通过硬膜外刺激进行机器人姿势训练,帮助运动性完全脊髓损伤患者恢复直立姿势控制:试点研究。

IF 1.8 Q3 CLINICAL NEUROLOGY Neurotrauma reports Pub Date : 2024-03-15 eCollection Date: 2024-01-01 DOI:10.1089/neur.2024.0013
Enrico Rejc, Collin Bowersock, Tanvi Pisolkar, Isirame Omofuma, Tatiana Luna, Moiz Khan, Victor Santamaria, Beatrice Ugiliweneza, Claudia A Angeli, Gail F Forrest, Joel Stein, Sunil Agrawal, Susan J Harkema
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引用次数: 0

摘要

以活动为基础的训练和腰骶部脊髓硬膜外刺激(scES)有可能在运动性完全脊髓损伤(SCI)后通过自我平衡辅助恢复站立和行走。然而,在这一人群中,直立姿势控制的改善以前还没有涉及。在这里,我们使用 scES 进行了一种新颖的机器人姿势训练,这种训练是用双手进行的,目的是恢复慢性颈椎(5 人)或高胸椎(1 人)运动性完全脊髓损伤患者的直立姿势控制能力。机器人姿势训练使参与者重新获得和/或在很大程度上提高了控制稳定站立、自发躯干运动和上肢伸展运动的能力,同时他们还能双手自由站立,仅在骨盆控制方面接受外部辅助。这些改善与病变部位上下的神经肌肉激活模式适应有关。这些研究结果表明,当脊髓兴奋性受到 scES 调节时,损伤水平以下的人体脊髓可以产生有意义的姿势反应,并且可以通过学习改善这些反应。直立姿势控制的改善可以增强严重损伤后通过scES促进的功能性运动恢复。
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Robotic Postural Training With Epidural Stimulation for the Recovery of Upright Postural Control in Individuals With Motor Complete Spinal Cord Injury: A Pilot Study.

Activity-based training and lumbosacral spinal cord epidural stimulation (scES) have the potential to restore standing and walking with self-balance assistance after motor complete spinal cord injury (SCI). However, improvements in upright postural control have not previously been addressed in this population. Here, we implemented a novel robotic postural training with scES, performed with free hands, to restore upright postural control in individuals with chronic, cervical (n = 5) or high-thoracic (n = 1) motor complete SCI, who had previously undergone stand training with scES using a walker or a standing frame for self-balance assistance. Robotic postural training re-enabled and/or largely improved the participants' ability to control steady standing, self-initiated trunk movements and upper limb reaching movements while standing with free hands, receiving only external assistance for pelvic control. These improvements were associated with neuromuscular activation pattern adaptations above and below the lesion. These findings suggest that the human spinal cord below the level of injury can generate meaningful postural responses when its excitability is modulated by scES, and can learn to improve these responses. Upright postural control improvements can enhance functional motor recovery promoted by scES after severe SCI.

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