Recovery of control of posture and locomotion after a spinal cord injury: solutions staring us in the face.
Recovery of control of posture and locomotion after a spinal cord injury: solutions staring us in the face.
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DOI：
10.1016/s0079-6123(09)17526-x
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发表时间：
2009
影响因子：
--
通讯作者：
Edgerton VR
中科院分区：
文献类型：
--
作者：
Fong AJ;Roy RR;Ichiyama RM;Lavrov I;Courtine G;Gerasimenko Y;Tai YC;Burdick J;Edgerton VR
在过去的20年里，脊髓损伤的研究取得了巨大的进展。然而，由于我们被拼图的各个部分所消耗，我们作为一个社会未能抓住我们发现的总和的重要性。我们目前的知识应该使我们能够改善脊髓损伤患者的生活。多个领域的进展为寻求有效的策略组合提供了工具，用于在严重脊髓损伤后恢复行走和站立。肌肉生理学研究为脊髓损伤后如何保持肌肉功能特性提供了见解。了解脊髓网络在处理对产生运动功能很重要的感觉信息中的作用，将研究重点放在开发提高运动回路敏感性的治疗方法上，并仔细管理本体感受和皮肤刺激的呈现以促进恢复。药理学促进或抑制神经递质系统、脊髓刺激和康复运动训练，这些都通过调节脊髓回路的生理状态发挥作用，已经成为有前途的方法。早期的技术发展，如机器人训练系统和用于刺激脊髓的高密度电极阵列，可以显着提高精度，并最大限度地减少损伤后治疗的侵入性。寻求综合治疗的互补效应和有效整合生物工程相关技术进步的战略是一种尚未开发的潜力，可能会产生直接影响。在此，我们回顾了这些研究领域的主要发现，并提出了一个统一的愿景。尽管还有很多工作要做，但我们已经有能力，更重要的是，我们有责任帮助脊髓损伤患者。
Over the past 20 years, tremendous advances have been made in the field of spinal cord injury research. Yet, consumed with individual pieces of the puzzle, we have failed as a community to grasp the magnitude of the sum of our findings. Our current knowledge should allow us to improve the lives of patients suffering from spinal cord injury. Advances in multiple areas have provided tools for pursuing effective combination of strategies for recovering stepping and standing after a severe spinal cord injury. Muscle physiology research has provided insight into how to maintain functional muscle properties after a spinal cord injury. Understanding the role of the spinal networks in processing sensory information that is important for the generation of motor functions has focused research on developing treatments that sharpen the sensitivity of the locomotor circuitry and that carefully manage the presentation of proprioceptive and cutaneous stimuli to favor recovery. Pharmacological facilitation or inhibition of neurotransmitter systems, spinal cord stimulation, and rehabilitative motor training, which all function by modulating the physiological state of the spinal circuitry, have emerged as promising approaches. Early technological developments, such as robotic training systems and high-density electrode arrays for stimulating the spinal cord, can significantly enhance the precision and minimize the invasiveness of treatment after an injury. Strategies that seek out the complementary effects of combination treatments and that efficiently integrate relevant technical advances in bioengineering represent an untapped potential and are likely to have an immediate impact. Herein, we review key findings in each of these areas of research and present a unified vision for moving forward. Much work remains, but we already have the capability, and more importantly, the responsibility, to help spinal cord injury patients now.