Intraspinal microstimulation for the recovery of function following spinal cord injury.
Intraspinal microstimulation for the recovery of function following spinal cord injury.
复制标题
DOI：
10.1016/b978-0-444-53815-4.00004-2
复制
发表时间：
2011
影响因子：
--
通讯作者：
Mushahwar, Vivian K.
中科院分区：
文献类型：
--
作者：
Bamford, Jeremy A.;Mushahwar, Vivian K.
脊髓损伤是一种毁灭性的神经损伤，常导致膀胱、肠道和性功能的损害，以及对病变部位以下脊髓节段支配的肌肉失去自主控制。目前正在研究几种恢复失去的功能的疗法。这些包括鼓励神经保留和受影响组织的再生，以及通过药物和康复手段干预以改善功能。本文将重点介绍电流在脊髓中的应用，以重新激活现有的协调和控制损伤下方平滑肌和骨骼肌的电路。我们首先简要回顾了脊髓内微刺激（ISMS）在脊髓损伤后膀胱功能恢复中的应用，以及它作为一种研究工具来绘制协调运动的脊髓回路。然后，我们提出了回顾我们自己的结果与使用ISMS恢复站立和行走运动后脊髓损伤。我们讨论了ISMS的作用机制以及它们如何与动物模型中观察到的功能结果相关。这些包括通道纤维的激活，它导致激活通过脊髓的跨突触传播，以及ISMS产生抗疲劳、负重运动的能力。我们从植入技术、稳定性以及机械和电因素引起的损伤等方面阐述了ISMS的临床潜力。最后，我们建议在材料和技术方面进行改进，为临床原理证明做准备，并回顾我们目前为实现这些目标所做的努力。
Spinal cord injury is a devastating neurological trauma, often resulting in the impairment of bladder, bowel, and sexual function as well as the loss of voluntary control of muscles innervated by spinal cord segments below the lesion site. Research is ongoing into several classes of therapies to restore lost function. These include the encouragement of neural sparing and regeneration of the affected tissue, and the intervention with pharmacological and rehabilitative means to improve function. This review will focus on the application of electrical current in the spinal cord in order to reactivate extant circuitry which coordinates and controls smooth and skeletal muscle below the injury. We first present a brief historical review of intraspinal microstimulation (ISMS) focusing on its use for restoring bladder function after spinal cord injury as well as its utilization as a research tool for mapping spinal cord circuits that coordinate movements. We then present a review of our own results related to the use of ISMS for restoring standing and walking movements after spinal cord injury. We discuss the mechanisms of action of ISMS and how they relate to observed functional outcomes in animal models. These include the activation of fibers-in-passage which lead to the transsynaptic spread of activation through the spinal cord and the ability of ISMS to produce fatigue-resistant, weight-bearing movements. We present our thoughts on the clinical potential for ISMS with regard to implantation techniques, stability, and damage induced by mechanical and electrical factors. We conclude by suggesting improvements in materials and techniques that are needed in preparation for a clinical proof-of-principle and review our current attempts to achieve these.