Neurophysiological Changes After Paired Brain and Spinal Cord Stimulation Coupled With Locomotor Training in Human Spinal Cord Injury.
Neurophysiological Changes After Paired Brain and Spinal Cord Stimulation Coupled With Locomotor Training in Human Spinal Cord Injury.
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DOI：
10.3389/fneur.2021.627975
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发表时间：
2021
影响因子：
3.4
通讯作者：
Knikou M
中科院分区：
文献类型：
--
作者：
Pulverenti TS;Zaaya M;Grabowski M;Grabowski E;Islam MA;Li J;Murray LM;Knikou M
涉及通过重复刺激和运动训练的活动依赖性神经可塑性机制的神经生理学变化在研究中并不常见，尽管干预的组合是常见的临床实践。在这项随机临床试验中，我们建立了运动皮层的经颅磁刺激（TMS）与经皮胸腰段脊柱（transspinal）刺激在运动训练过程中提供的人脊髓损伤（SCI）时的神经生理学变化。我们假设，经颅磁刺激（TMS-经脊髓）刺激前交付促进功能重组的脊髓网络在步进。在该方案中，TMS诱导的皮质脊髓齐射在足够的时间到达脊髓，以与跨脊髓刺激诱导的多个脊髓节段上的α运动神经元的去极化相互作用。我们进一步假设，经脊髓（transspinal-TMS）刺激后提供TMS诱导不太明显的影响。在该方案中，在允许经脊髓刺激诱导的动作电位到达运动皮层并在其起源部位影响下行运动截击的时间递送经脊髓刺激。14名运动不完全和完全SCI患者参加了至少25次会议。两种刺激方案都是在受损较轻的腿的站立阶段进行的。每次训练包括240对刺激，在10分钟的块。在经脊髓-TMS中，左侧比目鱼肌H-反射在站立阶段增加，右侧比目鱼肌H-反射在摆动中期减少。在TMS-transspinal没有发现显着的变化。当比目鱼肌H-反射进行分组的TMS-目标肢体的基础上，transspinal-TMS和运动训练促进H-反射抑制摆动相，而TMS-transspinal和运动训练导致促进比目鱼肌H-反射的立场相的步骤周期。此外，transspinal-TMS和TMS-transspinalpaired-associative stimulation（PAS）和运动训练促进了更多的运动活动的生理调节，从而在辅助步进运动神经元的去极化。我们的研究结果支持，有针对性的非侵入性刺激皮质脊髓和脊髓神经元通路加上运动训练产生神经生理学的变化，有利于加强在SCI后的感觉运动功能的不同赤字的人。
Neurophysiological changes that involve activity-dependent neuroplasticity mechanisms via repeated stimulation and locomotor training are not commonly employed in research even though combination of interventions is a common clinical practice. In this randomized clinical trial, we established neurophysiological changes when transcranial magnetic stimulation (TMS) of the motor cortex was paired with transcutaneous thoracolumbar spinal (transspinal) stimulation in human spinal cord injury (SCI) delivered during locomotor training. We hypothesized that TMS delivered before transspinal (TMS-transspinal) stimulation promotes functional reorganization of spinal networks during stepping. In this protocol, TMS-induced corticospinal volleys arrive at the spinal cord at a sufficient time to interact with transspinal stimulation induced depolarization of alpha motoneurons over multiple spinal segments. We further hypothesized that TMS delivered after transspinal (transspinal-TMS) stimulation induces less pronounced effects. In this protocol, transspinal stimulation is delivered at time that allows transspinal stimulation induced action potentials to arrive at the motor cortex and affect descending motor volleys at the site of their origin. Fourteen individuals with motor incomplete and complete SCI participated in at least 25 sessions. Both stimulation protocols were delivered during the stance phase of the less impaired leg. Each training session consisted of 240 paired stimuli delivered over 10-min blocks. In transspinal-TMS, the left soleus H-reflex increased during the stance-phase and the right soleus H-reflex decreased at mid-swing. In TMS-transspinal no significant changes were found. When soleus H-reflexes were grouped based on the TMS-targeted limb, transspinal-TMS and locomotor training promoted H-reflex depression at swing phase, while TMS-transspinal and locomotor training resulted in facilitation of the soleus H-reflex at stance phase of the step cycle. Furthermore, both transspinal-TMS and TMS-transspinal paired-associative stimulation (PAS) and locomotor training promoted a more physiological modulation of motor activity and thus depolarization of motoneurons during assisted stepping. Our findings support that targeted non-invasive stimulation of corticospinal and spinal neuronal pathways coupled with locomotor training produce neurophysiological changes beneficial to stepping in humans with varying deficits of sensorimotor function after SCI.
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影响因子：
4
作者：
Côté MP;Murray LM;Knikou M
通讯作者：
Knikou M
影响因子：
9.2
作者：
Bunday, Karen L.;Perez, Monica A.
通讯作者：
Perez, Monica A.
影响因子：
5.3
作者：
Cote, Marie-Pascale;Gandhi, Sapan;Houle, John D.
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影响因子：
2
作者：
Klimstra, Marc;Zehr, E. Paul
通讯作者：
Zehr, E. Paul
影响因子：
2.5
作者：
Knikou, Maria;Murray, Lynda M.
通讯作者：
Murray, Lynda M.