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Hayashi Y, Yamazaki K, Komatsu S, Yamamoto N, Ueda S, Sato K, Yamaguchi T, Hatori K, Honaga K, Takakura T, Wada F, Tanuma A, Fujiwara T. Quadriceps muscle activity during walking with a knee ankle foot orthosis is associated with improved gait ability in acute hemiplegic stroke patients with severe gait disturbance. Front Neurol 2024; 15:1387607. [PMID: 38774057 PMCID: PMC11107341 DOI: 10.3389/fneur.2024.1387607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/19/2024] [Indexed: 05/24/2024] Open
Abstract
Introduction A knee-ankle-foot orthosis (KAFO) prevents knee buckling during walking and enables gait training for acute hemiplegic stroke patients with severe gait disturbances. Although the goal of gait training with a KAFO is to improve gait ability, that is, to acquire walking with an ankle-foot orthosis (AFO), it is not clear how gait training with a KAFO contributes to improving gait ability. Therefore, this study aimed to investigate the relationship between muscle activities during walking with a KAFO and the improvement of gait ability in hemiplegic stroke patients with severe gait disturbance. Methods A prospective cohort study was conducted. Fifty acute hemiplegic stroke patients who could not walk with an AFO participated. Muscle activities of the paretic rectus femoris, biceps femoris, tibialis anterior, and soleus were assessed with surface electromyogram during walking with a KAFO. Electromyograms were assessed at the beginning of gait training and at the time the Ambulation Independence Measure score improved by 3 or higher, or discharge. Results Even in patients with complete hemiplegia, paretic rectus femoris, biceps femoris, and soleus showed periodic muscle activity during walking with a KAFO. Twenty-three patients improved to an Ambulation Independence Measure score of 3 or higher and were able to walk with an AFO (good recovery group). At the beginning of gait training, paretic rectus femoris muscle activity during the first double-limb support phase was significantly higher in the good recovery group than in the poor recovery group. The rectus femoris muscle activity significantly increased from before to after acute rehabilitation, which consisted mainly of gait training with a KAFO. Discussion For acute hemiplegic stroke patients with severe disturbance, the induction and enhancement of paretic quadriceps muscle activity during walking with a KAFO play an important role in acquiring walking with an AFO.
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Affiliation(s)
- Yusuke Hayashi
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Rehabilitation Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kota Yamazaki
- Department of Rehabilitation Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Shinya Komatsu
- Department of Rehabilitation Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Naoaki Yamamoto
- Department of Rehabilitation Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Shujiro Ueda
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Rehabilitation Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kazunori Sato
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Rehabilitation Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Tomofumi Yamaguchi
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Kozo Hatori
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Rehabilitation Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kaoru Honaga
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomokazu Takakura
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Futoshi Wada
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Akira Tanuma
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshiyuki Fujiwara
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
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Angeli C, Wagers S, Harkema S, Rejc E. Sensory Information Modulates Voluntary Movement in an Individual with a Clinically Motor- and Sensory-Complete Spinal Cord Injury: A Case Report. J Clin Med 2023; 12:6875. [PMID: 37959340 PMCID: PMC10647542 DOI: 10.3390/jcm12216875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
Motor recovery following a complete spinal cord injury is not likely. This is partially due to insurance limitations. Rehabilitation strategies for individuals with this type of severe injury focus on the compensation for the activities of daily living in the home and community and not on the restoration of function. With limited time in therapies, the initial goals must focus on getting the patient home safely without the expectation of recovery of voluntary movement below the level of injury. In this study, we report a case of an individual with a chronic, cervical (C3)-level clinically motor- and sensory-complete injury who was able to perform voluntary movements with both upper and lower extremities when positioned in a sensory-rich environment conducive to the specific motor task. We show how he is able to intentionally perform push-ups, trunk extensions and leg presses only when appropriate sensory information is available to the spinal circuitry. These data show that the human spinal circuitry, even in the absence of clinically detectable supraspinal input, can generate motor patterns effective for the execution of various upper and lower extremity tasks, only when appropriate sensory information is present. Neurorehabilitation in the right sensory-motor environment that can promote partial recovery of voluntary movements below the level of injury, even in individuals diagnosed with a clinically motor-complete spinal cord injury.
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Affiliation(s)
- Claudia Angeli
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ 07052, USA;
- Department of Bioengineering, University of Louisville, Louisville, KY 40292, USA
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA; (S.W.); (S.H.)
| | - Sarah Wagers
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA; (S.W.); (S.H.)
- Division of Physical Medicine and Rehabilitation, University of Louisville, Louisville, KY 40292, USA
| | - Susan Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA; (S.W.); (S.H.)
| | - Enrico Rejc
- Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ 07052, USA;
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY 40202, USA; (S.W.); (S.H.)
- Department of Medicine, University of Udine, 33100 Udine, Italy
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Laflamme OD, Markin SN, Deska-Gauthier D, Banks R, Zhang Y, Danner SM, Akay T. Distinct roles of spinal commissural interneurons in transmission of contralateral sensory information. Curr Biol 2023; 33:3452-3464.e4. [PMID: 37531957 PMCID: PMC10528931 DOI: 10.1016/j.cub.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/29/2023] [Accepted: 07/10/2023] [Indexed: 08/04/2023]
Abstract
Crossed reflexes are mediated by commissural pathways transmitting sensory information to the contralateral side of the body, but the underlying network is not fully understood. Commissural pathways coordinating the activities of spinal locomotor circuits during locomotion have been characterized in mice, but their relationship to crossed reflexes is unknown. We show the involvement of two genetically distinct groups of commissural interneurons (CINs) described in mice, V0 and V3 CINs, in the crossed reflex pathways. Our data suggest that the exclusively excitatory V3 CINs are directly involved in the excitatory crossed reflexes and show that they are essential for the inhibitory crossed reflexes. In contrast, the V0 CINs, a population that includes excitatory and inhibitory CINs, are not directly involved in excitatory or inhibitory crossed reflexes but downregulate the inhibitory crossed reflexes. Our data provide insights into the spinal circuitry underlying crossed reflexes in mice, describing the roles of V0 and V3 CINs in crossed reflexes.
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Affiliation(s)
- Olivier D Laflamme
- Atlantic Mobility Action Project, Brain Repair Centre, Department of Medical Neuroscience, Dalhousie University, Halifax, NS B3T 0A6, Canada
| | - Sergey N Markin
- Department of Neurobiology and Anatomy, College of Medicine, Drexel University, Philadelphia, PA 19129, USA
| | - Dylan Deska-Gauthier
- Atlantic Mobility Action Project, Brain Repair Centre, Department of Medical Neuroscience, Dalhousie University, Halifax, NS B3T 0A6, Canada
| | - Rachel Banks
- Atlantic Mobility Action Project, Brain Repair Centre, Department of Medical Neuroscience, Dalhousie University, Halifax, NS B3T 0A6, Canada
| | - Ying Zhang
- Atlantic Mobility Action Project, Brain Repair Centre, Department of Medical Neuroscience, Dalhousie University, Halifax, NS B3T 0A6, Canada
| | - Simon M Danner
- Department of Neurobiology and Anatomy, College of Medicine, Drexel University, Philadelphia, PA 19129, USA
| | - Turgay Akay
- Atlantic Mobility Action Project, Brain Repair Centre, Department of Medical Neuroscience, Dalhousie University, Halifax, NS B3T 0A6, Canada.
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Laflamme OD, Markin SN, Banks R, Zhang Y, Danner SM, Akay T. Distinct roles of spinal commissural interneurons in transmission of contralateral sensory information. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.16.528842. [PMID: 36824871 PMCID: PMC9949098 DOI: 10.1101/2023.02.16.528842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Crossed reflexes (CR) are mediated by commissural pathways transmitting sensory information to the contralateral side of the body, but the underlying network is not fully understood. Commissural pathways coordinating the activities of spinal locomotor circuits during locomotion have been characterized in mice, but their relationship to CR is unknown. We show the involvement of two genetically distinct groups of commissural interneurons (CINs) described in mice, V0 and V3 CINs, in the CR pathways. Our data suggest that the exclusively excitatory V3 CINs are directly involved in the excitatory CR, and show that they are essential for the inhibitory CR. In contrast, the V0 CINs, a population that includes excitatory and inhibitory CINs, are not directly involved in excitatory or inhibitory CRs but down-regulate the inhibitory CR. Our data provide insights into the spinal circuitry underlying CR in mice, describing the roles of V0 and V3 CINs in CR.
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Affiliation(s)
- Olivier D. Laflamme
- Atlantic Mobility Action Project, Brain Repair Centre, Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sergey N. Markin
- Department of Neurobiology and Anatomy, College of Medicine, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Rachel Banks
- Atlantic Mobility Action Project, Brain Repair Centre, Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ying Zhang
- Atlantic Mobility Action Project, Brain Repair Centre, Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Simon M. Danner
- Department of Neurobiology and Anatomy, College of Medicine, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Turgay Akay
- Atlantic Mobility Action Project, Brain Repair Centre, Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
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Gouveia D, Cardoso A, Carvalho C, Almeida A, Gamboa Ó, Ferreira A, Martins Â. Approach to Small Animal Neurorehabilitation by Locomotor Training: An Update. Animals (Basel) 2022; 12:ani12243582. [PMID: 36552502 PMCID: PMC9774773 DOI: 10.3390/ani12243582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/05/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Neurorehabilitation has a wide range of therapies to achieve neural regeneration, reorganization, and repair (e.g., axon regeneration, remyelination, and restoration of spinal circuits and networks) to achieve ambulation for dogs and cats, especially for grade 1 (modified Frankel scale) with signs of spinal shock or grade 0 (deep pain negative), similar to humans classified with ASIA A lesions. This review aims to explain what locomotor training is, its importance, its feasibility within a clinical setting, and some possible protocols for motor recovery, achieving ambulation with coordinated and modulated movements. In addition, it cites some of the primary key points that must be present in the daily lives of veterinarians or rehabilitation nurses. These can be the guidelines to improve this exciting exercise necessary to achieve ambulation with quality of life. However, more research is essential in the future years.
