Robotic training and spinal cord plasticity.
Robotic training and spinal cord plasticity.
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DOI：
10.1016/j.brainresbull.2008.09.018
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发表时间：
2009-01-15
影响因子：
3.8
通讯作者：
Roy, Roland R.
中科院分区：
文献类型：
--
作者：
Edgerton, V. Reggie;Roy, Roland R.
关键词：
脊髓损伤后运动能力恢复的可能性有多大？人类和动物的研究都表明，脊髓有可能重组和/或重新调整脊柱上输入的损失，并利用剩余的周围输入来实际控制行走和站立。运动训练可用于在特定任务的脊髓回路中提供感觉集成，例如，步骤训练可改善行走，站立训练可改善站立。这种学习的一个重要组成部分是肢体内部和肢体之间机动池协调能力的提高。最成功的训练类型包括执行任务的可变性，即单调重复完全相同的感觉运动模式导致“习得性废弃”。机器人技术用于特定运动任务的训练最近变得越来越普遍，我们在这里报道，在严重脊髓损伤后使用“按需辅助”方法进行步进训练提供了成功康复的高概率。“按需辅助”模式允许在特定边界内的台阶轨迹变化，这样机器人手臂就可以模仿在正常、完整条件下观察到的方式来约束偏差。机器人设备或步训练的另一个关键特征似乎是能够整合正常的髋关节和腿部运动，因为在正常的步中发生。这些类型的机器人设备有可能在临床环境中帮助治疗师，并增强脊髓损伤个体恢复最大运动能力的能力。
What is the potential for recovery of locomotor ability after a spinal cord injury? Both human and animal studies show that the spinal cord has the potential to reorganize and/or readjust to the loss of supraspinal input and utilize the remaining peripheral input to actually control stepping and standing. Motor training can be used to provide sensory ensembles within the spinal circuitry that are task-specific, i.e., step training improves stepping and stand training improves standing. A large component of this learning is a function of improved coordination of motor pools within and among limbs. The most successful type of training includes variability in the performed task, i.e., monotonous repetition of the exact same sensorimotor pattern results in “learned disuse”. The use of robotics for training specific motor tasks has become more prevalent recently and we report here that using an “assist-as-needed” approach for step training after a severe spinal cord injury provides a high probability of successful rehabilitation. The “assist-as-needed” paradigm allows variability in the step trajectory within specific boundaries such that the robotic arms constrain the deviations in a manner mimicking that observed under normal, intact conditions. Another critical feature of robotic devices or step training seems to be the ability to integrate normal hip and leg motion as occurs during normal stepping. These types of robotic devices have the potential to aid therapists in the clinical setting and to enhance the ability of spinal cord injured individuals to regain the maximum locomotor ability possible.
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