McKenzie Kelly, Veit Nicole, Aalla Shreya, Yang Chen, Giffhorn Matt, Lynott Alec, Buchler Kristine, Kishta Ameen, Barry Alex, Sandhu Milap, Moon Yaejin, Rymer William Zev, Jayaraman Arun
Shirley Ryan AbilityLab, Chicago.
Shirley Ryan AbilityLab, Chicago; Department of Biomedical Engineering, Northwestern University, Evanston.
Arch Phys Med Rehabil. 2024 Oct;105(10):1930-1937. doi: 10.1016/j.apmr.2024.06.011. Epub 2024 Jul 3.
To evaluate if acute intermittent hypoxia (AIH) coupled with transcutaneous spinal cord stimulation (tSCS) enhances task-specific training and leads to superior and more sustained gait improvements as compared with each of these strategies used in isolation in persons with chronic, incomplete spinal cord injury.
Proof of concept, randomized crossover trial.
Outpatient, rehabilitation hospital.
Ten participants completed 3 intervention arms: (1) AIH, tSCS, and gait training (AIH + tSCS); (2) tSCS plus gait training (SHAM AIH + tSCS); and (3) gait training alone (SHAM + SHAM). Each arm consisted of 5 consecutive days of intervention with a minimum of a 4-week washout between arms. The order of arms was randomized. The study took place from December 3, 2020, to January 4, 2023.
10-meter walk test at self-selected velocity (SSV) and fast velocity, 6-minute walk test, timed Up and Go (TUG) and secondary outcome measures included isometric ankle plantarflexion and dorsiflexion torque RESULTS: TUG improvements were 3.44 seconds (95% CI: 1.24-5.65) significantly greater in the AIH + tSCS arm than the SHAM AIH + tSCS arm at post-intervention (POST), and 3.31 seconds (95% CI: 1.03-5.58) greater than the SHAM + SHAM arm at 1-week follow up (1WK). SSV was 0.08 m/s (95% CI: 0.02-0.14) significantly greater following the AIH + tSCS arm than the SHAM AIH + tSCS at POST. Although not significant, the AIH + tSCS arm also demonstrated the greatest average improvements compared with the other 2 arms at POST and 1WK for the 6-minute walk test, fast velocity, and ankle plantarflexion torque.
This pilot study is the first to demonstrate that combining these 3 neuromodulation strategies leads to superior improvements in the TUG and SSV for individuals with chronic incomplete spinal cord injury and warrants further investigation.
评估急性间歇性低氧（AIH）联合经皮脊髓刺激（tSCS）与单独使用这两种策略相比，是否能增强特定任务训练，并使慢性不完全性脊髓损伤患者的步态改善更显著且更持久。
概念验证性随机交叉试验。
门诊康复医院。
10名参与者完成3个干预组：（1）AIH、tSCS和步态训练（AIH + tSCS）；（2）tSCS加步态训练（假AIH + tSCS）；（3）仅步态训练（假 + 假）。每个组连续进行5天干预，组间至少间隔4周洗脱期。组的顺序是随机的。研究于2020年12月3日至2023年1月4日进行。
自选速度（SSV）和快速速度下的10米步行测试、6分钟步行测试、定时起立行走测试（TUG），次要结局指标包括等长踝关节跖屈和背屈扭矩。结果：干预后（POST），AIH + tSCS组的TUG改善比假AIH + tSCS组显著多3.44秒（95%CI：1.24 - 5.65），1周随访（1WK）时比假 + 假组多3.31秒（95%CI：1.03 - 5.58）。干预后，AIH + tSCS组的SSV比假AIH + tSCS组显著快0.08米/秒（95%CI：0.02 - 0.14）。虽然不显著，但在POST和1WK时，AIH + tSCS组在6分钟步行测试、快速速度和踝关节跖屈扭矩方面与其他两组相比，也显示出最大的平均改善。
这项初步研究首次表明，将这三种神经调节策略结合起来，能使慢性不完全性脊髓损伤患者的TUG和SSV得到更显著改善，值得进一步研究。