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Affiliation(s)
- Débora Gouveia
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1950-396 Lisboa, Portugal
- Faculty of Veterinary Medicine, Lusófona University, Campo Grande, 1749-024 Lisboa, Portugal
- Correspondence:
| | - Ana Cardoso
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
| | - Carla Carvalho
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
| | - António Almeida
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal
| | - Óscar Gamboa
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal
| | - António Ferreira
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal
- CIISA—Centro Interdisciplinar-Investigaçāo em Saúde Animal, Faculdade de Medicina Veterinária, Av. Universi dade Técnica de Lisboa, 1300-477 Lisboa, Portugal
| | - Ângela Martins
- Arrábida Veterinary Hospital—Arrábida Animal Rehabilitation Center, 2925-538 Setubal, Portugal
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1950-396 Lisboa, Portugal
- Faculty of Veterinary Medicine, Lusófona University, Campo Grande, 1749-024 Lisboa, Portugal
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal
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Sun SY, Giszter SF, Harkema SJ, Angeli CA. Modular organization of locomotor networks in people with severe spinal cord injury. Front Neurosci 2022; 16:1041015. [PMID: 36570830 PMCID: PMC9768556 DOI: 10.3389/fnins.2022.1041015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Previous studies support modular organization of locomotor circuitry contributing to the activation of muscles in a spatially and temporally organized manner during locomotion. Human spinal circuitry may reorganize after spinal cord injury; however, it is unclear if reorganization of spinal circuitry post-injury affects the modular organization. Here we characterize the modular synergy organization of locomotor muscle activity expressed during assisted stepping in subjects with complete and incomplete spinal cord injury (SCI) of varying chronicity, before any explicit training regimen. We also investigated whether the synergy characteristics changed in two subjects who achieved independent walking after training with spinal cord epidural stimulation. Methods To capture synergy structures during stepping, individuals with SCI were stepped on a body-weight supported treadmill with manual facilitation, while electromyography (EMGs) were recorded from bilateral leg muscles. EMGs were analyzed using non-negative matrix factorization (NMF) and independent component analysis (ICA) to identify synergy patterns. Synergy patterns from the SCI subjects were compared across different clinical characteristics and to non-disabled subjects (NDs). Results Results for both NMF and ICA indicated that the subjects with SCI were similar among themselves, but expressed a greater variability in the number of synergies for criterion variance capture compared to NDs, and weaker correlation to NDs. ICA yielded a greater number of muscle synergies than NMF. Further, the clinical characteristics of SCI subjects and chronicity did not predict any significant differences in the spatial synergy structures despite any neuroplastic changes. Further, post-training synergies did not become closer to ND synergies in two individuals. Discussion These findings suggest fundamental differences between motor modules expressed in SCIs and NDs, as well as a striking level of spatial and temporal synergy stability in motor modules in the SCI population, absent the application of specific interventions.
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Affiliation(s)
- Soo Yeon Sun
- Department of Physical Therapy, Alvernia University, Reading, PA, United States
| | - Simon F. Giszter
- Department of Neurobiology and Anatomy, College of Medicine, Drexel University, Philadelphia, PA, United States,School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, United States
| | - Susan J. Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States,Frazier Rehab Institute, University of Louisville Health, Louisville, KY, United States
| | - Claudia A. Angeli
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States,Frazier Rehab Institute, University of Louisville Health, Louisville, KY, United States,Department of Bioengineering, University of Louisville, Louisville, KY, United States,*Correspondence: Claudia A. Angeli,
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Historical development and contemporary use of neuromodulation in human spinal cord injury. Curr Opin Neurol 2022; 35:536-543. [PMID: 35856918 DOI: 10.1097/wco.0000000000001080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW There is a long history of neuromodulation of the spinal cord after injury in humans with recent momentum of studies showing evidence for therapeutic potential. Nonrandomized, mechanistic, hypothesis-driven, small cohort, epidural stimulation proof of principle studies provide insight into the human spinal circuitry functionality and support the pathway toward clinical treatments. RECENT FINDINGS Individuals living with spinal cord injury can recover motor, cardiovascular, and bladder function even years after injury using neuromodulation. Integration of continuous feedback from sensory information, task-specific training, and optimized excitability state of human spinal circuitry are critical spinal mechanisms. Neuromodulation activates previously undetectable residual supraspinal pathways to allow intentional (voluntary) control of motor movements. Further discovery unveiled the human spinal circuitry integrated regulatory control of motor and autonomic systems indicating the realistic potential of neuromodulation to improve the capacity incrementally, but significantly for recovery after severe spinal cord injury. SUMMARY The discovery that both motor and autonomic function recovers with lumbosacral spinal cord placement of the electrode reveals exciting avenues for a synergistic overall improvement in function, health, and quality of life for those who have been living with the consequences of spinal cord injury even for decades.
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Transcutaneous spinal cord stimulation combined with locomotor training to improve walking ability in people with chronic spinal cord injury: study protocol for an international multi-centred double-blinded randomised sham-controlled trial (eWALK). Spinal Cord 2022; 60:491-497. [PMID: 35013547 DOI: 10.1038/s41393-021-00734-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN An international multi-centred, double-blinded, randomised sham-controlled trial (eWALK). OBJECTIVE To determine the effect of 12 weeks of transcutaneous spinal stimulation (TSS) combined with locomotor training on walking ability in people with spinal cord injury (SCI). SETTING Dedicated SCI research centres in Australia, Spain, USA and Scotland. METHODS Fifty community-dwelling individuals with chronic SCI will be recruited. Participants will be eligible if they have bilateral motor levels between T1 and T11, a reproducible lower limb muscle contraction in at least one muscle group, and a Walking Index for SCI II (WISCI II) between 1 and 6. Eligible participants will be randomised to one of two groups, either the active stimulation group or the sham stimulation group. Participants allocated to the stimulation group will receive TSS combined with locomotor training for three 30-min sessions a week for 12 weeks. The locomotor sessions will include walking on a treadmill and overground. Participants allocated to the sham stimulation group will receive the same locomotor training combined with sham stimulation. The primary outcome will be walking ability with stimulation using the WISCI II. Secondary outcomes will record sensation, strength, spasticity, bowel function and quality of life. TRIAL REGISTRATION ANZCTR.org.au identifier ACTRN12620001241921.
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Lin JT, Hsu CJ, Dee W, Chen D, Rymer WZ, Wu M. Anodal transcutaneous DC stimulation enhances learning of dynamic balance control during walking in humans with spinal cord injury. Exp Brain Res 2022; 240:1943-1955. [PMID: 35622090 PMCID: PMC9297533 DOI: 10.1007/s00221-022-06388-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/12/2022] [Indexed: 11/29/2022]
Abstract
Deficits in locomotor function, including impairments in walking speed and balance, are major problems for many individuals with incomplete spinal cord injury (iSCI). However, it remains unclear which type of training paradigms are more effective in improving balance, particularly dynamic balance, in individuals with iSCI. The purpose of this study was to determine whether anodal transcutaneous spinal direct current stimulation (tsDCS) can facilitate learning of balance control during walking in individuals with iSCI. Fifteen individuals with iSCI participated in this study and were tested in two sessions (i.e., tsDCS and sham conditions). Each session consisted of 1 min of treadmill walking without stimulation or perturbation (baseline), 10 min of walking with either anodal tsDCS or sham stimulation, paired with bilateral pelvis perturbation (adaptation), and finally 2 min of walking without stimulation and perturbation (post-adaptation). The outcome measures were the dynamic balance, assessed using the minimal margin of stability (MoS), and electromyography of leg muscles. Participants demonstrated a smaller MoS during the late adaptation period for the anodal tsDCS condition compared to sham (p = 0.041), and this MoS intended to retain during the early post-adaptation period (p = 0.05). In addition, muscle activity of hip abductors was greater for the anodal tsDCS condition compared to sham during the late adaptation period and post-adaptation period (p < 0.05). Results from this study suggest that anodal tsDCS may modulate motor adaptation to pelvis perturbation and facilitate learning of dynamic balance control in individuals with iSCI.
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Affiliation(s)
- Jui-Te Lin
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, Chicago, IL, 60611, USA.,Seton Hall University, South Orange, NJ, USA
| | - Chao-Jung Hsu
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, Chicago, IL, 60611, USA
| | - Weena Dee
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, Chicago, IL, 60611, USA
| | - David Chen
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, Chicago, IL, 60611, USA
| | - W Zev Rymer
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, Chicago, IL, 60611, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Ming Wu
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, Chicago, IL, 60611, USA. .,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA. .,Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, USA.
