Klab4Recovery Research Laboratory, Department of Physical Therapy, College of Staten Island, New York, NY, USA.
PhD Program in Biology and Collaborative Neuroscience Program, Graduate Center of The City University of New York, New York, NY, USA.
Spinal Cord Ser Cases. 2021 Jul 3;7(1):55. doi: 10.1038/s41394-021-00421-6.
Pilot study (case series).
The objective of this study was to establish spinal neurophysiological changes following high-frequency transspinal stimulation during robot-assisted step training in individuals with chronic motor complete spinal cord injury (SCI).
University research laboratory (Klab4Recovery).
Four individuals with motor complete SCI received an average of 18 sessions of transspinal stimulation over the thoracolumbar region with a pulse train at 333 Hz during robotic-assisted step training. Each session lasted ~1 h, with an average of 240 stimulations delivered during each training session. Before and after the combined intervention, we evaluated the amplitude modulation of the long-latency tibialis anterior (TA) flexion reflex and transspinal evoked potentials (TEP) recorded from flexors and extensors during assisted stepping, and the TEP recruitment curves at rest.
The long-latency TA flexion reflex was depressed in all phases of the step cycle and the phase-dependent amplitude modulation of TEPs was altered during assisted stepping, while spinal motor output based on TEP recruitment curves was increased after the combined intervention.
This is the first study documenting noninvasive transspinal stimulation coupled with locomotor training depresses flexion reflex excitability and concomitantly increases motoneuron output over multiple spinal segments for both flexors and extensors in people with motor complete SCI. While both transspinal stimulation and locomotor training may act via similar activity-dependent neuroplasticity mechanisms, combined interventions for rehabilitation of neurological disorders has not been systematically assessed. Our current findings support locomotor training induced neuroplasticity may be augmented with transspinal stimulation.
初步研究（病例系列）。
本研究的目的是在机器人辅助步训期间，对慢性运动完全性脊髓损伤（SCI）患者进行高频经脊髓刺激，从而确定脊柱神经生理变化。
大学研究实验室（Klab4Recovery）。
4 名运动完全性 SCI 患者接受了平均 18 次高频经脊髓刺激，在机器人辅助步训期间，采用 333Hz 的脉冲序列对胸腰椎进行刺激。每次治疗持续约 1 小时，平均每次治疗过程中进行 240 次刺激。在联合干预前后，我们评估了长潜伏期胫骨前肌（TA）屈肌反射的幅度调制，以及辅助行走期间记录的屈肌和伸肌的经脊髓诱发电位（TEP），并评估了静息时的 TEP 募集曲线。
在步周期的所有阶段，长潜伏期 TA 屈肌反射均受到抑制，辅助行走时 TEP 的相位依赖性幅度调制也发生改变，而基于 TEP 募集曲线的脊髓运动输出在联合干预后增加。
这是第一项记录非侵入性经脊髓刺激与运动训练相结合，可抑制运动完全性 SCI 患者的屈肌反射兴奋性，同时增加多个脊髓节段的屈肌和伸肌运动神经元输出的研究。虽然经脊髓刺激和运动训练都可能通过类似的活动依赖性神经可塑性机制起作用，但针对神经障碍的联合干预尚未得到系统评估。我们目前的发现支持，经脊髓刺激可能增强运动训练诱导的神经可塑性。
