Kosair Charities School of Physical Therapy, Spalding University, Louisville, Kentucky.
Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky.
Top Spinal Cord Inj Rehabil. 2023 Winter;29(1):16-32. doi: 10.46292/sci21-00084. Epub 2022 Dec 9.
Neuromodulation via spinal stimulation is a promising therapy that can augment the neuromuscular capacity for voluntary movements, standing, stepping, and posture in individuals with spinal cord injury (SCI). The spinal locomotor-related neuronal network known as a central pattern generator (CPG) can generate a stepping-like motor output in the absence of movement-related afferent signals from the limbs. Using epidural stimulation (EP) in conjunction with activity-based locomotor training (ABLT), the neural circuits can be neuromodulated to facilitate the recovery of locomotor functions in persons with SCI. Recently, transcutaneous spinal stimulation (scTS) has been developed as a noninvasive alternative to EP. Early studies of scTS at thoracolumbar, coccygeal, and cervical regions have demonstrated its effectiveness in producing voluntary leg movements, posture control, and independent standing and improving upper extremity function in adults with chronic SCI. In pediatric studies, the technology of spinal neuromodulation is not yet widespread. There are a limited number of publications reporting on the use of scTS in children and adolescents with either cerebral palsy, spina bifida, or SCI.
脊髓刺激的神经调节是一种有前途的治疗方法，它可以增强脊髓损伤（SCI）患者的自主运动、站立、跨步和姿势的神经肌肉能力。脊髓运动相关的神经元网络，即中枢模式发生器（CPG），可以在没有来自四肢的运动相关传入信号的情况下产生类似踏步的运动输出。通过使用硬膜外刺激（EP）结合基于活动的运动训练（ABLT），可以对神经回路进行神经调节，以促进 SCI 患者运动功能的恢复。最近，经皮脊髓刺激（scTS）已被开发为 EP 的非侵入性替代方法。在胸腰椎、尾骨和颈椎区域进行的早期 scTS 研究表明，它在产生自主腿部运动、姿势控制和独立站立以及改善慢性 SCI 成人上肢功能方面具有有效性。在儿科研究中，脊髓神经调节技术尚未广泛应用。只有少数出版物报告了 scTS 在脑瘫、脊柱裂或 SCI 儿童和青少年中的使用情况。
