经皮刺激颈脊髓可促进运动神经元放电,并改善脊髓损伤后的手部运动功能。
Transcutaneous stimulation of the cervical spinal cord facilitates motoneuron firing and improves hand-motor function after spinal cord injury.
作者信息
Verma Nikhil, Oh Jeonghoon, Bedoy Ernesto, Chetty Nikole, Steele Alexander G, Park Seo Jeong, Guerrero Jaime R, Faraji Amir H, Weber Douglas, Sayenko Dimitry G
机构信息
Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States.
Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, United States.
出版信息
J Neurophysiol. 2025 Jul 1;134(1):128-143. doi: 10.1152/jn.00422.2024. Epub 2025 Jun 10.
Spinal cord injury (SCI) interrupts signal transmission between the brain and muscles, often leading to permanent motor impairments. Improving hand function is the highest priority for people with tetraplegia. Electrically engaging spinal circuits using spinal cord stimulation has been demonstrated to improve hand function in people with paralysis post-SCI. Here, we used a noninvasive intervention, transcutaneous spinal cord stimulation (tSCS), to facilitate voluntary hand function after SCI. We used a multi-cathode tSCS array to study recruitment patterns across various upper-limb muscles, including forearm subcompartments, in five neurologically intact (NI) participants and five participants with SCI. Our primary objectives was to use tSCS over the cervical spinal cord to delineate the stimulation-evoked response patterns and assess the effects of tSCS on hand motor function in both groups. We demonstrated that tonic tSCS targeting hand muscles enhanced muscle activity (by up to 21%), increased grip strength (by up to 55%), and improved activation patterns in the participants with SCI. Furthermore, using high-density electromyography-based extraction of motor unit activity, we provided experimental evidence that tSCS can transsynaptically modulate the activity of individual motor units, enabling integration of supraspinal inputs within these networks. Our results indicate that targeted tSCS can immediately improve hand motor function after SCI and suggest potential mechanisms for its facilitatory effects. Similar facilitation of motor unit activity, enhanced muscle activation (up to 65%), and, in some cases, grip strength increases of up to 66%, were also observed in NI participants, indicating that cervical tSCS engages spinal sensorimotor circuits consistently across populations. A multicathode transcutaneous spinal cord stimulation (tSCS) array, combined with high-density electromyography (HDEMG) was used to precisely characterize selectivity in recruitment of motor pools in the cervical spinal cord. Through surface HDEMG-based motor unit extraction, the study demonstrated that tonic, subthreshold tSCS transiently facilitates motor unit firing, via recruitment of sensory afferents, resulting in enhanced muscle output, grip strength, and task-specific muscle activation patterns in individuals with tetraplegia post-SCI.
脊髓损伤(SCI)会中断大脑与肌肉之间的信号传递,常常导致永久性运动功能障碍。改善手部功能是四肢瘫痪患者的首要任务。已证明使用脊髓刺激电刺激脊髓回路可改善脊髓损伤后瘫痪患者的手部功能。在此,我们采用一种非侵入性干预措施,即经皮脊髓刺激(tSCS),来促进脊髓损伤后的自主手部功能。我们使用多阴极tSCS阵列研究了五名神经功能正常(NI)参与者和五名脊髓损伤参与者的包括前臂各亚区在内的各种上肢肌肉的募集模式。我们的主要目标是通过对颈脊髓进行tSCS来描绘刺激诱发的反应模式,并评估tSCS对两组手部运动功能的影响。我们证明,针对手部肌肉的持续性tSCS可增强肌肉活动(增幅高达21%)、增加握力(增幅高达55%),并改善脊髓损伤参与者的激活模式。此外,通过基于高密度肌电图提取运动单位活动,我们提供了实验证据,表明tSCS可通过突触调节单个运动单位的活动,使这些网络内的脊髓上输入得以整合。我们的结果表明,靶向tSCS可在脊髓损伤后立即改善手部运动功能,并提示其促进作用的潜在机制。在NI参与者中也观察到了类似的运动单位活动促进、增强的肌肉激活(增幅高达65%),在某些情况下握力增加高达66%,这表明颈段tSCS在不同人群中均能一致地激活脊髓感觉运动回路。使用多阴极经皮脊髓刺激(tSCS)阵列结合高密度肌电图(HDEMG)来精确表征颈脊髓运动池募集的选择性。通过基于表面HDEMG的运动单位提取,该研究表明,持续性、阈下tSCS通过募集感觉传入神经来短暂促进运动单位放电,从而增强脊髓损伤后四肢瘫痪个体的肌肉输出、握力和特定任务的肌肉激活模式。