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Advanced Equipment Development and Clinical Application in Neurorehabilitation for Spinal Cord Injury: Historical Perspectives and Future Directions. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Partial to complete paralysis following spinal cord injury (SCI) causes deterioration in health and has severe effects on the ability to perform activities of daily living. Following the discovery of neural plasticity, neurorehabilitation therapies have emerged that aim to reconstruct the motor circuit of the damaged spinal cord. Functional electrical stimulation (FES) has been incorporated into devices that reconstruct purposeful motions in the upper and lower limbs, the most recent of which do not require percutaneous electrode placement surgery and thus enable early rehabilitation after injury. FES-based devices have shown promising results for improving upper limb movement, including gripping and finger function, and for lower limb function such as the ability to stand and walk. FES has also been employed in hybrid cycling and rowing to increase total body fitness. Training using rehabilitation robots is advantageous in terms of consistency of quality and quantity of movements and is particularly applicable to walking training. Initiation of motor reconstruction at the early stage following SCI is likely to advance rapidly in the future, with the combined use of technologies such as regenerative medicine, brain machine interfaces, and rehabilitation robots with FES showing great promise.
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Balbinot G, Joner Wiest M, Li G, Pakosh M, Cesar Furlan J, Kalsi-Ryan S, Zariffa J. The use of surface EMG in neurorehabilitation following traumatic spinal cord injury: a scoping review. Clin Neurophysiol 2022; 138:61-73. [DOI: 10.1016/j.clinph.2022.02.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/06/2022] [Accepted: 02/27/2022] [Indexed: 11/03/2022]
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Abe H, Kadowaki K, Tsujimoto N, Okanuka T. A Narrative Review of Alternate Gait Training Using Knee-ankle-foot Orthosis in Stroke Patients with Severe Hemiparesis. Phys Ther Res 2022; 24:195-203. [PMID: 35036252 DOI: 10.1298/ptr.r0015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/15/2021] [Indexed: 12/26/2022]
Abstract
Impairments resulting from stroke lead to persistent difficulties with walking. Subsequently, an improved walking ability is one of the highest priorities for people living with stroke. The degree to which gait can be restored after a stroke is related to both the initial impairment in walking ability and the severity of paresis of the lower extremities. However, there are some patients with severe motor paralysis and a markedly disrupted corticospinal tract who regain their gait function. Recently, several case reports have described the recovery of gait function in stroke patients with severe hemiplegia by providing alternate gait training. Multiple studies have demonstrated that gait training can induce "locomotor-like" coordinated muscle activity of paralyzed lower limbs in people with spinal cord injury. In the present review, we discuss the neural mechanisms of gait, and then we review case reports on the restoration of gait function in stroke patients with severe hemiplegia.
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Affiliation(s)
- Hiroaki Abe
- Fukushima Medical University School of Health Sciences, Japan
| | - Kei Kadowaki
- Department of Rehabilitation, Osaki Citizen General Hospital, Japan
| | - Naohide Tsujimoto
- Department of Rehabilitation Medicine, Nishiyamato Rehabilitation Hospital, Japan
| | - Toru Okanuka
- Department of Rehabilitation Medicine, Kohnan Hospital, Japan
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Naro A, Billeri L, Balletta T, Lauria P, Onesta MP, Calabrò RS. Finding the Way to Improve Motor Recovery of Patients with Spinal Cord Lesions: A Case-Control Pilot Study on a Novel Neuromodulation Approach. Brain Sci 2022; 12:119. [PMID: 35053862 PMCID: PMC8773706 DOI: 10.3390/brainsci12010119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 12/16/2022] Open
Abstract
Robot-assisted rehabilitation (RAR) and non-invasive brain stimulation (NIBS) are interventions that, both individually and combined, can significantly enhance motor performance after spinal cord injury (SCI). We sought to determine whether repetitive transcranial magnetic stimulation (rTMS) combined with active transvertebral direct current stimulation (tvDCS) (namely, NIBS) in association with RAR (RAR + NIBS) improves lower extremity motor function more than RAR alone in subjects with motor incomplete SCI (iSCI). Fifteen adults with iSCI received one daily session of RAR+NIBS in the early afternoon, six sessions weekly, for eight consecutive weeks. Outcome measures included the 6 min walk test (6MWT), the 10 m walk test (10MWT), the timed up and go (TUG) to test mobility and balance, the Walking Index for Spinal Cord Injury (WISCI II), the Functional Independence Measure-Locomotion (FIM-L), the manual muscle testing for lower extremity motor score (LEMS), the modified Ashworth scale for lower limbs (MAS), and the visual analog scale (VAS) for pain. The data of these subjects were compared with those of 20 individuals matched for clinical and demographic features who previously received the same amount or RAR without NIBS (RAR - NIBS). All patients completed the trial, and none reported any side effects either during or following the training. The 10MWT improved in both groups, but the increase was significantly greater following RAR + NIBS than RAR - NIBS. The same occurred for the FIM-L, LEMS, and WISCI II. No significant differences were appreciable concerning the 6MWT and TUG. Conversely, RAR - NIBS outperformed RAR + NIBS regarding the MAS and VAS. Pairing tvDCS with rTMS during RAR can improve lower extremity motor function more than RAR alone can do. Future research with a larger sample size is recommended to determine longer-term effects on motor function and activities of daily living.
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Affiliation(s)
- Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
| | - Luana Billeri
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
| | - Tina Balletta
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
| | - Paola Lauria
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
| | | | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
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Martins Â, Gouveia D, Cardoso A, Carvalho C, Coelho T, Silva C, Viegas I, Gamboa Ó, Ferreira A. A Controlled Clinical Study of Intensive Neurorehabilitation in Post-Surgical Dogs with Severe Acute Intervertebral Disc Extrusion. Animals (Basel) 2021; 11:ani11113034. [PMID: 34827767 PMCID: PMC8614363 DOI: 10.3390/ani11113034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/16/2021] [Accepted: 10/20/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary This study explores the potential intensive neurorehabilitation plasticity effects in post-surgical paraplegic dogs with severe acute intervertebral disc extrusion aiming to achieve ambulatory status. The intensive neurorehabilitation protocol translated in 99.4% (167/168) of recovery in deep pain perception-positive dogs and 58.5% (55/94) in deep pain perception-negative dogs. There was 37.3% (22/59) spinal reflex locomotion, obtained within a maximum period of 3 months. Thus, intensive neurorehabilitation may be a useful approach for this population of dogs, avoiding future euthanasia and promoting an estimated time window of 3 months to recover. Abstract This retrospective controlled clinical study aimed to verify if intensive neurorehabilitation (INR) could improve ambulation faster than spontaneous recovery or conventional physiotherapy and provide a possible therapeutic approach in post-surgical paraplegic deep pain perception-positive (DPP+) (with absent/decreased flexor reflex) and DPP-negative (DDP−) dogs, with acute intervertebral disc extrusion. A large cohort of T10-L3 Spinal Cord Injury (SCI) dogs (n = 367) were divided into a study group (SG) (n = 262) and a control group (CG) (n = 105). The SG was based on prospective clinical cases, and the CG was created by retrospective medical records. All SG dogs performed an INR protocol by the hospitalization regime based on locomotor training, electrical stimulation, and, for DPP−, a combination with pharmacological management. All were monitored throughout the process, and measuring the outcome for DPP+ was performed by OFS and, for the DPP−, by the new Functional Neurorehabilitation Scale (FNRS-DPP−). In the SG, DPP+ dogs had an ambulation rate of 99.4% (n = 167) and, in DPP−, of 58.5% (n = 55). Moreover, in DPP+, there was a strong statistically significant difference between groups regarding ambulation (p < 0.001). The same significant difference was verified in the DPP– dogs (p = 0.007). Furthermore, a tendency toward a significant statistical difference (p = 0.058) regarding DPP recovery was demonstrated between groups. Of the 59 dogs that did not recover DPP, 22 dogs achieved spinal reflex locomotion (SRL), 37.2% within a maximum of 3 months. The progressive myelomalacia cases were 14.9% (14/94). Therefore, although it is difficult to assess the contribution of INR for recovery, the results suggested that ambulation success may be improved, mainly regarding time.
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Affiliation(s)
- Ângela Martins
- Faculty of Veterinary Medicine, Lusófona University, Campo Grande, 1300-477 Lisboa, Portugal
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (T.C.); (C.S.); (I.V.)
- CIISA—Centro Interdisciplinar-Investigação em Saúde Animal, Faculdade de Medicina Veterinária, Av. Universidade Técnica de Lisboa, 1300-477 Lisboa, Portugal;
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1300-477 Lisboa, Portugal
- Correspondence:
| | - Débora Gouveia
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (T.C.); (C.S.); (I.V.)
