A Pilot Study of Intensive Locomotor-Related Skill Training and Transcranial Direct Current Stimulation in Chronic Spinal Cord Injury.

IF 2.6 3区医学 Q2 CLINICAL NEUROLOGY Journal of Neurologic Physical Therapy Pub Date : 2022-10-01 DOI:10.1097/NPT.0000000000000403

Nicholas H Evans, Edelle C Field-Fote

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引用次数: 1

Abstract

Background and purpose: Improved walking function is a priority among persons with motor-incomplete spinal cord injury (PwMISCI). Accessibility and cost limit long-term participation in locomotor training offered in specialized centers. Intensive motor training that facilitates neuroplastic mechanisms that support skill learning and can be implemented in the home/community may be advantageous for promoting long-term restoration of walking function. Additionally, increasing corticospinal drive via transcranial direct current stimulation (tDCS) may enhance training effects. In this pilot study, we investigated whether a moderate-intensity motor skill training (MST) circuit improved walking function in PwMISCI and whether augmenting training with tDCS influenced outcomes.

Methods: Twenty-five adults (chronic, motor-incomplete spinal cord injury) were randomized to a 3-day intervention of a locomotor-related MST circuit and concurrent application of sham tDCS (MST+tDCS sham ) or active tDCS (MST+tDCS). The primary outcome was overground walking speed. Secondary outcomes included walking distance, cadence, stride length, and step symmetry index (SI).

Results: Analyses revealed significant effects of the MST circuit on walking speed, walking distance, cadence, and bilateral stride length but no effect on interlimb SI. No significant between-groups differences were observed. Post hoc analyses revealed within-groups change in walking speed (ΔM = 0.13 m/s, SD = 0.13) that app-roached the minimally clinically important difference of 0.15 m/s.

Discussion and conclusions: Brief, intensive MST involving locomotor-related activities significantly increased walking speed, walking distance, and spatiotemporal measures in PwMISCI. Significant additive effects of tDCS were not observed; however, participation in only 3 days of MST was associated with changes in walking speed that were comparable to longer locomotor training studies.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A386 ).

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强化运动相关技能训练和经颅直流电刺激治疗慢性脊髓损伤的初步研究。

背景和目的:改善行走功能是运动不完全性脊髓损伤(PwMISCI)患者的首要任务。无障碍和费用限制了长期参与专业中心提供的运动训练。强化运动训练可促进支持技能学习的神经可塑性机制，并可在家庭/社区实施，可能有利于促进长期行走功能的恢复。此外，通过经颅直流电刺激(tDCS)增加皮质脊髓驱动可能会增强训练效果。在这项初步研究中，我们调查了中等强度运动技能训练(MST)回路是否能改善PwMISCI患者的行走功能，以及tDCS增强训练是否会影响结果。方法:25名成人(慢性，运动不完全性脊髓损伤)随机分为3天的运动相关MST回路干预组和假性tDCS (MST+tDCS假性)或活动tDCS (MST+tDCS)同步应用组。主要结果是地上行走速度。次要结果包括步行距离、步幅、步幅长度和步对称指数(SI)。结果:分析显示MST电路对步行速度、步行距离、节奏和双侧步幅有显著影响，但对肢间SI没有影响。各组间无显著差异。事后分析显示，组内步行速度的变化(ΔM = 0.13 m/s, SD = 0.13)接近0.15 m/s的最小临床重要差异。讨论和结论:包括运动相关活动的短暂、密集的MST显著增加PwMISCI患者的步行速度、步行距离和时空测量。tDCS未观察到显著的加性效应;然而，仅参加3天的MST与步行速度的变化有关，这与较长时间的运动训练研究相当。视频摘要可获得作者的更多见解(参见视频，补充数字内容1，可在:http://links.lww.com/JNPT/A386)。

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来源期刊

Journal of Neurologic Physical Therapy CLINICAL NEUROLOGY-REHABILITATION

CiteScore

5.70

自引率

2.60%

发文量

审稿时长

>12 weeks

期刊介绍： The Journal of Neurologic Physical Therapy (JNPT) is an indexed resource for dissemination of research-based evidence related to neurologic physical therapy intervention. High standards of quality are maintained through a rigorous, double-blinded, peer-review process and adherence to standards recommended by the International Committee of Medical Journal Editors. With an international editorial board made up of preeminent researchers and clinicians, JNPT publishes articles of global relevance for examination, evaluation, prognosis, intervention, and outcomes for individuals with movement deficits due to neurologic conditions. Through systematic reviews, research articles, case studies, and clinical perspectives, JNPT promotes the integration of evidence into theory, education, research, and practice of neurologic physical therapy, spanning the continuum from pathophysiology to societal participation.