Effect of epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study.
Effect of epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study.
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DOI：
10.1016/s0140-6736(11)60547-3
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发表时间：
2011-06-04
期刊：
影响因子：
168.9
通讯作者：
Edgerton, V. Reggie
中科院分区：
文献类型：
--
作者：
Harkema, Susan;Gerasimenko, Yury;Hodes, Jonathan;Burdick, Joel;Angeli, Claudia;Chen, Yangsheng;Ferreira, Christie;Willhite, Andrea;Rejc, Enrico;Grossman, Robert G.;Edgerton, V. Reggie
反复刺激脊髓和训练似乎增强了有意识地控制运动的能力。1例C7-T1半脱位3年后出现临床可检测到的自主运动功能完全丧失，T1脊髓节段以下的感觉部分保留。在170次运动训练后，将16电极阵列手术放置在硬脑膜（L1-S1脊髓段）上，以允许慢性电刺激。植入后和整个站立再训练与硬膜外刺激，进行了29个实验。广泛的刺激组合和参数进行了测试，以实现站立和踏步。硬膜外刺激使人腰骶脊髓回路能够动态地引起完全负重站立，仅在临床运动完全SCI受试者中提供4·25分钟的平衡辅助。这发生在使用刺激参数优化站立时，同时提供双边承重本体感受输入。运动样的模式，也观察到刺激参数进行了优化时，步进。此外，植入后7个月，受试者恢复了对某些腿部运动的脊髓上控制，但仅在硬膜外刺激期间。即使在严重的下颈椎损伤后，腰骶段内残留的神经网络也可以被重新激活进入功能状态，以便它可以识别感觉输入集合的特定细节，从而可以作为神经控制的来源。此外，新形成的对同一腰骶段的棘上输入可以作为另一个控制源重新出现。硬膜外刺激的特定任务训练可能重新激活了先前沉默的备用神经回路或促进了可塑性。这表明，这些干预措施可能是一种可行的临床方法，用于严重瘫痪后的功能恢复。美国国立卫生研究院和克里斯托弗和达纳里夫基金会。
Repeated periods of stimulation of the spinal cord and training seems to have amplified the ability to consciously control movement. An individual three years post C7-T1 subluxation presented with a complete loss of clinically detectable voluntary motor function and partial preservation of sensation below the T1 cord segment. Following 170 locomotor training sessions, a 16-electrode array was surgically placed on the dura (L1-S1 cord segments) to allow for chronic electrical stimulation. After implantation and throughout stand retraining with epidural stimulation, 29 experiments were performed. Extensive stimulation combinations and parameters were tested to achieve standing and stepping. Epidural stimulation enabled the human lumbosacral spinal circuitry to dynamically elicit full weight-bearing standing with assistance provided only for balance for 4·25 minutes in a subject with a clinically motor complete SCI. This occurred when using stimulation at parameters optimized for standing while providing bilateral load-bearing proprioceptive input. Locomotor-like patterns were also observed when stimulation parameters were optimized for stepping. In addition, seven months after implantation, the subject recovered supraspinal control of certain leg movements, but only during epidural stimulation. Even after a severe low cervical spinal injury, the neural networks remaining within the lumbosacral segments can be reactivated into functional states so that it can recognize specific details of ensembles of sensory input to the extent that it can serve as the source of neural control. In addition, newly formed supraspinal input to this same lumbosacral segments can re-emerge as another source of control. Task specific training with epidural stimulation may have reactivated previously silent spared neural circuits or promoted plasticity. This suggests that these interventions could be a viable clinical approach for functional recovery after severe paralysis. National Institutes of Health and Christopher and Dana Reeve Foundation.