Crawford Research Institute, Shepherd Center, Atlanta, Georgia (N.H.E., E.F.F.); Program in Applied Physiology, Georgia Institute of Technology, Atlanta (N.H.E., E.F.F.); and Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia (E.F.F.).
J Neurol Phys Ther. 2022 Oct 1;46(4):281-292. doi: 10.1097/NPT.0000000000000403. Epub 2022 May 11.
Improved walking function is a priority among persons with motor-incomplete spinal cord injury (PwMISCI). Accessibility and cost limit long-term participation in locomotor training offered in specialized centers. Intensive motor training that facilitates neuroplastic mechanisms that support skill learning and can be implemented in the home/community may be advantageous for promoting long-term restoration of walking function. Additionally, increasing corticospinal drive via transcranial direct current stimulation (tDCS) may enhance training effects. In this pilot study, we investigated whether a moderate-intensity motor skill training (MST) circuit improved walking function in PwMISCI and whether augmenting training with tDCS influenced outcomes.
Twenty-five adults (chronic, motor-incomplete spinal cord injury) were randomized to a 3-day intervention of a locomotor-related MST circuit and concurrent application of sham tDCS (MST+tDCS sham ) or active tDCS (MST+tDCS). The primary outcome was overground walking speed. Secondary outcomes included walking distance, cadence, stride length, and step symmetry index (SI).
Analyses revealed significant effects of the MST circuit on walking speed, walking distance, cadence, and bilateral stride length but no effect on interlimb SI. No significant between-groups differences were observed. Post hoc analyses revealed within-groups change in walking speed (ΔM = 0.13 m/s, SD = 0.13) that app-roached the minimally clinically important difference of 0.15 m/s.
Brief, intensive MST involving locomotor-related activities significantly increased walking speed, walking distance, and spatiotemporal measures in PwMISCI. Significant additive effects of tDCS were not observed; however, participation in only 3 days of MST was associated with changes in walking speed that were comparable to longer locomotor training studies.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A386 ).
提高运动功能是运动不完全性脊髓损伤患者（PwMISCI）的首要目标。由于可及性和成本限制，患者无法长期参与专门中心提供的行走训练。强化运动训练可以促进支持技能学习的神经可塑性机制，并且可以在家庭/社区中实施，这可能有利于促进长期行走功能的恢复。此外，通过经颅直流电刺激（tDCS）增加皮质脊髓驱动可能会增强训练效果。在这项初步研究中，我们研究了中等强度运动技能训练（MST）电路是否可以改善 PwMISCI 的行走功能，以及是否通过 tDCS 增强训练会影响结果。
25 名成年人（慢性、运动不完全性脊髓损伤）被随机分配到 3 天的运动相关 MST 电路干预和假 tDCS （MST+tDCS 假）或真 tDCS （MST+tDCS 真）联合应用。主要结果是地面行走速度。次要结果包括行走距离、步频、步长和步对称指数（SI）。
分析显示 MST 电路对行走速度、行走距离、步频和双侧步长有显著影响，但对肢体间 SI 没有影响。未观察到组间差异。事后分析显示，组内行走速度变化（ΔM = 0.13m/s，SD = 0.13）接近 0.15m/s 的最小临床重要差异。
涉及运动相关活动的短暂、密集的 MST 显著提高了 PwMISCI 的行走速度、行走距离和时空测量值。未观察到 tDCS 的显著附加效应；然而，仅参与 3 天的 MST 训练与行走速度的变化相关，该变化与更长时间的行走训练研究相当。视频摘要可从作者处获得更多见解（观看视频，请访问：http://links.lww.com/JNPT/A386）。
