Dietz V, Colombo G, Jensen L, Baumgartner L
Paraplegic Centre, University Hospital Balgrist, Zurich, Switzerland.
Ann Neurol. 1995 May;37(5):574-82. doi: 10.1002/ana.410370506.
The induction of complex bilateral leg muscle activation combined with coordinated stepping movements is demonstrated in patients with complete paraplegia. This was achieved by partially unloading patients who were on a moving treadmill. In comparison to healthy subjects, the paraplegic patients displayed a less dynamic mode of muscle activation. In all other respects leg muscle electromyographic activity was modulated in a similar manner to that in healthy subjects. However, the level of electromyographic activity in the gastrocnemius (the main antigravity muscle during gait) was considerably lower in the patients. During the course of a daily locomotor training program, the amplitude of gastrocnemius electromyographic activity increased significantly during the stance phase, while inappropriate tibialis anterior activation decreased. Incompletely paraplegic patients benefited from the training with respect to performance of unsupported stepping movements on solid ground. In about half of completely paraplegic patients with low muscle tone, no beneficial effect of the training was seen. This may be due to an inhibitory effect on spinal neuronal activity by drugs patients were taking (e.g., prazosin, clonidine, cannabinoids). In this study intrathecal application of clonidine drastically reduced, while epinephrine enhanced locomotor muscle electromyographic activity. The results of this study promise to be significant in the treatment of paraplegic patients.
在完全性截瘫患者中已证实可诱导复杂的双侧腿部肌肉激活并伴有协调的踏步运动。这是通过对在移动跑步机上的患者进行部分减重来实现的。与健康受试者相比，截瘫患者表现出肌肉激活的动态模式较差。在所有其他方面，腿部肌肉的肌电图活动与健康受试者的调节方式相似。然而，患者腓肠肌（步态中主要的抗重力肌肉）的肌电图活动水平明显较低。在每日运动训练计划过程中，腓肠肌肌电图活动的幅度在站立期显著增加，而不适当的胫前肌激活减少。不完全性截瘫患者在在坚实地面上进行无支撑踏步运动的表现方面从训练中受益。在大约一半肌张力低的完全性截瘫患者中，未观察到训练的有益效果。这可能是由于患者正在服用的药物（例如哌唑嗪、可乐定、大麻素）对脊髓神经元活动的抑制作用。在本研究中，鞘内注射可乐定可显著降低运动肌肉的肌电图活动，而肾上腺素则增强其活动。这项研究的结果有望在截瘫患者的治疗中具有重要意义。