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1300-477 Lisboa, Portugal
| | - Ana Cardoso
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (T.C.); (C.S.); (I.V.)
| | - Carla Carvalho
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (T.C.); (C.S.); (I.V.)
| | - Tiago Coelho
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (T.C.); (C.S.); (I.V.)
| | - Cátia Silva
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (T.C.); (C.S.); (I.V.)
| | - Inês Viegas
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (T.C.); (C.S.); (I.V.)
| | - Óscar Gamboa
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal;
| | - António Ferreira
- CIISA—Centro Interdisciplinar-Investigação em Saúde Animal, Faculdade de Medicina Veterinária, Av. Universidade Técnica de Lisboa, 1300-477 Lisboa, Portugal;
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal;
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Martins Â, Gouveia D, Cardoso A, Carvalho C, Silva C, Coelho T, Gamboa Ó, Ferreira A. Functional Neurorehabilitation in Dogs with an Incomplete Recovery 3 Months following Intervertebral Disc Surgery: A Case Series. Animals (Basel) 2021; 11:ani11082442. [PMID: 34438900 PMCID: PMC8388785 DOI: 10.3390/ani11082442] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/13/2021] [Accepted: 08/15/2021] [Indexed: 12/27/2022] Open
Abstract
Simple Summary A non-invasive neurorehabilitation multimodal protocol (NRMP) may be applicable to chronic T3-L3 dogs 3 months after undergoing surgery for acute Intervertebral Disc Disease (IVDD) Hansen type I; this protocol has been shown to be safe, feasible, and potentially effective at improving ambulation in both open field score (OFS) 0 and OFS 1 dogs. The specific sample population criteria limit the number of dogs included, mainly due to owners withdrawing over time. Thus, the present case series study aimed to demonstrate that an NRMP could contribute to a functional treatment possibly based on synaptic and anatomic reorganization of the spinal cord. Abstract This case series study aimed to evaluate the safety, feasibility, and positive outcome of the neurorehabilitation multimodal protocol (NRMP) in 16 chronic post-surgical IVDD Hansen type I dogs, with OFS 0/DPP− (n = 9) and OFS 1/DPP+ (n = 7). All were enrolled in the NRMP for a maximum of 90 days and were clinically discharged after achieving ambulation. The NRMP was based on locomotor training, functional electrical stimulation, transcutaneous electrical spinal cord stimulation, and 4-aminopyridine (4-AP) pharmacological management. In the Deep Pain Perception (DPP)+ dogs, 100% recovered ambulation within a mean period of 47 days, reaching OFS ≥11, which suggests that a longer period of time is needed for recovery. At follow-up, all dogs presented a positive evolution with voluntary micturition. Of the DPP− dogs admitted, all achieved a flexion/extension locomotor pattern within 30 days, and after starting the 4-AP, two dogs were discharged at outcome day 45, with 78% obtaining Spinal Reflex Locomotion (SRL) and automatic micturition within a mean period of 62 days. At follow-up, all dogs maintained their neurological status. After the NRMP, ambulatory status was achieved in 88% (14/16) of dogs, without concurrent events. Thus, an NRMP may be an important therapeutic option to reduce the need for euthanasia in the clinical setting.
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Affiliation(s)
- Ângela Martins
- Faculty of Veterinary Medicine, Lusófona University, Campo Grande, 1300-477 Lisboa, Portugal
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (C.S.); (T.C.)
- CIISA—Centro Interdisciplinar-Investigação em Saúde Animal, Faculdade de Medicina Veterinária, Av. Universidade Técnica de Lisboa, 1300-477 Lisboa, Portugal;
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1300-477 Lisboa, Portugal
- Correspondence:
| | - Débora Gouveia
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (C.S.); (T.C.)
- Superior School of Health, Protection and Animal Welfare, Polytechnic Institute of Lusophony, Campo Grande, 1300-477 Lisboa, Portugal
| | - Ana Cardoso
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (C.S.); (T.C.)
| | - Carla Carvalho
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (C.S.); (T.C.)
| | - Cátia Silva
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (C.S.); (T.C.)
| | - Tiago Coelho
- Animal Rehabilitation Center, Arrábida Veterinary Hospital, Azeitão, 2925-583 Setúbal, Portugal; (D.G.); (A.C.); (C.C.); (C.S.); (T.C.)
| | - Óscar Gamboa
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal;
| | - António Ferreira
- CIISA—Centro Interdisciplinar-Investigação em Saúde Animal, Faculdade de Medicina Veterinária, Av. Universidade Técnica de Lisboa, 1300-477 Lisboa, Portugal;
- Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisboa, Portugal;
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16
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Alashram AR, Annino G, Padua E. Robot-assisted gait training in individuals with spinal cord injury: A systematic review for the clinical effectiveness of Lokomat. J Clin Neurosci 2021; 91:260-269. [PMID: 34373038 DOI: 10.1016/j.jocn.2021.07.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/04/2021] [Accepted: 07/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Spinal cord injury (SCI) is a critical medical condition that causes numerous impairments leading to accompanying disability. Robotic-assisted gait training (RAGT) offers many advantages, including the capability to increase the intensity and total duration of training while maintaining a physiological gait pattern. The effects of the RAGT 'Lokomat' on various impairments following SCI remain unclear. OBJECTIVES This review was conducted to examine the impacts of the RAGT 'Lokomat' on the impairments following SCI. METHODS We searched PubMed, SCOPUS, PEDro, REHABDATA, MEDLINE, EMBASE, and web of science from inception to January 2021. Experimental studies examining the effects of the Lokomat on the impairments following incomplete SCI were selected. The methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. RESULTS Sixteen studies were met the inclusion criteria. Thirteen were randomized controlled trials, two were clinical trials, and one was a pilot study. The scores on the PEDro scale ranged from two to eight, with a median score of six. The results showed evidence for the beneficial effects of the Lokomat on many motor impairments following incomplete SCI. CONCLUSIONS The Lokomat may improve gait speed, walking distance, strength, range of motion, and mobility after incomplete SCI. There is insufficient evidence for the effect of the Lokomat on balance, depression, cardiorespiratory fitness, and quality of life. The effects of the Lokomat on the lower extremity spasticity were limited.
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Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Isra University, Amman, Jordan.
| | - Giuseppe Annino
- Department of Medicine Systems, University of Rome "Tor Vergata", Rome, Italy
| | - Elvira Padua
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
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17
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Gill ML, Linde MB, Hale RF, Lopez C, Fautsch KJ, Calvert JS, Veith DD, Beck LA, Garlanger KL, Sayenko DG, Lavrov IA, Thoreson AR, Grahn PJ, Zhao KD. Alterations of Spinal Epidural Stimulation-Enabled Stepping by Descending Intentional Motor Commands and Proprioceptive Inputs in Humans With Spinal Cord Injury. Front Syst Neurosci 2021; 14:590231. [PMID: 33584209 PMCID: PMC7875885 DOI: 10.3389/fnsys.2020.590231] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/11/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Regaining control of movement following a spinal cord injury (SCI) requires utilization and/or functional reorganization of residual descending, and likely ascending, supraspinal sensorimotor pathways, which may be facilitated via task-specific training through body weight supported treadmill (BWST) training. Recently, epidural electrical stimulation (ES) combined with task-specific training demonstrated independence of standing and stepping functions in individuals with clinically complete SCI. The restoration of these functions may be dependent upon variables such as manipulation of proprioceptive input, ES parameter adjustments, and participant intent during step training. However, the impact of each variable on the degree of independence achieved during BWST stepping remains unknown. Objective: To describe the effects of descending intentional commands and proprioceptive inputs, specifically body weight support (BWS), on lower extremity motor activity and vertical ground reaction forces (vGRF) during ES-enabled BWST stepping in humans with chronic sensorimotor complete SCI. Furthermore, we describe perceived changes in the level of assistance provided by clinicians when intent and BWS are modified. Methods: Two individuals with chronic, mid thoracic, clinically complete SCI, enrolled in an IRB and FDA (IDE G150167) approved clinical trial. A 16-contact electrode array was implanted in the epidural space between the T11-L1 vertebral regions. Lower extremity motor output and vertical ground reaction forces were obtained during clinician-assisted ES-enabled treadmill stepping with BWS. Consecutive steps were achieved during various experimentally-controlled conditions, including intentional participation and varied BWS (60% and 20%) while ES parameters remain unchanged. Results: During ES-enabled BWST stepping, the knee extensors exhibited an increase in motor activation during trials in which stepping was passive compared to active or during trials in which 60% BWS was provided compared to 20% BWS. As a result of this increased motor activation, perceived clinician assistance increased during the transition from stance to swing. Intentional participation and 20% BWS resulted in timely and purposeful activation of the lower extremities muscles, which improved independence and decreased clinician assistance. Conclusion: Maximizing participant intention and optimizing proprioceptive inputs through BWS during ES-enabled BWST stepping may facilitate greater independence during BWST stepping for individuals with clinically complete SCI. Clinical Trial Registration:ClinicalTrials.gov identifier: NCT02592668.
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Affiliation(s)
- Megan L Gill
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Margaux B Linde
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Rena F Hale
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Cesar Lopez
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Kalli J Fautsch
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Jonathan S Calvert
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, United States
| | - Daniel D Veith
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Lisa A Beck
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Kristin L Garlanger
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Dimitry G Sayenko
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Hospital, Houston, TX, United States
| | - Igor A Lavrov
- Department of Neurology, Mayo Clinic, Rochester, MN, United States.,Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Andrew R Thoreson
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States
| | - Peter J Grahn
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States.,Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States.,Office for Education Diversity, Equity and Inclusion, Mayo Clinic, Rochester, MN, United States
| | - Kristin D Zhao
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN, United States.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
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Hubscher CH, Wyles J, Gallahar A, Johnson K, Willhite A, Harkema SJ, Herrity AN. Effect of Different Forms of Activity-Based Recovery Training on Bladder, Bowel, and Sexual Function After Spinal Cord Injury. Arch Phys Med Rehabil 2020; 102:865-873. [PMID: 33278365 DOI: 10.1016/j.apmr.2020.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/15/2020] [Accepted: 11/02/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To investigate whether the urogenital and bowel functional gains previously demonstrated post-locomotor step training after chronic spinal cord injury could have been derived due to weight-bearing alone or from exercise in general. DESIGN Prospective cohort study; pilot trial with small sample size. SETTING Urogenital and bowel scientific core facility at a rehabilitation institute and spinal cord injury research center in the United States. PARTICIPANTS Men and women (N=22) with spinal cord injury (American Spinal Injury Association Impairment Scale grades of A-D) participated in this study. INTERVENTIONS Approximately 80 daily 1-hour sessions of either stand training or nonweight-bearing arm crank ergometry. Comparisons were made with previously published locomotor training data (step; N=7). MAIN OUTCOME MEASURES Assessments at both pre- and post-training timepoints included cystometry for bladder function and International Data Set Questionnaires for bowel and sexual functions. RESULTS Cystometry measurements revealed a significant decrease in bladder pressure and limited improvement in compliance with nonweight-bearing exercise but not with standing. Although International Data Set questionnaires revealed profound bowel dysfunction and marked deficits in sexual function pretraining, no differences were identified poststand or after nonweight-bearing exercise. CONCLUSIONS These pilot trial results suggest that, although stand and weight-bearing alone do not benefit pelvic organ functions after spinal cord injury, exercise in general may contribute at least partially to the lowering of bladder pressure and the increase in compliance that was seen previously with locomotor training, potentially through metabolic, humoral, and/or cardiovascular mechanisms. Thus, to maximize activity-based recovery training benefits for functions related to storage and emptying, an appropriate level of sensory input to the spinal cord neural circuitries controlling bladder and bowel requires task-specific stepping.
