Impact of long-term epidural electrical stimulation enabled task-specific training on secondary conditions of chronic paraplegia in two humans
Impact of long-term epidural electrical stimulation enabled task-specific training on secondary conditions of chronic paraplegia in two humans
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DOI：
10.1080/10790268.2020.1739894
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发表时间：
2020-03-20
影响因子：
1.7
通讯作者：
Zhao, Kristin
中科院分区：
文献类型：
--
作者：
Beck, Lisa;Veith, Daniel;Zhao, Kristin
简介：脊髓损伤（SCI）通常会导致与自主神经和代谢功能障碍相关的慢性继发性健康状况。硬膜外电刺激（EES）结合特定任务训练已被证明能够使慢性瘫痪患者的运动功能。报告的EES对继发性健康状况（如膀胱功能和身体成分）的影响有限。我们报告了EES对膀胱功能和身体成分中SCI相关继发性健康变化的影响。研究方法：两名运动和感觉完全性SCI的参与者在腰骶脊髓表面植入16电极阵列后，在没有EES的情况下进行了6个月的康复，随后使用EES进行了12个月的特定任务训练。参与者每周在实验室进行三天的培训，并在此时间范围内在家中使用EES进行特定任务活动。膀胱和身体组成的变化分别通过临床可用的神经性膀胱功能测试和双能X线吸收测定法记录。结果如下：在一名参与者中，我们观察到研究结束时尿失禁发作增加，膀胱顺应性和压力恶化。两名参与者的骨矿物质密度变化均不显著;然而，一名参与者通过减少android/gynoid比率（-0.15; 6个月的训练）重新分配体脂，显示瘦体重大幅增加（+9.1 kg; 6个月的训练）。结论：针对站立和踏步优化的EES可能会对神经源性膀胱功能产生负面影响。密切监测膀胱健康是必要的，以防止不良的膀胱顺应性，这可能导致上尿路恶化。相反，EES可以作为常规锻炼方式的辅助工具，通过激活SCI以下脊柱节段支配的肌肉组织来改善身体组成。
Introduction: Spinal cord injury (SCI) often results in chronic secondary health conditions related to autonomic and metabolic dysfunction. Epidural electrical stimulation (EES) combined with task-specific training has been shown to enable motor function in individuals with chronic paralysis. The reported effects of EES on secondary health conditions, such as bladder function and body composition, are limited. We report the impact of EES on SCI-related secondary health changes in bladder function and body composition. Methods: Two participants with motor and sensory complete SCI performed 6 months of rehabilitation without EES followed by 12 months of task-specific training with EES after implantation of a 16-electrode array on the surface of the lumbosacral spinal cord. Participants performed three days of training per week in the laboratory, and additionally performed task-specific activities with EES at home during this time frame. Changes in bladder and body composition were recorded via clinically-available testing of neurogenic bladder functionality and dual-energy X-ray absorptiometry, respectively. Results: In one participant, we observed an increase in episodes of urinary incontinence with worsening bladder compliance and pressures at the end of the study. Bone mineral density changes were insignificant in both participants; however, one participant showed a substantial increase in lean mass (+9.1 kg; 6 months of training) via redistribution of body fat through an android/gynoid ratio reduction (-0.15; 6 months of training). Conclusion: EES optimized for standing and stepping may negatively impact neurogenic bladder functionality. Close monitoring of bladder health is imperative to prevent undesirable bladder compliance, which can lead to upper urinary tract deteriorations. Conversely, EES may serve as an adjunct tool with regular exercise modalities to improve body composition through activation of musculature innervated by spinal segments that are below the SCI.