Spinal Reflexes in Ankle Flexor and Extensor Muscles After Chronic Central Nervous System Lesions and Functional Electrical Stimulation
Spinal Reflexes in Ankle Flexor and Extensor Muscles After Chronic Central Nervous System Lesions and Functional Electrical Stimulation
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慢性中枢神经系统损伤和功能性电刺激后踝关节屈肌和伸肌的脊髓反射
DOI：
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发表时间：
2009
影响因子：
4.2
通讯作者：
R. Stein
中科院分区：
文献类型：
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作者：
A. Thompson;Kristen L. Estabrooks;S. Chong;R. Stein
Objective.在患有慢性中枢神经系统（CNS）病变的步行参与者中研究了踝伸肌和屈肌的脊髓相互抑制和兴奋性反射，这些病变导致足下垂，作为病变和刺激器使用后时间的函数。方法.研究了39例进展性（如继发性进展性MS）和36例一般非进展性（如卒中）疾病的参与者。测量胫骨前肌（TA）和比目鱼肌最大H反射/M波（Hmax/Mmax）比值和最大自主收缩（MVC），并与年龄匹配的对照组进行比较。相互抑制被测量为拮抗剂肌肉神经刺激产生的持续肌电图（EMG）活动的抑制。结果CNS病变的参与者比目鱼肌Hmax/Mmax比值显著高于对照组，并且两种肌肉的反射自发调节均减少。腓总神经（CP）刺激比目鱼肌的相互抑制与对照组无显著差异。胫神经刺激对TA的抑制减少，最终被非进行性疾病参与者的兴奋所取代。进展性疾病无显著变化。使用足下垂刺激器增加了TA，但不是比目鱼肌MVC的整体。H-反射仅表现出较小的变化。TA的相互抑制大大增加，而比目鱼肌的肌肉减少对控制值。结论.导致足下垂的疾病也会产生反射变化，其中一些只会在几年甚至几十年内发展。经常使用足下垂刺激器可以加强自主神经通路，并改变一些朝向控制值的反射。因此，刺激器可以为足下垂的人提供多种益处。
Objective. Spinal reciprocal inhibitory and excitatory reflexes of ankle extensor and flexor muscles were investigated in ambulatory participants with chronic central nervous system (CNS) lesions causing foot drop as a function of time after lesion and stimulator use. Methods. Thirty-nine participants with progressive (eg, secondary progressive MS) and 36 with generally nonprogressive (eg, stroke) conditions were studied. The tibialis anterior (TA) and soleus maximum H-reflex/M-wave (Hmax/Mmax) ratios and maximum voluntary contractions (MVC) were measured and compared with those in age-matched control participants. Reciprocal inhibition was measured as a depression of the ongoing electromyographic (EMG) activity produced by antagonist muscle—nerve stimulation. Results. Participants with CNS lesions had significantly higher soleus Hmax/Mmax ratios than control participants, and reduced voluntary modulation of the reflexes occurred in both muscles. Reciprocal inhibition of soleus from common peroneal (CP) nerve stimulation was not significantly different from controls in either group. Inhibition of the TA by tibial nerve stimulation decreased and was eventually replaced by excitation in participants with nonprogressive disorders. No significant change occurred in progressive disorders. Use of a foot drop stimulator increased the TA, but not the soleus MVC overall. H-reflexes only showed small changes. Reciprocal inhibition of the TA increased considerably, while that of the soleus muscle decreased toward control values. Conclusions. Disorders that produce foot drop also produce reflex changes, some of which only develop over a period of years or even decades. Regular use of a foot drop stimulator strengthens voluntary pathways and changes some reflexes toward control values. Thus, stimulators may provide multiple benefits to people with foot drop.