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Affiliation(s)
- Charles H Hubscher
- Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, KY; Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY.
| | - Jennifer Wyles
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY; Department of Neurological Surgery, University of Louisville, Louisville, KY
| | - Anthony Gallahar
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY; Department of Neurological Surgery, University of Louisville, Louisville, KY
| | - Kristen Johnson
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY; Department of Neurological Surgery, University of Louisville, Louisville, KY
| | - Andrea Willhite
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY; Department of Neurological Surgery, University of Louisville, Louisville, KY
| | - Susan J Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY; Department of Neurological Surgery, University of Louisville, Louisville, KY
| | - April N Herrity
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY; Department of Neurological Surgery, University of Louisville, Louisville, KY
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van Kammen K, Reinders-Messelink HA, Elsinghorst AL, Wesselink CF, Meeuwisse-de Vries B, van der Woude LHV, Boonstra AM, den Otter R. Amplitude and stride-to-stride variability of muscle activity during Lokomat guided walking and treadmill walking in children with cerebral palsy. Eur J Paediatr Neurol 2020; 29:108-117. [PMID: 32900595 DOI: 10.1016/j.ejpn.2020.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 08/09/2020] [Accepted: 08/18/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Lokomat is a commercially available exoskeleton for gait training in persons with cerebral palsy (CP). Because active contributions and variability over movement repetitions are determinants of training effectiveness, we studied muscle activity in children with CP, and determined (i) differences between treadmill and Lokomat walking, and (ii) the effects of Lokomat training parameters, on the amplitude and the stride-to-stride variability. METHODS Ten children with CP (age 13.2 ± 2.9, GMFCS level II(n = 6)/III(n = 4)) walked on a treadmill (±1 km/h; 0% bodyweight support(BWS)), and in the Lokomat (50% and 100% guidance; ±1 km/h and ±2 km/h; 0% and 50% BWS). Activity was recorded from Gluteus Medius (GM), Vastus Lateralis (VL), Biceps Femoris (BF), Medial Gastrocnemius (MG) and Tibialis Anterior (TA) of the most affected side. The averaged amplitude per gait phase, and the second order coefficient of variation was used to determine the active contribution and stride-to-stride variability, respectively. RESULTS Generally, the amplitude of activity was lower in the Lokomat than on the treadmill. During Lokomat walking, providing guidance and BWS resulted in slightly lower amplitudes whereas increased speed was associated with higher amplitudes. No significant differences in stride-to-stride variability were observed between Lokomat and treadmill walking, and in the Lokomat only speed (MG) and guidance (BF) affected variability. CONCLUSIONS Lokomat walking reduces muscle activity in children with CP, whereas altering guidance or BWS generally does not affect amplitude. This urges additional measures to encourage active patient contributions, e.g. by increasing speed or through instruction.
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Affiliation(s)
- Klaske van Kammen
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands; Rehabilitation Center 'Revalidatie Friesland', Beetsterzwaag, the Netherlands.
| | - Heleen A Reinders-Messelink
- Rehabilitation Center 'Revalidatie Friesland', Beetsterzwaag, the Netherlands; University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, the Netherlands.
| | - Anne L Elsinghorst
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands; Rehabilitation Center 'Revalidatie Friesland', Beetsterzwaag, the Netherlands.
| | - Carlijn F Wesselink
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands; Rehabilitation Center 'Revalidatie Friesland', Beetsterzwaag, the Netherlands.
| | | | - Lucas H V van der Woude
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, the Netherlands.
| | - Anne M Boonstra
- Rehabilitation Center 'Revalidatie Friesland', Beetsterzwaag, the Netherlands.
| | - Rob den Otter
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands.
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Alam M, Ling YT, Wong AYL, Zhong H, Edgerton VR, Zheng YP. Reversing 21 years of chronic paralysis via non-invasive spinal cord neuromodulation: a case study. Ann Clin Transl Neurol 2020; 7:829-838. [PMID: 32436278 PMCID: PMC7261759 DOI: 10.1002/acn3.51051] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/28/2020] [Accepted: 04/06/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The objective of the current study was to investigate if a non-invasive spinal cord neuromodulation modality could restore sensorimotor functions in a patient with chronic spinal cord injury (SCI). METHODS In this study, transcutaneous electrical stimulation (tES) to the spinal cord was utilized to restore sensorimotor functions in a chronic SCI patient who sustained a traumatic C7 cervical cord injury 21 years ago. At baseline, the patient had very limited volitional movement in her right leg, and her left leg was completely paralyzed. tES parameters were optimized in eight stimulation sessions before the treatment. The therapeutic stimulation involved biphasic tES, applied to T11 and L1 spinal levels during a 1-hour standing and walking training, 2-4 times per week for 16 weeks. RESULTS Our pre-treatment tests indicated that a shorter burst duration (100 µsec) was more effective than a longer burst duration of tES in improving functional movements. After 32 training sessions with tES, the patient regained significant left-leg volitional movements (grade 0 to grade 10 according to the ISNCSCI scale). Right-leg motor scores also increased from 17 to 21. The tES treatment also improved her pinprick sensation (from 73 to 79). Upon completion of the treatment (52 sessions), the patient's standing ability noticeably improved. She could stabilize her knee to stand without any assistance. She could also squat while holding onto a walker. INTERPRETATION These promising results demonstrate beneficial effects of non-invasive tES in regaining volitional control of plegic lower limbs in patients with chronic paralysis.
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Affiliation(s)
- Monzurul Alam
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Yan To Ling
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Arnold Y L Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Hui Zhong
- Department of Neurobiology, University of California, Los Angeles, CA
| | - Victor Reggie Edgerton
- Department of Neurobiology, University of California, Los Angeles, CA.,Department of Integrative Biology and Physiology, University of California, Los Angeles, CA, United States
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Lee SSM, Lam T, Pauhl K, Wakeling JM. Quantifying muscle coactivation in individuals with incomplete spinal cord injury using wavelets. Clin Biomech (Bristol, Avon) 2020; 73:101-107. [PMID: 31958701 DOI: 10.1016/j.clinbiomech.2020.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 02/11/2019] [Accepted: 01/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Individuals with incomplete spinal cord injury often have decreased gait function and coactivation of antagonistic muscle pairs. Common ways of quantifying coactivation using electromyographic signals do not consider frequency information in the signal. As electromyographic signals from different motor unit types have different frequency components and muscle fiber type can change in individuals with spinal cord injury, it may be beneficial to consider frequency components. The aims were to demonstrate the utility of using a method which considers temporal and frequency components of the electromyographical signal to quantify coactivation in lower extremity muscles in individuals with incomplete spinal cord injury through 1) comparison with able-bodied individuals and 2) comparison before and after body weight supported treadmill training. METHODS Frequency decomposition techniques were applied to electromyographical signals to consider the temporal and frequency components of the electromyographical signals to quantify coactivation over a range of frequencies. RESULTS Our main findings show that correlation coefficients between total EMG intensities of rectus femoris-biceps femoris and medial gastrocnemius-tibialis anterior were significantly different between able-bodied individuals and those with incomplete spinal cord injury (p = 0006, p = 0.01). The correlation spectra of medial gastrocnemius-tibialis anterior of the spinal cord injury group were substantially different than those the able-bodied group, while the EMG normalcy score was significantly different (p = 0.002). We also found that there was a change in coactivation of ankle muscles after body weight supported treadmill training. INTERPRETATION Our findings indicate that there may be frequency specific differences in muscle coactivation between able-bodied individuals and those with incomplete spinal cord injury. Changes in coactivation were also observed before and after body weight supported treadmill training. These differences may reflect the changes in recruitment patterns of different motor unit types.
