Effect of Combined Treadmill Training and Magnetic Stimulation on Spasticity and Gait Impairments after Cervical Spinal Cord Injury
Effect of Combined Treadmill Training and Magnetic Stimulation on Spasticity and Gait Impairments after Cervical Spinal Cord Injury
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DOI：
10.1089/neu.2013.3096
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发表时间：
2014-06-15
影响因子：
4.2
通讯作者：
Bose, Prodip
中科院分区：
文献类型：
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作者：
Hou, Jiamei;Nelson, Rachel;Bose, Prodip
痉挛和步态障碍是颈髓损伤后常见的两种残疾。本研究采用大鼠低位C6/7中度挫伤后C-SCI模型，观察早期平板运动训练(TM)对大鼠低位C6/7中度挫伤后痉挛和步态损害的治疗作用。与对照组或单一治疗组相比，联合治疗组(TM+TSMSC)显示出与速度相关的脚踝扭矩和小腿三头肌肌电爆发幅度的最大幅度的下降，这些幅度被时间锁定在延长的初始阶段，并且在通过三维运动学和走秀步态分析量化的肢体协调性方面改善最大。与C-SCI非治疗动物的组织相比，这些与治疗相关的痉挛和步态障碍指标的显著降低还伴随着与治疗相关的腰椎脊髓(SC)节段多巴胺β-羟基酶、谷氨酸脱羧酶67、伽马氨基丁酸B受体和脑源性神经营养因子的显著上调。我们认为，治疗诱导的这些系统的上调增强了SC的适应性可塑性，部分是通过增强突触前和突触后反射调节过程的表达。此外，我们认为，在C-SCI的背景下进行运动训练可能会降低自发的节段性异常可塑性和下行可塑性。因此，TM SC治疗的特点是一种佐剂刺激，可以进一步增强这种能力。这些数据首次表明，TM和TM联合应用可有效治疗C-SCI所致的痉挛和步态损害，并为C-SCI后早期TM-SC干预的可行性和有效性提供了临床前论证。
Spasticity and gait impairments are two common disabilities after cervical spinal cord injury (C-SCI). In this study, we tested the therapeutic effects of early treadmill locomotor training (Tm) initiated at postoperative (PO) day 8 and continued for 6 weeks with injury site transcranial magnetic stimulation (TMSsc) on spasticity and gait impairments after low C6/7 moderate contusion C-SCI in a rat model. The combined treatment group (Tm + TMSsc) showed the most robust decreases in velocity-dependent ankle torques and triceps surae electromyography burst amplitudes that were time locked to the initial phase of lengthening, as well as the most improvement in limb coordination quantitated using three-dimensional kinematics and CatWalk gait analyses, compared to the control or single-treatment groups. These significant treatment-associated decreases in measures of spasticity and gait impairment were also accompanied by marked treatment-associated up-regulation of dopamine beta-hydroxylase, glutamic acid decarboxylase 67, gamma-aminobutyric acid B receptor, and brain-derived neurotrophic factor in the lumbar spinal cord (SC) segments of the treatment groups, compared to tissues from the C-SCI nontreated animals. We propose that the treatment-induced up-regulation of these systems enhanced the adaptive plasticity in the SC, in part through enhanced expression of pre- and postsynaptic reflex regulatory processes. Further, we propose that locomotor exercise in the setting of C-SCI may decrease aspects of the spontaneous maladaptive segmental and descending plasticity. Accordingly, TMSsc treatment is characterized as an adjuvant stimulation that may further enhance this capacity. These data are the first to suggest that a combination of Tm and TMSsc across the injury site can be an effective treatment modality for C-SCI-induced spasticity and gait impairments and provided a pre-clinical demonstration for feasibility and efficacy of early TMSsc intervention after C-SCI.