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Comparison of post-SCI locomotor training techniques

SCI后运动训练技术比较

基本信息

批准号：
7087948
负责人：
EDELLE C. FIELD-FOTE
金额：
$ 23.3万
依托单位：
UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2002
资助国家：
美国
起止时间：
2002-06-01 至 2008-05-31
项目状态：
已结题

项目摘要

In recent years there has been an increased understanding of the role of activity-dependent plasticity in promoting functional recovery following neurologic injury. There is also an emerging appreciation for the role of spinal mechanisms in control of behaviors such as walking. Research indicates that activity-dependent adaptive changes in spinal cord circuitry may play an important part in the recovery of walking function in individuals with spinal cord injury (SCI), perhaps long after the stage of spontaneous recovery. Two technologies that appear effective in promoting functional recovery are body weight support (BWS) and functional electrical stimulation (FES). In preliminary studies, improved overground walking speed, leg strength and endurance was observed in subjects with SCI who trained using an approach combining these interventions. This proposal will assess, in individuals with chronic incomplete SCI, responses to a BWS-assisted treadmill training regimen under one of three training conditions: 1) passive (manual)-assisted stepping, 2) active (FES)-assisted stepping, or 3) non-assisted (voluntary) stepping. Each condition has distinct advantages. Manually-assisted stepping allows assistance to be graded to individual needs; FES-assisted stepping takes advantage of spinal reflex circuitry and may contribute to beneficial changes in spinal cord neurophysiology; and voluntary stepping may encourage the greatest voluntary effort. These investigations will determine which condition best promotes efficient overground walking, and will examine changes in spinal cord neurophysiology, strength and cardiorespiratory capacity associated with the three forms of training. Performance-based measures will include: computerized kinematic analysis to assess lower limb coordination and key parameters of gait (speed, stride length and step rhythm), electromyographic assessment of muscle recruitment and work capacity evaluation to assess changes in strength and gait efficiency. Neurophysiologic techniques (e.g., reflex testing and transcranial magnetic stimulation) will be used to assess supraspinal, spinal and peripheral control of mechanisms that contribute to walking, to voluntary movement and to reflex activation. The proposed experiments will test the hypotheses that: 1) walking performance in subjects with SCI improve to a greater extent when active, as opposed to passive or no assistance is given to advance the limb, 2) post-training spinal cord reflex activity will be more similar to normal values in those subjects who participate in the FES-assisted group, and 3) electromyographic (EMG) activity observed during walking will be more robust than EMG observed during voluntary movement. These studies will allow us to compare the efficacy of rehabilitation strategies aimed at improving functional mobility in individuals with SCI. In addition, they will provide information about neural and cardiorespiratory bases of these functional changes.

近年来，人们对活动依赖性可塑性在促进神经损伤后功能恢复中的作用有了越来越多的了解。人们也开始认识到脊柱机制在控制行走等行为中的作用。研究表明，脊髓回路的活动依赖性适应性变化可能在脊髓损伤（SCI）个体的行走功能恢复中发挥重要作用，可能在自发恢复阶段很久之后。体重支持 (BWS) 和功能性电刺激 (FES) 是两种可有效促进功能恢复的技术。在初步研究中，使用结合这些干预措施进行训练的 SCI 受试者观察到地面行走速度、腿部力量和耐力有所改善。该提案将评估慢性不完全性 SCI 患者在以下三种训练条件之一下对 BWS 辅助跑步机训练方案的反应：1) 被动（手动）辅助踏步，2）主动（FES）辅助踏步，或 3）非辅助（自愿）踏步。每种条件都有独特的优势。手动辅助迈步可以根据个人需求对辅助进行分级； FES 辅助迈步利用脊髓反射回路，可能有助于脊髓神经生理学的有益变化；自愿迈步可以鼓励最大的自愿努力。这些研究将确定哪种条件最能促进有效的地面行走，并将检查与三种训练形式相关的脊髓神经生理学、力量和心肺能力的变化。基于表现的测量将包括：计算机运动学分析，以评估下肢协调性和步态的关键参数（速度、步长和步伐节奏）、肌肉募集的肌电图评估和工作能力评估，以评估力量和步态效率的变化。神经生理学技术（例如反射测试和经颅磁刺激）将用于评估有助于行走、随意运动和反射激活的脊髓上、脊髓和外周机制的控制。拟议的实验将测试以下假设：1）SCI 受试者的步行表现在主动时会得到更大程度的改善，而不是被动或不给予帮助来推进肢体，2）训练后脊髓反射活动将更类似于参与 FES 辅助组的受试者的正常值，3）步行期间观察到的肌电图（EMG）活动将比随意运动期间观察到的肌电图更强劲。这些研究将使我们能够比较旨在改善 SCI 患者功能活动能力的康复策略的效果。此外，他们还将提供有关这些功能变化的神经和心肺基础的信息。