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Affiliation(s)
- Sabrina S M Lee
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada; Department of Physical Therapy and Human Movement Sciences, Northwestern University, 645 N Michigan Avenue, Chicago, IL, USA.
| | - Tania Lam
- School of Kinesiology, The University of British Columbia, 210-6081 University Boulevard, Vancouver, BC V6T 1Z1, Canada; International Collaboration on Repair Discoveries, 818 W. 10th Ave., Vancouver V5Z 1M9, Canada
| | - Katherine Pauhl
- School of Kinesiology, The University of British Columbia, 210-6081 University Boulevard, Vancouver, BC V6T 1Z1, Canada; International Collaboration on Repair Discoveries, 818 W. 10th Ave., Vancouver V5Z 1M9, Canada
| | - James M Wakeling
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, 645 N Michigan Avenue, Chicago, IL, USA
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22
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Mohammed R, Opara K, Lall R, Ojha U, Xiang J. Evaluating the effectiveness of anti-Nogo treatment in spinal cord injuries. Neural Dev 2020; 15:1. [PMID: 31918754 PMCID: PMC6953157 DOI: 10.1186/s13064-020-0138-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 01/05/2020] [Indexed: 02/08/2023] Open
Abstract
As humans, we cannot regenerate axons within the central nervous system (CNS), therefore, making any damage to it permanent. This leads to the loss of sensory and motor function below the site of injury and can be crippling to a person’s health. Spontaneous recovery can occur from plastic changes, but it is minimal. The absence of regeneration is due to the inhibitory environment of the CNS as well as the inherent inability of CNS axons to form growth cones. Amongst many factors, one of the major inhibitory signals of the CNS environment is the myelin-associated Nogo pathway. Nogo-A, Nogo-B and Nogo-C (Nogo), stimulate the Nogo receptor, inhibiting neurite outgrowth by causing growth cones to collapse through activation of Rho Kinase (ROCK). Antibodies can be used to target this signalling pathway by binding to Nogo and thus promote the outgrowth of neuronal axons in the CNS. This use of anti-Nogo antibodies has been shown to upregulate CNS regeneration as well as drastically improve sensory and motor function in both rats and primates when coupled with adequate training. Here, we evaluate whether the experimental success of anti-Nogo at improving CNS regeneration can be carried over into the clinical setting to treat spinal cord injuries (SCI) and their symptoms successfully. Furthermore, we also discuss potential methods to improve the current treatment and any developmental obstacles.
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Affiliation(s)
- Raihan Mohammed
- Department of Medicine, School of Clinical Medicine, University of Cambridge, Hills Rd, Cambridge, CB2 0SP, UK.
| | - Kaesi Opara
- Department of Medicine, School of Clinical Medicine, University of Cambridge, Hills Rd, Cambridge, CB2 0SP, UK
| | - Rahul Lall
- Department of Medicine, School of Clinical Medicine, University of Cambridge, Hills Rd, Cambridge, CB2 0SP, UK
| | - Utkarsh Ojha
- Faculty of Medicine, Imperial College London, London, UK
| | - Jinpo Xiang
- Faculty of Medicine, Imperial College London, London, UK
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23
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Gait ability required to achieve therapeutic effect in gait and balance function with the voluntary driven exoskeleton in patients with chronic spinal cord injury: a clinical study. Spinal Cord 2019; 58:520-527. [DOI: 10.1038/s41393-019-0403-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 12/02/2019] [Accepted: 12/04/2019] [Indexed: 12/27/2022]
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24
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Laliberte AM, Goltash S, Lalonde NR, Bui TV. Propriospinal Neurons: Essential Elements of Locomotor Control in the Intact and Possibly the Injured Spinal Cord. Front Cell Neurosci 2019; 13:512. [PMID: 31798419 PMCID: PMC6874159 DOI: 10.3389/fncel.2019.00512] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/29/2019] [Indexed: 12/22/2022] Open
Abstract
Propriospinal interneurons (INs) communicate information over short and long distances within the spinal cord. They act to coordinate different parts of the body by linking motor circuits that control muscles across the forelimbs, trunk, and hindlimbs. Their role in coordinating locomotor circuits near and far may be invaluable to the recovery of locomotor function lost due to injury to the spinal cord where the flow of motor commands from the brain and brainstem to spinal motor circuits is disrupted. The formation and activation of circuits established by spared propriospinal INs may promote the re-emergence of locomotion. In light of progress made in animal models of spinal cord injury (SCI) and in human patients, we discuss the role of propriospinal INs in the intact spinal cord and describe recent studies investigating the assembly and/or activation of propriospinal circuits to promote recovery of locomotion following SCI.
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Affiliation(s)
- Alex M Laliberte
- Department of Biology, Faculty of Science, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Sara Goltash
- Department of Biology, Faculty of Science, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Nicolas R Lalonde
- Department of Biology, Faculty of Science, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Tuan Vu Bui
- Department of Biology, Faculty of Science, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
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25
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Shimizu Y, Kadone H, Kubota S, Suzuki K, Saotome K, Ueno T, Abe T, Marushima A, Watanabe H, Endo A, Tsurumi K, Ishimoto R, Matsushita A, Koda M, Matsumura A, Sankai Y, Hada Y, Yamazaki M. Voluntary ambulation using voluntary upper limb muscle activity and Hybrid Assistive Limb® (HAL®) in a patient with complete paraplegia due to chronic spinal cord injury: A case report. J Spinal Cord Med 2019; 42:460-468. [PMID: 29351051 PMCID: PMC6718935 DOI: 10.1080/10790268.2017.1423267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Context: We sought to describe our experience with the Hybrid Assistive Limb® (HAL®) for active knee extension and voluntary ambulation with remaining muscle activity in a patient with complete paraplegia after spinal cord injury. Findings: A 30-year-old man with complete paraplegia used the HAL® for 1 month (10 sessions) using his remaining muscle activity, including hip flexor and upper limb activity. Electromyography was used to evaluate muscle activity of the gluteus maximus, tensor fascia lata, quadriceps femoris, and hamstring muscles in synchronization with the Vicon motion capture system. A HAL® session included a knee extension session with the hip flexor and voluntary gait with upper limb activity. After using the HAL® for one month, the patient's manual muscle hip flexor scores improved from 1/5 to 2/5 for the right and from 2/5 to 3/5 for the left knee, and from 0/5 to 1/5 for the extension of both knees. Conclusion/clinical relevance: Knee extension sessions with HAL®, and hip flexor and upper-limb-triggered HAL® ambulation seem a safe and feasible option in a patient with complete paraplegia due to spinal cord injury.
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Affiliation(s)
- Yukiyo Shimizu
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Ibaraki, Japan,Correspondence to: Yukiyo Shimizu, MD, PhD, Department of Rehabilitation Medicine, University of Tsukuba Hospital, 2-1-1, Amakubo, Tsukuba, Ibaraki, 305-8576, Japan; Ph: +81-29-853-3219, Fax: +81-29-853-3162.
| | - Hideki Kadone
- Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Ibaraki, Japan
| | - Shigeki Kubota
- Division of Regenerative Medicine for Musculoskeletal System, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kenji Suzuki
- Center for Cybernics Research, University of Tsukuba, Ibaraki, Japan
| | - Kousaku Saotome
- Center for Cybernics Research, University of Tsukuba, Ibaraki, Japan
| | - Tomoyuki Ueno
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Tetsuya Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hiroki Watanabe
- Center for Cybernics Research, University of Tsukuba, Ibaraki, Japan,Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Ayumu Endo
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Kazue Tsurumi
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Ryu Ishimoto
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Akira Matsushita
- Department of Neurosurgery, Ibaraki Prefectural University Hospital of Health Sciences, Ibaraki, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Akira Matsumura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yoshiyuki Sankai
- Faculty of Systems and Information Engineering, University of Tsukuba, Ibaraki, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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26
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Sayenko DG, Rath M, Ferguson AR, Burdick JW, Havton LA, Edgerton VR, Gerasimenko YP. Self-Assisted Standing Enabled by Non-Invasive Spinal Stimulation after Spinal Cord Injury. J Neurotrauma 2019; 36:1435-1450. [PMID: 30362876 PMCID: PMC6482915 DOI: 10.1089/neu.2018.5956] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Neuromodulation of spinal networks can improve motor control after spinal cord injury (SCI). The objectives of this study were to (1) determine whether individuals with chronic paralysis can stand with the aid of non-invasive electrical spinal stimulation with their knees and hips extended without trainer assistance, and (2) investigate whether postural control can be further improved following repeated sessions of stand training. Using a double-blind, balanced, within-subject cross-over, and sham-controlled study design, 15 individuals with SCI of various severity received transcutaneous electrical spinal stimulation to regain self-assisted standing. The primary outcomes included qualitative comparison of need of external assistance for knee and hip extension provided by trainers during standing without and in the presence of stimulation in the same participants, as well as quantitative measures, such as the level of knee assistance and amount of time spent standing without trainer assistance. None of the participants could stand unassisted without stimulation or in the presence of sham stimulation. With stimulation all participants could maintain upright standing with minimum and some (n = 7) without external assistance applied to the knees or hips, using their hands for upper body balance as needed. Quality of balance control was practice-dependent, and improved with subsequent training. During self-initiated body-weight displacements in standing enabled by spinal stimulation, high levels of leg muscle activity emerged, and depended on the amount of muscle loading. Our findings indicate that the lumbosacral spinal networks can be modulated transcutaneously using electrical spinal stimulation to facilitate self-assisted standing after chronic motor and sensory complete paralysis.
