善。最引人注目的是，所有六名参与者在刺激后至少三个月至六个月内保持了他们的改善，表明长期神经可塑性介导的功能恢复。一些参与者恢复了他们的爱好，这些爱好需要精细的运动控制，例如弹吉他和油画，这是他们受伤以来长达 12 年的第一次。我们的研究结果表明，经皮脊髓网络的非侵入性电刺激可恢复完全瘫痪和长期脊髓损伤患者的手部和手臂的运动和功能。
