Brain and spinal cord paired stimulation coupled with locomotor training facilitates motor output in human spinal cord injury.
Brain and spinal cord paired stimulation coupled with locomotor training facilitates motor output in human spinal cord injury.
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DOI：
10.3389/fneur.2022.1000940
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发表时间：
2022
影响因子：
3.4
通讯作者：
中科院分区：
文献类型：
--
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神经调节的联合干预导致神经康复得到了研究人员的极大关注，类似于临床康复方法。在这项随机临床试验中，我们确定了在运动训练期间，初级运动皮质的经颅磁刺激(TMS)与胸腰椎区域的经皮脊髓(TSP)刺激配对时，步态过程中支配多条腿肌肉的运动神经元的净输出的变化。在受损较少的小腿的站立阶段，TMS在(TMS-经脊髓)之前或之后(TMS-TMS)被给予。10名慢性不完全性或完全性脊髓损伤患者接受了至少20次训练。每次训练包括240对刺激，在机动跑步机上进行机器人辅助踏步训练，时间超过10分钟，持续1小时。体重支持、腿部指导力和跑步机速度根据每个受试者不弯曲膝盖或拖拽脚趾的能力进行调整。在辅助踏步过程中，在每次踝部和膝部肌肉干预前后记录到的大部分跨脊髓诱发电位(TEP)都是以相位依赖的模式调制的。经脊髓TMS和运动训练影响膝关节和踝部肌肉的运动神经元输出，踝部TEP以相位依赖的方式进行调制。TMS-经脊柱和运动训练增加了膝关节的运动神经元输出，但不增加脚踝肌肉的运动神经元输出。我们的结果支持，在慢性脊髓损伤患者中，有针对性的脑和脊髓刺激改变了多个脊髓节段神经元的反应。脑和脊髓无创刺激结合运动训练是一种新的神经调节方法，有望成为人类脊髓损伤后康复的一种方式。
Combined interventions for neuromodulation leading to neurorecovery have gained great attention by researchers to resemble clinical rehabilitation approaches. In this randomized clinical trial, we established changes in the net output of motoneurons innervating multiple leg muscles during stepping when transcranial magnetic stimulation (TMS) of the primary motor cortex was paired with transcutaneous spinal (transspinal) stimulation over the thoracolumbar region during locomotor training. TMS was delivered before (TMS-transspinal) or after (transspinal-TMS) transspinal stimulation during the stance phase of the less impaired leg. Ten individuals with chronic incomplete or complete SCI received at least 20 sessions of training. Each session consisted of 240 paired stimuli delivered over 10-min blocks for 1 h during robotic assisted step training on a motorized treadmill. Body weight support, leg guidance force and treadmill speed were adjusted based on each subject's ability to step without knee buckling or toe dragging. Most transspinal evoked potentials (TEPs) recorded before and after each intervention from ankle and knee muscles during assisted stepping were modulated in a phase-dependent pattern. Transspinal-TMS and locomotor training affected motor neuron output of knee and ankle muscles with ankle TEPs to be modulated in a phase-dependent manner. TMS-transspinal and locomotor training increased motor neuron output for knee but not for ankle muscles. Our results support that targeted brain and spinal cord stimulation alters responsiveness of neurons over multiple spinal segments in people with chronic SCI. Noninvasive stimulation of the brain and spinal cord along with locomotor training is a novel neuromodulation method that can become a promising modality for rehabilitation in humans after SCI.
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