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Affiliation(s)
- Dimitry G. Sayenko
- Department of Integrative Biology and Physiology, University of California, Los Angeles, California
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, Texas
| | - Mrinal Rath
- Department of Integrative Biology and Physiology, University of California, Los Angeles, California
- Department of Biomedical Engineering, University of California, Los Angeles, California
| | - Adam R. Ferguson
- Brain and Spinal Injury Center, Department of Neurological Surgery, University of California, San Francisco, California
| | - Joel W. Burdick
- Division of Engineering and Applied Sciences, California Institute of Technology, Pasadena, California
| | - Leif A. Havton
- Department of Neurology and Neurobiology, University of California, Los Angeles, California
| | - V. Reggie Edgerton
- Department of Integrative Biology and Physiology, University of California, Los Angeles, California
- Department of Biomedical Engineering, University of California, Los Angeles, California
- Institut Guttmann, Hospital de Neurorehabilitació, Institut Universitari adscrit a la Universitat Autònoma de Barcelona, Barcelona, Badalona, Spain
- Department of Neurobiology and Neurosurgery, University of California, Los Angeles, California
- Centre for Neuroscience and Regenerative Medicine, Faculty of Science, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Yury P. Gerasimenko
- Department of Integrative Biology and Physiology, University of California, Los Angeles, California
- Pavlov Institute of Physiology, St. Petersburg, Russia
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27
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Geiger DE, Behrendt F, Schuster-Amft C. EMG Muscle Activation Pattern of Four Lower Extremity Muscles during Stair Climbing, Motor Imagery, and Robot-Assisted Stepping: A Cross-Sectional Study in Healthy Individuals. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9351689. [PMID: 31019976 PMCID: PMC6452562 DOI: 10.1155/2019/9351689] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/18/2019] [Accepted: 03/06/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Stair climbing can be a challenging part of daily life and a limiting factor for social participation, in particular for patients after stroke. In order to promote motor relearning of stair climbing, different therapeutical measures can be applied such as motor imagery and robot-assisted stepping therapy. Both are common therapy measures and a positive influence on the rehabilitation process has been reported. However, there are contradictory results regarding the neuromuscular effect of motor imagery, and the effect of robot-assisted tilt table stepping on the EMG activation compared to stair climbing itself is not known. Thus, we investigated the EMG activity during (1) a stepping task on the robot-assisted tilt table Erigo, (2) motor imagery of stair climbing, and (3) real stair climbing in healthy individuals for a subsequent study on patients with lower limb motor impairment. The aim was to assess potential amplitude independent changes of the EMG activation as a function of the different conditions. METHODS EMG data of four muscles of the dominant leg were recorded in m. rectus femoris, m. biceps femoris, m. tibialis anterior, and m. gastrocnemius medialis. The cross-correlation analysis was performed to measure similarity/dissimilarity of the EMG curves. RESULTS The data of the study participants revealed high cross-correlation coefficients comparing the EMG activation modulation of stair climbing and robot-assisted tilt table stepping in three muscles except for the m. gastrocnemius medialis. As the EMG activation amplitude did not differ between motor imagery and the resting phase the according EMG data of the motor imagery condition were not subjected to a further analysis. CONCLUSION Robot-assisted tilt table stepping, but rather not motor imagery, evokes a similar activation in certain leg muscles compared to real stair climbing.
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Affiliation(s)
- Damaris E. Geiger
- Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Frank Behrendt
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
| | - Corina Schuster-Amft
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
- Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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28
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Yu P, Zhang W, Liu Y, Sheng C, So KF, Zhou L, Zhu H. The effects and potential mechanisms of locomotor training on improvements of functional recovery after spinal cord injury. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2019; 147:199-217. [DOI: 10.1016/bs.irn.2019.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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29
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Short-term inhibition of spinal reflexes in multiple lower limb muscles after neuromuscular electrical stimulation of ankle plantar flexors. Exp Brain Res 2018; 237:467-476. [DOI: 10.1007/s00221-018-5437-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 11/16/2018] [Indexed: 10/27/2022]
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30
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Chu VWT, Hornby TG, Schmit BD. Stepping responses to treadmill perturbations vary with severity of motor deficits in human SCI. J Neurophysiol 2018; 120:497-508. [PMID: 29668389 DOI: 10.1152/jn.00486.2017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In this study, we investigated the responses to tread perturbations during human stepping on a treadmill. Our approach was to test the effects of perturbations to a single leg using a split-belt treadmill in healthy participants and in participants with varying severity of spinal cord injury (SCI). We recruited 11 people with incomplete SCI and 5 noninjured participants. As participants walked on an instrumented treadmill, the belt on one side was stopped or accelerated briefly during midstance to late stance. A majority of participants initiated an unnecessary swing when the treadmill was stopped in midstance, although the likelihood of initiating a step was decreased in participants with more severe SCI. Accelerating or decelerating one belt of the treadmill during stance altered the characteristics of swing. We observed delayed swing initiation when the belt was decelerated (i.e., the hip was in a more flexed position at time of swing) and advanced swing initiation with acceleration (i.e., hip extended at swing initiation). Furthermore, the timing and leg posture of heel strike appeared to remain constant, reflected by a sagittal plane hip angle at heel strike that remained the same regardless of the perturbation. In summary, our results supported the current understanding of the role of sensory feedback and central drive in the control of stepping in participants with incomplete SCI and noninjured participants. In particular, the observation of unnecessary swing during a stop perturbation highlights the interdependence of central and sensory drive in walking control. NEW & NOTEWORTHY Using a novel approach with a split-belt treadmill, we tested the effects of hip angle perturbations to a single leg in healthy participants and participants with varying severity of spinal cord injury (SCI). A majority of participants initiated an unnecessary swing when the treadmill was stopped in midstance, although the likelihood of initiating a step decreased with the severity of SCI. Our results demonstrated interdependence of central and sensory drive in walking control.
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Affiliation(s)
- Virginia W T Chu
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago , Chicago, Illinois
| | - T George Hornby
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago , Chicago, Illinois.,Department of Physical Therapy, University of Illinois at Chicago , Chicago, Illinois
| | - Brian D Schmit
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago , Chicago, Illinois.,Department of Biomedical Engineering, Marquette University , Milwaukee, Wisconsin
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31
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Apte S, Plooij M, Vallery H. Influence of body weight unloading on human gait characteristics: a systematic review. J Neuroeng Rehabil 2018; 15:53. [PMID: 29925400 PMCID: PMC6011391 DOI: 10.1186/s12984-018-0380-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 04/30/2018] [Indexed: 11/15/2022] Open
Abstract
Background Body weight support (BWS) systems have shown promise as rehabilitation tools for neurologically impaired individuals. This paper reviews the experiment-based research on BWS systems with the aim: (1) To investigate the influence of body weight unloading (BWU) on gait characteristics; (2) To study whether the effects of BWS differ between treadmill and overground walking and (3) To investigate if modulated BWU influences gait characteristics less than unmodulated BWU. Method A systematic literature search was conducted in the following search engines: Pubmed, Scopus, Web of Science and Google Scholar. Statistical analysis was used to quantify the effects of BWU on gait parameters. Results 54 studies of experiments with healthy and neurologically impaired individuals walking in a BWS system were included and 32 of these were used for the statistical analysis. Literature was classified using three distinctions: (1) treadmill or overground walking; (2) the type of subjects and (3) the nature of unloading force. Only 27% studies were based on neurologically impaired subjects; a low number considering that they are the primary user group for BWS systems. The studies included BWU from 5% to 100% and the 30% and 50% BWU conditions were the most widely studied. The number of participants varied from 1 to 28, with an average of 12. It was seen that due to the increase in BWU level, joint moments, muscle activity, energy cost of walking and ground reaction forces (GRF) showed higher reduction compared to gait spatio-temporal and joint kinematic parameters. The influence of BWU on kinematic and spatio-temporal gait parameters appeared to be limited up to 30% unloading. 5 gait characteristics presented different behavior in response to BWU for overground and treadmill walking. Remaining 21 gait characteristics showed similar behavior but different magnitude of change for overground and treadmill walking. Modulated unloading force generally led to less difference from the 0% condition than unmodulated unloading. Conclusion This review has shown that BWU influences all gait characteristics, albeit with important differences between the kinematic, spatio-temporal and kinetic characteristics. BWU showed stronger influence on the kinetic characteristics of gait than on the spatio-temporal parameters and the kinematic characteristics. It was ascertained that treadmill and overground walking can alter the effects of BWU in a different manner. Our results indicate that task-specific gait training is likely to be achievable at a BWU level of 30% and below. Electronic supplementary material The online version of this article (10.1186/s12984-018-0380-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Salil Apte
- Mechanical, Maritime and Materials Engineering (3mE), TU Delft, Mekelweg 2, Delft, 2628 CD, Netherlands
| | - Michiel Plooij
- Mechanical, Maritime and Materials Engineering (3mE), TU Delft, Mekelweg 2, Delft, 2628 CD, Netherlands.,Motekforce Link, Hogehilweg 18-C, Amsterdam, 1101 CD, Netherlands
| | - Heike Vallery
- Mechanical, Maritime and Materials Engineering (3mE), TU Delft, Mekelweg 2, Delft, 2628 CD, Netherlands.
