Transcutaneous Spinal Cord Stimulation Restores Hand and Arm Function After Spinal Cord Injury
Transcutaneous Spinal Cord Stimulation Restores Hand and Arm Function After Spinal Cord Injury
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经皮脊髓刺激恢复脊髓损伤后的手和手臂功能
DOI：
10.1109/tnsre.2021.3049133
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发表时间：
2021-01-01
影响因子：
4.9
通讯作者：
Moritz, Chet T.
中科院分区：
文献类型：
--
作者：
Inanici, Fatma;Brighton, Lorie N.;Moritz, Chet T.
脊髓损伤后的上肢瘫痪严重限制了患者的独立性和生活质量。对瘫痪患者来说，恢复手部和手臂运动控制是最优先的治疗事项，比恢复行走能力高6倍。然而，目前改善上肢功能的方法通常不能恢复独立性。脊髓刺激是一种新兴的神经调节策略，以恢复运动功能。最近的研究表明，通过手术植入电极可以显著改善站立和行走的自主控制能力。在这里，我们表明经皮脊髓电刺激导致手和手臂功能的快速和持续的恢复，甚至在完全瘫痪后。值得注意的是，这些改善的幅度与先前报道的手术植入刺激的结果相匹配或超过。此外，肌肉痉挛减少，自主神经功能包括心率、体温调节和膀胱功能改善。也许最引人注目的是，所有六名参与者在刺激后至少保持了三到六个月的收益，这表明长期神经可塑性介导的功能恢复。几名参与者在受伤长达12年后，第一次恢复了需要精细运动控制的爱好，比如弹吉他和油画。我们的研究结果表明，脊髓网络的非侵入性经皮电刺激可以恢复完全瘫痪和长期脊髓损伤患者的手部和手臂的运动和功能。
Paralysis of the upper extremity severely restricts independence and quality of life after spinal cord injury. Regaining control of hand and arm movements is the highest treatment priority for people with paralysis, 6-fold higher than restoring walking ability. Nevertheless, current approaches to improve upper extremity function typically do not restore independence. Spinal cord stimulation is an emerging neuromodulation strategy to restore motor function. Recent studies using surgically implanted electrodes demonstrate impressive improvements in voluntary control of standing and stepping. Here we show that transcutaneous electrical stimulation of the spinal cord leads to rapid and sustained recovery of hand and arm function, even after complete paralysis. Notably, the magnitude of these improvements matched or exceeded previously reported results from surgically implanted stimulation. Additionally, muscle spasticity was reduced and autonomic functions including heart rate, thermoregulation, and bladder function improved. Perhaps most striking is that all six participants maintained their gains for at least three to six months beyond stimulation, indicating functional recovery mediated by long-term neuroplasticity. Several participants resumed their hobbies that require fine motor control, such as playing the guitar and oil painting, for the first time in up to 12 years since their injuries. Our findings demonstrate that non-invasive transcutaneous electrical stimulation of the spinal networks restores movement and function of the hands and arm for people with both complete paralysis and long-term spinal cord injury.