HAL® exoskeleton training improves walking parameters and normalizes cortical excitability in primary somatosensory cortex in spinal cord injury patients.
HAL® exoskeleton training improves walking parameters and normalizes cortical excitability in primary somatosensory cortex in spinal cord injury patients.
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DOI：
10.1186/s12984-015-0058-9
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发表时间：
2015-08-20
影响因子：
5.1
通讯作者：
Tegenthoff M
中科院分区：
文献类型：
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作者：
Sczesny-Kaiser M;Höffken O;Aach M;Cruciger O;Grasmücke D;Meindl R;Schildhauer TA;Schwenkreis P;Tegenthoff M
感觉运动皮层的重组伴随着兴奋性的增加和身体表征的扩大是脊髓损伤（SCI）的结果。机器人辅助体重支持的跑步机训练（BWSTT）被假设为诱导重组和改善步行功能。评估BWSTT与混合辅助肢体®（HAL®）外骨骼是否影响SCI患者初级体感皮层（S1）的皮层兴奋性，通过在损伤水平以上刺激的成对脉冲体感诱发电位（ppSEP）进行测量。11名SCI患者参加了为期3个月的HAL®辅助BWSTT。在该训练期之前和之后进行PpSEP，其中评估振幅比（双脉冲后的SEP振幅-单脉冲后的SEP振幅）并与11名健康对照受试者进行比较。为了评估步行功能的改善，我们使用了10米步行试验、定时起身行走试验、6分钟步行试验和下肢运动评分。与基线对照组相比，SCI患者的PpSEP显著增加。训练后，ppSEP从基线增加，与对照组相比不再有显著差异。行走参数也显示出显著改善，但ppSEP测量值与行走参数之间没有显著相关性。研究结果表明，在SCI患者中使用HAL®的机器人辅助BWSTT能够在高度重复、主动运动使用麻痹腿后诱导皮质可塑性。虽然兴奋性与行走参数没有显著相关性，但S1以外的脑区可能反映了行走功能的改善。EEG和神经影像学研究可为脊髓损伤康复提供更多有关脊髓上可塑性过程和病灶的信息。
Reorganization in the sensorimotor cortex accompanied by increased excitability and enlarged body representations is a consequence of spinal cord injury (SCI). Robotic-assisted bodyweight supported treadmill training (BWSTT) was hypothesized to induce reorganization and improve walking function. To assess whether BWSTT with hybrid assistive limb® (HAL®) exoskeleton affects cortical excitability in the primary somatosensory cortex (S1) in SCI patients, as measured by paired-pulse somatosensory evoked potentials (ppSEP) stimulated above the level of injury. Eleven SCI patients took part in HAL® assisted BWSTT for 3 months. PpSEP were conducted before and after this training period, where the amplitude ratios (SEP amplitude following double pulses - SEP amplitude following single pulses) were assessed and compared to eleven healthy control subjects. To assess improvement in walking function, we used the 10-m walk test, timed-up-and-go test, the 6-min walk test, and the lower extremity motor score. PpSEPs were significantly increased in SCI patients as compared to controls at baseline. Following training, ppSEPs were increased from baseline and no longer significantly differed from controls. Walking parameters also showed significant improvements, yet there was no significant correlation between ppSEP measures and walking parameters. The findings suggest that robotic-assisted BWSTT with HAL® in SCI patients is capable of inducing cortical plasticity following highly repetitive, active locomotive use of paretic legs. While there was no significant correlation of excitability with walking parameters, brain areas other than S1 might reflect improvement of walking functions. EEG and neuroimaging studies may provide further information about supraspinal plastic processes and foci in SCI rehabilitation.