Non-Invasive Activation of Cervical Spinal Networks after Severe Paralysis
Non-Invasive Activation of Cervical Spinal Networks after Severe Paralysis
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DOI：
10.1089/neu.2017.5461
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发表时间：
2018-09-01
影响因子：
4.2
通讯作者：
Edgerton, V. Reggie
中科院分区：
文献类型：
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作者：
Gad, Parag;Lee, Sujin;Edgerton, V. Reggie
颈脊髓损伤（SCI）后的上肢瘫痪严重损害了一个人独立生活的能力。虽然恢复手部功能或抓握能力被认为是四肢瘫痪患者最期望的功能之一，但迄今为止，在高度严重颈椎损伤患者中，这方面的治疗进展有限。潜在的假设是，在严重的颈椎脊髓损伤后，颈脊髓内的非功能性感觉-运动网络可以经皮神经调节到生理状态，从而实现并增强手部的自主控制。在每个测试对象的单次会话中，自愿手功能都得到了改善。经过8次非侵入性经皮刺激，结合超过4周的训练，慢性颈椎脊髓损伤受试者的最大自主握力增加了约325%（有刺激时）和约225%（无同时刺激时测试握力）（美国脊髓损伤协会损伤量表[AIS] B， n=3; AIS C, n=5） -损伤后1-21年)。左手和右手的最大握力都有所提高，增加的幅度与手的优势无关。我们引用经皮激活运动控制的神经调节方法来强调所使用的刺激参数是为了避免直接诱导肌肉收缩而设计的，而是为了使任务能够根据受试者的自愿意图执行。在一些受试者中，自主神经功能、下肢运动功能和感觉在病变水平以下有改善。虽然在每个受试者中都观察到神经调节训练效果，但需要进一步的对照和盲法研究来确定更大更广泛的受试者群体的反应性，这些受试者在类型、严重程度和损伤后年份上都有所不同。然而，似乎相当令人信服的是，在控制步进神经调节剂的腰骶神经网络中普遍认为的中枢模式生成现象并不是脊髓神经调节在脊髓网络中恢复功能的关键因素。
Paralysis of the upper extremities following cervical spinal cord injury (SCI) significantly impairs one's ability to live independently. While regaining hand function or grasping ability is considered one of the most desired functions in tetraplegics, limited therapeutic development in this direction has been demonstrated to date in humans with a high severe cervical injury. The underlying hypothesis is that after severe cervical SCI, nonfunctional sensory-motor networks within the cervical spinal cord can be transcutaneously neuromodulated to physiological states that enable and amplify voluntary control of the hand. Improved voluntary hand function occurred within a single session in every subject tested. After eight sessions of non-invasive transcutaneous stimulation, combined with training over 4 weeks, maximum voluntary hand grip forces increased by approximate to 325% (in the presence of stimulation) and approximate to 225% (when grip strength was tested without simultaneous stimulation) in chronic cervical SCI subjects (American Spinal Injury Association Impairment Scale [AIS] B, n=3; AIS C, n=5) 1-21 years post-injury). Maximum grip strength improved in both the left and right hands and the magnitude of increase was independent of hand dominance. We refer to the neuromodulatory method used as transcutaneous enabling motor control to emphasize that the stimulation parameters used are designed to avoid directly inducing muscular contractions, but to enable task performance according to the subject's voluntary intent. In some subjects, there were improvements in autonomic function, lower extremity motor function, and sensation below the level of the lesion. Although a neuromodulation-training effect was observed in every subject tested, further controlled and blinded studies are needed to determine the responsiveness of a larger and broader population of subjects varying in the type, severity, and years post-injury. It appears rather convincing, however, that a central pattern generation phenomenon as generally perceived in the lumbosacral networks in controlling stepping neuromodulator is not a critical element of spinal neuromodulation to regain function among spinal networks.