Improve dynamic lateral balance of humans with SCI

 描述(申请人提供)：脊髓损伤(SCI)患者的一个主要目标是恢复行走能力，因为活动能力的限制会影响大多数日常生活能力。此外，脊髓损伤患者可能会因为平衡和步态受损而摔倒的发生率更高。此外，脊髓损伤患者跌倒的后果比健康老年人严重得多。动态平衡控制在人类脊髓损伤的运动过程中起着至关重要的作用。因此，改善的动态平衡可能会促进这一群体的运动。目前的平衡训练模式可以有效地改善站立时的平衡，但在改善运动时的动态平衡方面效果较差。因此，有必要开发新的模式来改善脊髓损伤患者的动态平衡和运动功能。本研究的目的是探索脊髓损伤患者行走时对骨盆内侧外力的运动适应，并测试骨盆扰动训练配合经皮脊髓直流电刺激(TsDCS)是否能有效改善脊髓损伤患者的动态平衡和运动功能。我们推测，在跑步机训练期间，对骨盆提供扰动力将增加 在走路时用来保持侧向平衡的肌肉的活动。此外，重复激活特定的感觉运动通路(通过反复暴露在骨盆扰动力中)可能会通过一种依赖使用的神经可塑性机制加强用于横向平衡控制的回路和突触。然而，脊髓损伤后，由于上级控制中枢下行驱动信号的减少，脊髓神经回路的兴奋性可能受到抑制，这可能会降低康复后实现的神经可塑性改变的有效性。神经通路的兴奋性是康复后实现神经重组的关键。最近的研究表明，tsDCs可能调节脊髓损伤患者脊髓神经回路的兴奋性。因此，我们假定 在改善脊髓损伤患者的动态平衡和运动功能方面，控制性骨盆扰动训练配合tsDCS训练比配合假手术训练更有效。这项研究的结果将导致一种创新的临床治疗方法，旨在改善患有脊髓损伤的人类的平衡和行走功能。平衡和行走功能的改善可能允许更多地参与社区步行和活动，并显著提高脊髓损伤患者的生活质量。这项研究所获得的科学知识的改进可以推广到其他行走功能较低的脊髓损伤患者，或其他患者群体，如卒中后的个体。

 DESCRIPTION (provided by applicant): A major goal of patients with spinal cord injury (SCI) is to regain walking ability, as limitations in mobility can affect most activities of daily living In addition, patients with SCI may experience a higher incidence of falls due to impaired balance and gait. Further, the consequence of falls in patients with SCI is much greater than that for healthy older adults. Dynamic balance control plays a crucial role during locomotion in human SCI. Thus, improved dynamic balance may facilitate locomotion in this population. Current balance training paradigms can be effective in improving balance during standing, but are less effective in improving dynamic balance during locomotion in humans with SCI. Thus, there is a need to develop new paradigms for improving dynamic balance and locomotor function in patients with SCI. The goal of this proposed research is to explore motor adaptation to a mediolateral force applied at the pelvis during walking in humans with SCI and test whether pelvis perturbation training paired with transcutaneous spinal direct current stimulation (tsDCS) will be effective in improving dynamic balance and locomotor function in humans with SCI. We postulate that providing a perturbation force to the pelvis during treadmill training will increase the activation of muscles used for maintaining lateral balance while walking. Further, repeated activation of particular sensorimotor pathways (through repeated exposure to a pelvic perturbation force) may reinforce circuits and synapses used for lateral balance control through a use-dependent neural-plasticity mechanism. However, the excitability of spinal cord neural circuitries may be depressed due to the reduced descending drive signals from the upper level control center after SCI, which may reduce the efficacy of neural plastic changes achieved following rehabilitation. The excitability of neural pathways is crucial for neural reorganization achieved following rehabilitation. Recently studies indicate that tsDCS may modulate the excitability of neural circuitries of the spinal cord in patients with SCI. Thus, we postulate that controlled pelvis perturbation training paired with tsDCS will be more effective than that paired with a sham in improving dynamic balance and locomotor function in humans with SCI. Results obtained from this study will lead to an innovative clinical therapy aimed at improving balance and walking function in humans with SCI. Improvements in balance and walking function may allow for increased participation in community-based ambulation and activities, and significantly improve quality of life in humans with SCI. The improvements of scientific knowledge obtained from this study may be extended to other SCI patients with lower walking function, or other patient populations, such as individuals post-stroke.