Influence of Spinal Cord Integrity on Gait Control in Human Spinal Cord Injury.
Influence of Spinal Cord Integrity on Gait Control in Human Spinal Cord Injury.
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DOI：
10.1177/1545968315600524
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发表时间：
2016-07
影响因子：
4.2
通讯作者：
Curt A
中科院分区：
文献类型：
--
作者：
Awai L;Bolliger M;Ferguson AR;Courtine G;Curt A
脊髓损伤(SCI)的临床试验主要依靠简化的结果指标(如速度、距离)来获得步态控制复杂变化的全局替代。然而，这些评估缺乏足够的敏感性来确定潜在损害的具体模式，并针对更具体的治疗干预措施。解开SCI后行走步态模式的差异控制，超越时间和距离的度量。22名运动不完全性脊髓损伤患者和21名健康对照使用高分辨率三维运动跟踪系统进行步态评估，并应用无偏多因素分析进行临床和电生理评估。运动不完全性脊髓损伤患者表现出不同程度的脊髓完整性(脊髓导电性)，行走速度严重受限，步态模式改变。对所有收集的数据进行主成分分析(PCA)，发现与行走速度、肢体内协调变形和脊髓完整性相关的参数之间存在显著的一致性，可解释结果方差的45%(PC1)。与第一个PC不同的是，步态周期变量(步长、步态周期相位、节奏；PC 2)的调制相对于恢复的步行速度保持正常，而髋关节和膝关节的运动范围相对于步行速度明显改变(PC 3)。在运动不完全性脊髓损伤中，可以辨别出不同的离散控制步态参数簇，这些参数可以细化步态损伤的评估，而不是步行速度和距离的结果。这些发现特别不同于其他神经疾病(中风、帕金森)，在针对和解开干预措施的复杂影响方面更加离散，以改善运动不全脊髓损伤后的步行结果。
Clinical trials in spinal cord injury (SCI) primarily rely on simplified outcome metrics (i.e. speed, distance) to obtain a global surrogate for the complex alterations of gait control. However, these assessments lack sufficient sensitivity to identify specific patterns of underlying impairment and to target more specific treatment interventions. To disentangle the differential control of walking gait patterns following SCI beyond measures of time and distance. The gait of 22 motor incomplete SCI subjects and 21 healthy controls was assessed using a high-resolution three-dimensional motion tracking system and complemented by clinical and electrophysiological evaluations applying unbiased multivariate analysis. Motor incomplete SCI patients showed varying degrees of spinal cord integrity (spinal conductivity) with severe limitations in walking speed and altered gait patterns. Principal component analysis (PCA) applied on all the collected data uncovered robust coherence between parameters related to walking speed, distortion of intralimb coordination and spinal cord integrity explaining 45% of outcome variance (PC 1). Distinct from the first PC, the modulation of gait-cycle variables (step length, gait-cycle phases, cadence; PC 2) remained normal with respect to regained walking speed while hip and knee ranges of motion were distinctly altered with respect to walking speed (PC 3). In motor incomplete SCI distinct clusters of discretely-controlled gait parameters can be discerned that refine the evaluation of gait impairment beyond outcomes of walking speed and distance. These findings are specifically different from other neurological disorders (stroke, Parkinson) and are more discrete at targeting and disentangling the complex effects of interventions to improve walking outcome following motor incomplete SCI.