Initiation and modulation of locomotor circuitry output with multisite transcutaneous electrical stimulation of the spinal cord in noninjured humans
Initiation and modulation of locomotor circuitry output with multisite transcutaneous electrical stimulation of the spinal cord in noninjured humans
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DOI：
10.1152/jn.00609.2014
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发表时间：
2015-02-01
影响因子：
2.5
通讯作者：
Edgerton, V. Reggie
中科院分区：
文献类型：
--
作者：
Gerasimenko, Yury;Gorodnichev, Ruslan;Edgerton, V. Reggie
哺乳动物的腰髓具有在没有来自大脑的输入的情况下产生运动活动的能力。之前，我们报道了在脊椎水平T11处的脊髓的经皮电刺激可以激活未受伤受试者的运动回路，当他们的腿被置于重力中性位置时（Gorodnichev RM，Mavarova EA，Pukhov A，Moiseev SA，Savokhin AA，Moshonkina TR，Shcherbakova NA，Kilimnik VA，Selionov VA，Kozlovskaia IB，埃杰顿VR，Gerasimenko IU. 2012）。在本研究中，我们假设刺激多个脊髓部位，因此独特的网络组合汇聚在姿势和运动腰骶网络将更有效地诱导更强大的运动行为和更有选择性的控制比刺激更受限制的网络。我们证明，在颈部，胸部和腰部水平的同时刺激诱导协调的步进运动，在6个未受伤的受试者中的5个在多个关节的运动范围更大。我们发现，除了在L1和/或在C5刺激T11刺激立即导致增强运动学和肢体间协调以及近端和远端腿部肌肉的EMG模式。在C5，然后在L1顺序停止刺激导致逐步退化的步进模式。经皮刺激的协同和相互作用的影响表明，多节段的收敛下降和上升，最有可能propriospinal，影响与运动活动相关的脊髓神经元回路。使用多部位脊髓刺激作为神经调节脊髓回路的策略的潜在影响对于进一步理解控制姿势和运动的机制以及即使在严重脊髓损伤后恢复显著的感觉运动功能具有重要意义。
The mammalian lumbar spinal cord has the capability to generate locomotor activity in the absence of input from the brain. Previously, we reported that transcutaneous electrical stimulation of the spinal cord at vertebral level T11 can activate the locomotor circuitry in noninjured subjects when their legs are placed in a gravity-neutral position (Gorodnichev RM, Pivovarova EA, Pukhov A, Moiseev SA, Savokhin AA, Moshonkina TR, Shcherbakova NA, Kilimnik VA, Selionov VA, Kozlovskaia IB, Edgerton VR, Gerasimenko IU. Fiziol Cheloveka 38: 46-56, 2012). In the present study we hypothesized that stimulating multiple spinal sites and therefore unique combinations of networks converging on postural and locomotor lumbosacral networks would be more effective in inducing more robust locomotor behavior and more selective control than stimulation of more restricted networks. We demonstrate that simultaneous stimulation at the cervical, thoracic, and lumbar levels induced coordinated stepping movements with a greater range of motion at multiple joints in five of six noninjured subjects. We show that the addition of stimulation at L1 and/or at C5 to stimulation at T11 immediately resulted in enhancing the kinematics and interlimb coordination as well as the EMG patterns in proximal and distal leg muscles. Sequential cessation of stimulation at C5 and then at L1 resulted in a progressive degradation of the stepping pattern. The synergistic and interactive effects of transcutaneous stimulation suggest a multisegmental convergence of descending and ascending, and most likely propriospinal, influences on the spinal neuronal circuitries associated with locomotor activity. The potential impact of using multisite spinal cord stimulation as a strategy to neuromodulate the spinal circuitry has significant implications in furthering our understanding of the mechanisms controlling posture and locomotion and for regaining significant sensorimotor function even after a severe spinal cord injury.