Functional reorganization of soleus H-reflex modulation during stepping after robotic-assisted step training in people with complete and incomplete spinal cord injury
Functional reorganization of soleus H-reflex modulation during stepping after robotic-assisted step training in people with complete and incomplete spinal cord injury
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DOI：
10.1007/s00221-013-3560-y
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发表时间：
2013-07-01
影响因子：
2
通讯作者：
Knikou, Maria
中科院分区：
文献类型：
--
作者：
Knikou, Maria
在电动跑步机上进行体重支撑（BWS）机器人辅助步行训练，旨在改善脊髓损伤后的行走能力。然而，这种干预对受损的人脊髓神经元回路的重组潜力尚不清楚。本研究的目的是确定慢性脊髓损伤（SCI）患者在BWS机器人辅助步进训练后，在步进过程中比目鱼肌H反射调制模式和腿部肌肉激活曲线的变化。14名患有慢性临床完全性、运动完全性和运动不完全性SCI的患者平均接受了45次训练，每周5天，每天1小时。在训练前后，在相似的BWS水平和跑步机速度下，通过常规方法诱发并记录比目鱼肌H反射。在BWS机器人辅助步训练后，比目鱼肌H反射在后期站姿、站姿到挥杆过渡和挥杆阶段开始时被抑制，从而允许从站姿到挥杆的平滑过渡。比目鱼肌H-反射保持压抑在早期和中期摆动阶段的步骤周期促进相互激活的踝关节屈肌和伸肌。脊髓反射电路重组，然而，更复杂的，与比目鱼肌H反射从右腿被调制以类似或相反的方式在左腿中观察到在训练后的步骤周期的给定阶段。最后，BWS机器人辅助步行训练改变了步行过程中肌肉活动的幅度和起始，减少了步行持续时间，提高了步态速度。BWS机器人辅助步训练重组了脊髓运动神经元网络，促进了比目鱼肌H反射的功能性振幅调制，从而促进了步进程。这些发现支持临床完全、运动完全或运动不完全SCI患者的脊髓神经元网络有可能进行内源性介导的重组，并通过BWS机器人辅助步训练改善脊髓反射功能和行走功能。
Body weight-supported (BWS) robotic-assisted step training on a motorized treadmill is utilized with the aim to improve walking ability in people after damage to the spinal cord. However, the potential for reorganization of the injured human spinal neuronal circuitry with this intervention is not known. The objectives of this study were to determine changes in the soleus H-reflex modulation pattern and activation profiles of leg muscles during stepping after BWS robotic-assisted step training in people with chronic spinal cord injury (SCI). Fourteen people who had chronic clinically complete, motor complete, and motor incomplete SCI received an average of 45 training sessions, 5 days per week, 1 h per day. The soleus H-reflex was evoked and recorded via conventional methods at similar BWS levels and treadmill speeds before and after training. After BWS robotic-assisted step training, the soleus H-reflex was depressed at late stance, stance-to-swing transition, and swing phase initiation, allowing a smooth transition from stance to swing. The soleus H-reflex remained depressed at early and mid-swing phases of the step cycle promoting a reciprocal activation of ankle flexors and extensors. The spinal reflex circuitry reorganization was, however, more complex, with the soleus H-reflex from the right leg being modulated either in a similar or in an opposite manner to that observed in the left leg at a given phase of the step cycle after training. Last, BWS robotic-assisted step training changed the amplitude and onset of muscle activity during stepping, decreased the step duration, and improved the gait speed. BWS robotic-assisted step training reorganized spinal locomotor neuronal networks promoting a functional amplitude modulation of the soleus H-reflex and thus step progression. These findings support that spinal neuronal networks of persons with clinically complete, motor complete, or motor incomplete SCI have the potential to undergo an endogenous-mediated reorganization, and improve spinal reflex function and walking function with BWS robotic-assisted step training.