Evans Nicholas H, Suri Cazmon, Field-Fote Edelle C
Shepherd Center, Crawford Research Institute, Atlanta, GA, United States.
Department of Applied Physiology, Georgia Institute of Technology, Atlanta, GA, United States.
Front Hum Neurosci. 2022 May 11;16:849297. doi: 10.3389/fnhum.2022.849297. eCollection 2022.
Motor training to improve walking and balance function is a common aspect of rehabilitation following motor-incomplete spinal cord injury (MISCI). Evidence suggests that moderate- to high-intensity exercise facilitates neuroplastic mechanisms that support motor skill acquisition and learning. Furthermore, enhancing corticospinal drive via transcranial direct current stimulation (tDCS) may augment the effects of motor training. In this pilot study, we investigated whether a brief moderate-intensity locomotor-related motor skill training (MST) circuit, with and without tDCS, improved walking and balance outcomes in persons with MISCI. In addition, we examined potential differences between within-day (online) and between-day (offline) effects of MST. Twenty-six adults with chronic MISCI, who had some walking ability, were enrolled in a 5-day double-blind, randomized study with a 3-day intervention period. Participants were assigned to an intensive locomotor MST circuit and concurrent application of either sham tDCS (MST+tDCS) or active tDCS (MST+tDCS). The primary outcome was overground walking speed measured during the 10-meter walk test. Secondary outcomes included spatiotemporal gait characteristics (cadence and stride length), peak trailing limb angle (TLA), intralimb coordination (ACC), the Berg Balance Scale (BBS), and the Falls Efficacy Scale-International (FES-I) questionnaire. Analyses revealed a significant effect of the MST circuit, with improvements in walking speed, cadence, bilateral stride length, stronger limb TLA, weaker limb ACC, BBS, and FES-I observed in both the MST+tDCS and MST+tDCS groups. No differences in outcomes were observed between groups. Between-day change accounted for a greater percentage of the overall change in walking outcomes. In persons with MISCI, brief intensive MST involving a circuit of ballistic, cyclic locomotor-related skill activities improved walking outcomes, and selected strength and balance outcomes; however, concurrent application of tDCS did not further enhance the effects of MST.
[ClinicalTrials.gov], identifier [NCT03237234].
运动训练以改善步行和平衡功能是运动不完全性脊髓损伤（MISCI）后康复的常见内容。有证据表明，中高强度运动可促进支持运动技能获得和学习的神经可塑性机制。此外，通过经颅直流电刺激（tDCS）增强皮质脊髓驱动可能会增强运动训练的效果。在这项前瞻性研究中，我们调查了一个简短的中强度运动相关运动技能训练（MST）循环，无论有无tDCS，是否能改善MISCI患者的步行和平衡结果。此外，我们研究了MST在日内（在线）和日间（离线）效应之间的潜在差异。26名有一定步行能力的慢性MISCI成人参加了一项为期5天的双盲随机研究，其中有3天的干预期。参与者被分配到强化运动MST循环，并同时应用假tDCS（MST+tDCS）或活性tDCS（MST+tDCS）。主要结果是在10米步行测试中测得的地面步行速度。次要结果包括时空步态特征（步频和步长）、峰值后肢角度（TLA）、肢体内协调性（ACC）、伯格平衡量表（BBS）和国际跌倒效能量表（FES-I）问卷。分析显示MST循环有显著效果，在MST+tDCS组和MST+tDCS组中均观察到步行速度、步频、双侧步长、优势肢体TLA、非优势肢体ACC、BBS和FES-I的改善。两组之间的结果没有差异。日间变化在步行结果的总体变化中占更大比例。在MISCI患者中，涉及一系列快速、循环运动相关技能活动的简短强化MST改善了步行结果以及选定的力量和平衡结果；然而，同时应用tDCS并没有进一步增强MST的效果。
[ClinicalTrials.gov]，标识符 [NCT03237234]。
