Porter Jane A, Barss Trevor S, Mann Darren J, Karamzadeh Zahra, Okusanya Deborah O, Hemakumara Sisuri G, Zehr E Paul, Klarner Taryn, Mushahwar Vivian K
Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Alberta, Edmonton, AB T6G 2G3, Canada.
Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB T6G 2R3, Canada.
Biomedicines. 2025 May 19;13(5):1228. doi: 10.3390/biomedicines13051228.
The ability to walk is often lost after neural injury, leading to multiple secondary complications that reduce quality of life and increase healthcare costs. The current rehabilitation interventions primarily focus on restoring leg movements through intensive training on a treadmill or using robotic devices, but ignore engaging the arms. Several groups have recently shown that simultaneous arm and leg (A&L) cycling improves walking function and interlimb connectivity. These findings highlight the importance of neuronal pathways between the arm (cervical) and leg (lumbar) control regions in the spinal cord during locomotion, and emphasize the need for activating these pathways to improve walking after neural injury or disease. While the findings to date provide important evidence about actively including the arms in walking rehabilitation, these strategies have yet to be optimized. Moreover, improvements beyond A&L cycling alone may be possible with conjunctive targeted strategies to enhance spinal interlimb connectivity. The aim of this review is to highlight the current evidence for improvements in walking function and neural interlimb connectivity after neural injury or disease with cycling-based rehabilitation paradigms. Furthermore, strategies to enhance the outcomes of A&L cycling as a rehabilitation strategy are explored. These include the use of functional electrical stimulation-assisted cycling in acute care settings, utilizing non-invasive transcutaneous spinal cord stimulation to activate previously inaccessible circuitry in the spinal cord, and the use of paired arm and leg rehabilitation robotics. This review aims to consolidate the effects of exercise interventions that incorporate the arms on improved outcomes for walking, functional mobility, and neurological integrity, underscoring the importance of integrating the arms into the rehabilitation of walking after neurological conditions affecting sensorimotor function.
神经损伤后常丧失行走能力,导致多种继发并发症,降低生活质量并增加医疗成本。当前的康复干预主要集中在通过在跑步机上进行强化训练或使用机器人设备来恢复腿部运动,但忽略了手臂的参与。最近有几个研究小组表明,同时进行手臂和腿部(A&L)循环训练可改善行走功能和肢体间的连通性。这些发现突出了脊髓中手臂(颈部)和腿部(腰部)控制区域之间的神经元通路在运动过程中的重要性,并强调激活这些通路以改善神经损伤或疾病后的行走能力的必要性。虽然迄今为止的研究结果为在行走康复中积极纳入手臂提供了重要证据,但这些策略尚未得到优化。此外,通过联合靶向策略增强脊髓肢体间连通性,可能实现超越单纯A&L循环训练的进一步改善。本综述的目的是强调目前关于基于循环训练的康复范式在神经损伤或疾病后改善行走功能和神经肢体间连通性的证据。此外,还探讨了增强A&L循环训练作为康复策略效果的方法。这些方法包括在急性护理环境中使用功能性电刺激辅助循环训练,利用非侵入性经皮脊髓刺激激活脊髓中以前无法触及的神经回路,以及使用手臂和腿部配对的康复机器人。本综述旨在巩固将手臂纳入其中的运动干预对改善行走、功能移动性和神经完整性的效果,强调在影响感觉运动功能的神经疾病后将手臂纳入行走康复的重要性。