Engaging Cervical Spinal Cord Networks to Reenable Volitional Control of Hand Function in Tetraplegic Patients.
Engaging Cervical Spinal Cord Networks to Reenable Volitional Control of Hand Function in Tetraplegic Patients.
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DOI：
10.1177/1545968316644344
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发表时间：
2016-11
影响因子：
4.2
通讯作者：
Gerasimenko Y
中科院分区：
文献类型：
--
作者：
Lu DC;Edgerton VR;Modaber M;AuYong N;Morikawa E;Zdunowski S;Sarino ME;Sarrafzadeh M;Nuwer MR;Roy RR;Gerasimenko Y
脊髓损伤导致的上肢瘫痪会导致个人日常生活的独立性极大丧失。四肢瘫痪一年后，手部功能很少有有意义的改善。即使手部意志功能略有改善的治疗进展也会显着影响高位颈椎损伤患者的生活质量。最近已显示出通过硬膜外刺激神经调节腰骶脊髓回路以恢复姿势功能和腿部意志控制的能力。一个关键问题是是否可以使用类似的神经调节策略来改善上肢的意志运动控制，即被认为不如姿势和运动“自动”的运动任务的执行。在这项研究中，研究了颈椎硬膜外刺激对慢性颈髓损伤受试者手部功能的影响。在此，我们证明硬膜外刺激可以应用于慢性损伤的人类颈脊髓，以促进手部意志功能。植入颈部硬膜外电极阵列的两名受试者在硬膜外刺激下表现出手部力量（约三倍）和手部意志控制的改善。目前的数据足以表明，慢性四肢瘫痪患者的手部运动功能可以通过颈髓神经调节得到改善，因此应该作为一种可能的临床干预措施进行全面探索。
Paralysis of the upper-limbs from spinal cord injury results in an enormous loss of independence in an individual’s daily life. Meaningful improvement in hand function is rare after one year of tetraparesis. Therapeutic developments that result in even modest gains in hand volitional function will significantly impact the quality of life for patients afflicted with high cervical injury. The ability to neuromodulate the lumbosacral spinal circuitry via epidural stimulation in regaining postural function and volitional control of the legs has been recently shown. A key question is whether a similar neuromodulatory strategy can be used to improve volitional motor control of the upper-limbs, i.e., performance of motor tasks considered to be less “automatic” than posture and locomotion. In this study, the effects of cervical epidural stimulation on hand function are characterized in subjects with chronic cervical cord injury. Herein we show that epidural stimulation can be applied to the chronic injured human cervical spinal cord to promote volitional hand function. Two subjects implanted with an cervical epidural electrode array demonstrated improved hand strength (approximately three-fold) and volitional hand control in the presence of epidural stimulation. The present data are sufficient to suggest that hand motor function in individuals with chronic tetraplegia can be improved with cervical cord neuromodulation and thus should be comprehensively explored as a possible clinical intervention.