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颈部经皮刺激与腰骶部硬膜外刺激相结合可改善脊髓损伤个体对步行运动的自主控制。

Combined cervical transcutaneous with lumbosacral epidural stimulation improves voluntary control of stepping movements in spinal cord injured individuals.

作者信息

Angeli Claudia A, Gerasimenko Yury

机构信息

Bioengineering Department, J. B. Speed School of Engineering, University of Louisville, Louisville, KY, United States.

Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.

出版信息

Front Bioeng Biotechnol. 2023 Feb 2;11:1073716. doi: 10.3389/fbioe.2023.1073716. eCollection 2023.

Abstract

Lumbosacral spinal cord neuromodulation has shown the ability to restore voluntary control and stepping in individuals with chronic spinal cord injury. We combined cervical transcutaneous and lumbar epidural stimulation to explore the brain-spinal connectomes and their influence in spinal excitability and interlimb coupling. Four individuals with a prior implanted lumbosacral spinal cord epidural stimulator participated in the study. We assessed lower extremity muscle activity and kinematics during intentional stepping in both non-weight bearing and weight-bearing environments. Our results showed an inhibition of motor evoked potentials generated by spinal cord epidural stimulation when cervical transcutaneous stimulation is applied. In contrast, when intentional stepping is performed in a non-weight bearing setting, range of motion, motor output amplitude, and coordination are improved when cervical transcutaneous and lumbar epidural stimulations are combined. Similarly, with both stimulations applied, coordination is improved and motor output variability is decreased when intentional stepping is performed on a treadmill with body weight support. Combined transcutaneous cervical and epidural lumbar stimulation demonstrated an improvement of voluntary control of stepping in individuals with chronic motor complete paralysis. The immediate functional improvement promoted by the combination of cervical and lumbar stimulation adds to the body of evidence for increasing spinal excitability and improvement of function that is possible in individuals with chronic paralysis.

摘要

腰骶脊髓神经调节已显示出能够恢复慢性脊髓损伤患者的自主控制和行走能力。我们将颈部经皮刺激和腰部硬膜外刺激相结合,以探索脑-脊髓连接组及其对脊髓兴奋性和肢体间耦合的影响。四名先前植入腰骶脊髓硬膜外刺激器的患者参与了该研究。我们评估了在非负重和负重环境下有意行走过程中下肢肌肉活动和运动学情况。我们的结果表明,当施加颈部经皮刺激时,脊髓硬膜外刺激产生的运动诱发电位受到抑制。相反,在非负重环境下进行有意行走时,颈部经皮刺激和腰部硬膜外刺激相结合可改善运动范围、运动输出幅度和协调性。同样,在有体重支持的跑步机上进行有意行走时,同时施加两种刺激可改善协调性并降低运动输出变异性。经皮颈部刺激和硬膜外腰部刺激相结合证明可改善慢性运动完全性瘫痪患者的行走自主控制能力。颈部和腰部刺激相结合带来的即时功能改善为增加慢性瘫痪患者的脊髓兴奋性和功能改善提供了更多证据。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a3e0/9932494/9b4ea27263c0/fbioe-11-1073716-g001.jpg

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