Locomotor capacity and recovery of spinal cord function in paraplegic patients: a clinical and electrophysiological evaluation
Locomotor capacity and recovery of spinal cord function in paraplegic patients: a clinical and electrophysiological evaluation
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DOI：
10.1016/s0924-980x(98)00002-2
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发表时间：
1998-04-01
期刊：
影响因子：
--
通讯作者：
Curt, A
中科院分区：
文献类型：
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作者：
Dietz, V;Wirz, M;Curt, A
最近的研究表明，在使用移动跑步机进行身体卸载的情况下，可以诱导并训练截瘫患者的运动模式。本研究通过临床和电生理(胫神经体感诱发电位和运动诱发电位)检查，研究了运动模式的行为及其发展与脊髓功能自然恢复的关系。脊髓运动活动最早可以被诱导的时间是在脊髓休克的迹象消失时。这种活动有别于脊柱伸展反射活动。在完全性和不完全性截瘫患者中，在整个12周的训练期间，每天进行运动训练的踏步周期的站立阶段，腓肠肌肌电活动增加。这与身体下载量的显著减少是一致的。相反，在训练开始后，两组患者的临床和电生理检查分数都没有改善。仅在不完全性截瘫患者中，在训练开始前的一段时间内，神经学检查中获得的感觉和运动评分没有明显增加。在由于尾部损伤而导致截瘫的患者中，通过训练也可以看到运动功能的改善。因此，在脊髓损伤的患者中，除了对脊髓运动中心的影响外，训练对肌肉和肌腱的影响也是存在的。这项研究的发现可能对未来截瘫患者的临床治疗有一定的指导意义。(C)1998年爱思唯尔爱尔兰科学有限公司。
Recent studies have shown that a locomotor pattern can be induced and trained into paraplegic patients under conditions of body unloading using a moving treadmill. The present study investigated the behaviour of the locomotor pattern and also the relationship of its development to the spontaneous recovery of spinal cord function assessed by clinical and electrophysiological (tibial nerve somatosensory evoked potentials and motor evoked potentials) examinations. The earliest time that spinal locomotor activity could be induced was when signs of spinal shock had disappeared. This activity was distinct from spinal stretch reflex activity. In complete and incomplete paraplegic patients an increase of gastrocnemius electromyographic activity occurred during the stance phase of a step cycle with daily locomotor training over the whole training period of 12 weeks. This was coincident with a significant decrease in body unloading. In contrast to this, neither clinical nor electrophysiological examination scores improved after the onset of training in both patient groups. Only in incomplete paraplegic patients was there an insignificant increase in sensory and motor scores obtained in the neurological examination during the time period before onset of training. An improvement of locomotor function by training was also seen in patients with paraplegia due to a cauda lesion. Therefore, in patients with a spinal cord lesion training effects on muscles and tendons are present in addition to those on the spinal locomotor centres. The findings of this study may be relevant for future clinical treatment of paraplegic patients. (C) 1998 Elsevier Science Ireland Ltd.