Department of Rehabilitation Medicine, Xijing Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, 710032, PR China.
Lintong Rehabilitation and Convalescent Centre, Xi'an, 710600, PR China.
BMC Neurol. 2024 Jun 22;24(1):213. doi: 10.1186/s12883-024-03705-0.
After spinal cord injury (SCI), a large number of survivors suffer from severe motor dysfunction (MD). Although the injury site is in the spinal cord, excitability significantly decreases in the primary motor cortex (M1), especially in the lower extremity (LE) area. Unfortunately, M1 LE area-targeted repetitive transcranial magnetic stimulation (rTMS) has not achieved significant motor improvement in individuals with SCI. A recent study reported that the M1 hand area in individuals with SCl contains a compositional code (the movement-coding component of neural activity) that links matching movements from the upper extremities (UE) and the LE. However, the correlation between bilateral M1 hand area excitability and overall functional recovery is unknown.
To clarify the changes in the excitability of the bilateral M1 hand area after SCI and its correlation with motor recovery, we aim to specify the therapeutic parameters of rTMS for SCI motor rehabilitation.
This study is a 12-month prospective cohort study. The neurophysiological and overall functional status of the participants will be assessed. The primary outcomes included single-pulse and paired-pulse TMS. The second outcome included functional near-infrared spectroscopy (fNIRS) measurements. Overall functional status included total motor score, modified Ashworth scale score, ASIA Impairment Scale grade, spinal cord independence measure and modified Barthel index. The data will be recorded for individuals with SCI at disease durations of 1 month, 2 months, 4 months, 6 months and 12 months. The matched healthy controls will be measured during the same period of time after recruitment.
The present study is the first to analyze the role of bilateral M1 hand area excitability changes in the evaluation and prediction of overall functional recovery (including motor function and activities of daily living) after SCI, which will further expand the traditional theory of the predominant role of M1, optimize the current rTMS treatment, and explore the brain-computer interface design for individuals with SCI.
ChiCTR2300068831.
脊髓损伤（SCI）后，大量幸存者遭受严重运动功能障碍（MD）。尽管损伤部位在脊髓，但初级运动皮层（M1）的兴奋性明显降低，尤其是下肢（LE）区域。不幸的是，针对 M1 LE 区域的重复经颅磁刺激（rTMS）在 SCI 患者中并未实现显著的运动改善。最近的一项研究报告称，SCI 患者的 M1 手部区域包含一个组合码（神经活动的运动编码成分），可将上肢（UE）和 LE 的匹配运动联系起来。然而，双侧 M1 手部区域兴奋性与整体功能恢复之间的相关性尚不清楚。
为了阐明 SCI 后双侧 M1 手部区域兴奋性的变化及其与运动恢复的关系，我们旨在明确 rTMS 治疗 SCI 运动康复的治疗参数。
这是一项为期 12 个月的前瞻性队列研究。将评估参与者的神经生理学和整体功能状态。主要结局包括单脉冲和双脉冲 TMS。第二个结局包括功能性近红外光谱（fNIRS）测量。整体功能状态包括总运动评分、改良 Ashworth 量表评分、ASIA 损伤量表分级、脊髓独立性测量和改良巴氏指数。将在 SCI 发病 1 个月、2 个月、4 个月、6 个月和 12 个月时记录患者的数据。招募后同一时期将对匹配的健康对照组进行测量。
本研究首次分析了双侧 M1 手部区域兴奋性变化在 SCI 后整体功能恢复（包括运动功能和日常生活活动）评估和预测中的作用，这将进一步扩展传统的 M1 主导作用理论，优化当前的 rTMS 治疗，并探索 SCI 患者的脑机接口设计。
ChiCTR2300068831。
