Pulverenti Timothy S, Zaaya Morad, Grabowski Ewelina, Grabowski Monika, Knikou Maria
Klab4Recovery Research Program, The City University of New York, New York, NY, United States.
PhD Program in Biology and Collaborative Neuroscience Program, Graduate Center of the City University of New York and College of Staten Island, New York, NY, United States.
Front Neurol. 2022 Oct 13;13:1000940. doi: 10.3389/fneur.2022.1000940. eCollection 2022.
Combined interventions for neuromodulation leading to neurorecovery have gained great attention by researchers to resemble clinical rehabilitation approaches. In this randomized clinical trial, we established changes in the net output of motoneurons innervating multiple leg muscles during stepping when transcranial magnetic stimulation (TMS) of the primary motor cortex was paired with transcutaneous spinal (transspinal) stimulation over the thoracolumbar region during locomotor training. TMS was delivered before (TMS-transspinal) or after (transspinal-TMS) transspinal stimulation during the stance phase of the less impaired leg. Ten individuals with chronic incomplete or complete SCI received at least 20 sessions of training. Each session consisted of 240 paired stimuli delivered over 10-min blocks for 1 h during robotic assisted step training on a motorized treadmill. Body weight support, leg guidance force and treadmill speed were adjusted based on each subject's ability to step without knee buckling or toe dragging. Most transspinal evoked potentials (TEPs) recorded before and after each intervention from ankle and knee muscles during assisted stepping were modulated in a phase-dependent pattern. Transspinal-TMS and locomotor training affected motor neuron output of knee and ankle muscles with ankle TEPs to be modulated in a phase-dependent manner. TMS-transspinal and locomotor training increased motor neuron output for knee but not for ankle muscles. Our results support that targeted brain and spinal cord stimulation alters responsiveness of neurons over multiple spinal segments in people with chronic SCI. Noninvasive stimulation of the brain and spinal cord along with locomotor training is a novel neuromodulation method that can become a promising modality for rehabilitation in humans after SCI.
旨在实现神经恢复的联合神经调节干预措施已引起研究人员的广泛关注，以模拟临床康复方法。在这项随机临床试验中，我们研究了在运动训练期间，当对初级运动皮层进行经颅磁刺激（TMS）并同时对胸腰段区域进行经皮脊髓（经脊髓）刺激时，支配多条腿部肌肉的运动神经元在迈步过程中的净输出变化。在患侧较轻的腿的站立期，TMS在经脊髓刺激之前（TMS - 经脊髓）或之后（经脊髓 - TMS）施加。10名慢性不完全性或完全性脊髓损伤患者接受了至少20次训练。每次训练包括在电动跑步机上进行机器人辅助步行训练时，在10分钟的时间段内以240对刺激为一组，持续1小时。根据每个受试者在不出现膝盖屈曲或脚趾拖地的情况下行走的能力，调整体重支持、腿部引导力和跑步机速度。在辅助步行过程中，每次干预前后从踝关节和膝关节肌肉记录的大多数经脊髓诱发电位（TEP）以相位依赖模式进行调制。经脊髓 - TMS和运动训练以相位依赖方式调节膝关节和踝关节肌肉的运动神经元输出，影响踝关节TEP。TMS - 经脊髓和运动训练增加了膝关节但未增加踝关节肌肉的运动神经元输出。我们的结果支持，有针对性的脑和脊髓刺激可改变慢性脊髓损伤患者多个脊髓节段神经元的反应性。脑和脊髓的无创刺激以及运动训练是一种新型神经调节方法，有望成为脊髓损伤后人类康复的有效方式。