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32
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Gassert R, Dietz V. Rehabilitation robots for the treatment of sensorimotor deficits: a neurophysiological perspective. J Neuroeng Rehabil 2018; 15:46. [PMID: 29866106 PMCID: PMC5987585 DOI: 10.1186/s12984-018-0383-x] [Citation(s) in RCA: 145] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 05/07/2018] [Indexed: 11/30/2022] Open
Abstract
The past decades have seen rapid and vast developments of robots for the rehabilitation of sensorimotor deficits after damage to the central nervous system (CNS). Many of these innovations were technology-driven, limiting their clinical application and impact. Yet, rehabilitation robots should be designed on the basis of neurophysiological insights underlying normal and impaired sensorimotor functions, which requires interdisciplinary collaboration and background knowledge. Recovery of sensorimotor function after CNS damage is based on the exploitation of neuroplasticity, with a focus on the rehabilitation of movements needed for self-independence. This requires a physiological limb muscle activation that can be achieved through functional arm/hand and leg movement exercises and the activation of appropriate peripheral receptors. Such considerations have already led to the development of innovative rehabilitation robots with advanced interaction control schemes and the use of integrated sensors to continuously monitor and adapt the support to the actual state of patients, but many challenges remain. For a positive impact on outcome of function, rehabilitation approaches should be based on neurophysiological and clinical insights, keeping in mind that recovery of function is limited. Consequently, the design of rehabilitation robots requires a combination of specialized engineering and neurophysiological knowledge. When appropriately applied, robot-assisted therapy can provide a number of advantages over conventional approaches, including a standardized training environment, adaptable support and the ability to increase therapy intensity and dose, while reducing the physical burden on therapists. Rehabilitation robots are thus an ideal means to complement conventional therapy in the clinic, and bear great potential for continued therapy and assistance at home using simpler devices. This review summarizes the evolution of the field of rehabilitation robotics, as well as the current state of clinical evidence. It highlights fundamental neurophysiological factors influencing the recovery of sensorimotor function after a stroke or spinal cord injury, and discusses their implications for the development of effective rehabilitation robots. It thus provides insights on essential neurophysiological mechanisms to be considered for a successful development and clinical inclusion of robots in rehabilitation.
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Affiliation(s)
- Roger Gassert
- Department of Health Sciences and Technology, ETH Zurich, 8092, Zurich, Switzerland.
| | - Volker Dietz
- Spinal Cord Injury Center, Balgrist University Hospital, 8008, Zurich, Switzerland
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Klarner T, Zehr EP. Sherlock Holmes and the curious case of the human locomotor central pattern generator. J Neurophysiol 2018. [PMID: 29537920 DOI: 10.1152/jn.00554.2017] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Evidence first described in reduced animal models over 100 years ago led to deductions about the control of locomotion through spinal locomotor central pattern-generating (CPG) networks. These discoveries in nature were contemporaneous with another form of deductive reasoning found in popular culture, that of Arthur Conan Doyle's detective, Sherlock Holmes. Because the invasive methods used in reduced nonhuman animal preparations are not amenable to study in humans, we are left instead with deducing from other measures and observations. Using the deductive reasoning approach of Sherlock Holmes as a metaphor for framing research into human CPGs, we speculate and weigh the evidence that should be observable in humans based on knowledge from other species. This review summarizes indirect inference to assess "observable evidence" of pattern-generating activity that leads to the logical deduction of CPG contributions to arm and leg activity during locomotion in humans. The question of where a CPG may be housed in the human nervous system remains incompletely resolved at this time. Ongoing understanding, elaboration, and application of functioning locomotor CPGs in humans is important for gait rehabilitation strategies in those with neurological injuries.
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Affiliation(s)
- Taryn Klarner
- Rehabilitation Neuroscience Laboratory, University of Victoria , Victoria, British Columbia , Canada.,Human Discovery Science, International Collaboration on Repair Discoveries , Vancouver, British Columbia , Canada.,Centre for Biomedical Research, University of Victoria , Victoria, British Columbia , Canada
| | - E Paul Zehr
- Rehabilitation Neuroscience Laboratory, University of Victoria , Victoria, British Columbia , Canada.,Human Discovery Science, International Collaboration on Repair Discoveries , Vancouver, British Columbia , Canada.,Centre for Biomedical Research, University of Victoria , Victoria, British Columbia , Canada.,Division of Medical Sciences, University of Victoria, British Columbia, Canada
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Jansen O, Grasmuecke D, Meindl RC, Tegenthoff M, Schwenkreis P, Sczesny-Kaiser M, Wessling M, Schildhauer TA, Fisahn C, Aach M. Hybrid Assistive Limb Exoskeleton HAL in the Rehabilitation of Chronic Spinal Cord Injury: Proof of Concept; the Results in 21 Patients. World Neurosurg 2018; 110:e73-e78. [DOI: 10.1016/j.wneu.2017.10.080] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 10/13/2017] [Accepted: 10/14/2017] [Indexed: 12/28/2022]
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Hubscher CH, Herrity AN, Williams CS, Montgomery LR, Willhite AM, Angeli CA, Harkema SJ. Improvements in bladder, bowel and sexual outcomes following task-specific locomotor training in human spinal cord injury. PLoS One 2018; 13:e0190998. [PMID: 29385166 PMCID: PMC5791974 DOI: 10.1371/journal.pone.0190998] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 12/22/2017] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Locomotor training (LT) as a therapeutic intervention following spinal cord injury (SCI) is an effective rehabilitation strategy for improving motor outcomes, but its impact on non-locomotor functions is unknown. Given recent results of our labs' pre-clinical animal SCI LT studies and existing overlap of lumbosacral spinal circuitries controlling pelvic-visceral and locomotor functions, we addressed whether LT can improve bladder, bowel and sexual function in humans at chronic SCI time-points (> two years post-injury). STUDY DESIGN Prospective cohort study; pilot trial with small sample size. METHODS Eight SCI research participants who were undergoing 80 daily one-hour sessions of LT on a treadmill using body-weight support, or one-hour of LT and stand training on alternate days, as part of another research study conducted at the Kentucky Spinal Cord Injury Research Center, University of Louisville, were enrolled in this pilot trial. Urodynamic assessments were performed and International Data Set questionnaire forms completed for bladder, bowel and sexual functions at pre-and post-training time points. Four usual care (non-trained; regular at-home routine) research participants were also enrolled in this study and had the same assessments collected twice, at least 3 months apart. RESULTS Filling cystometry documented significant increases in bladder capacity, voiding efficiency and detrusor contraction time as well as significant decreases in voiding pressure post-training relative to baseline. Questionnaires revealed a decrease in the frequency of nocturia and urinary incontinence for several research participants as well as a significant decrease in time required for defecation and a significant increase in sexual desire post-training. No significant differences were found for usual care research participants. CONCLUSIONS These results suggest that an appropriate level of sensory information provided to the spinal cord, generated through task-specific stepping and/or loading, can positively benefit the neural circuitries controlling urogenital and bowel functions. TRIAL REGISTRATION ClinicalTrials.gov NCT03036527.
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Affiliation(s)
- Charles H. Hubscher
- Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, Kentucky, United States of America
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, United States of America
- * E-mail:
| | - April N. Herrity
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, United States of America
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, United States of America
| | - Carolyn S. Williams
- Department of Urology, University of Louisville, Louisville, Kentucky, United States of America
| | - Lynnette R. Montgomery
- Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, Kentucky, United States of America
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, United States of America
| | - Andrea M. Willhite
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, United States of America
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, United States of America
| | - Claudia A. Angeli
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, United States of America
- Frazier Rehabilitation Institute, Louisville, Kentucky, United States of America
| | - Susan J. Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, United States of America
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, United States of America
- Frazier Rehabilitation Institute, Louisville, Kentucky, United States of America
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Obata H, Ogawa T, Milosevic M, Kawashima N, Nakazawa K. Short-term effects of electrical nerve stimulation on spinal reciprocal inhibition depend on gait phase during passive stepping. J Electromyogr Kinesiol 2017; 38:151-154. [PMID: 29288924 DOI: 10.1016/j.jelekin.2017.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/20/2017] [Accepted: 12/24/2017] [Indexed: 11/28/2022] Open
Abstract
A combination of electrical nerve stimulation (ENS) and passive or active cyclic movements (i.e., pedaling and stepping) has been suggested to induce stronger short-term effects in spinal circuits as compared to either intervention alone. The purpose of the present study is to determine whether the effects of ENS during passive stepping are dependent on the timing of the stimulation during the stepping cycle. A total of 10 able-bodied participants were recruited for the study. Two interventions were assessed during passive ground stepping: (1) ENS of the common peroneal nerve (CPN) during the swing phase (ENSswing) and (2) stance phase (ENSstance). ENS was applied at the motor threshold intensity on the tibialis anterior muscle for a total of 30 min. Spinal reciprocal inhibition (RI) was assessed by conditioning the H-reflex in the soleus muscle with electrical stimulation to the CPN before (baseline), as well as 5, 15, and 30 min after each intervention. Compared to the baseline, the amount of RI was increased 5 and 15 min after the ENSswing intervention, whereas it was decreased after the ENSstance intervention. This suggests that ENS has a phase-dependent effect on RI during passive stepping. Overall, the results imply that phase-dependent timing of ENS is essential for guiding plasticity in the spinal circuits.
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Affiliation(s)
- Hiroki Obata
- Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Japan.
| | - Tetsuya Ogawa
- Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Japan
| | - Matija Milosevic
- Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Japan
| | - Noritaka Kawashima
- Department of Motor Dysfunction, Research Institute of National Rehabilitation Center for Persons with Disabilities, Japan
| | - Kimitaka Nakazawa
- Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Japan
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SAP97 Binding Partner CRIPT Promotes Dendrite Growth In Vitro and In Vivo. eNeuro 2017; 4:eN-NWR-0175-17. [PMID: 29218323 PMCID: PMC5718245 DOI: 10.1523/eneuro.0175-17.2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 10/30/2017] [Accepted: 10/30/2017] [Indexed: 01/15/2023] Open
Abstract
The dendritic tree is a key determinant of neuronal information processing. In the motor system, the dendritic tree of spinal cord neurons undergoes dramatic remodeling in an activity-dependent manner during early postnatal life. This leads to the proper segmental spinal cord connectivity that subserves normal locomotor behavior. One molecular system driving the establishment of dendrite architecture of mammalian motor neurons relies on AMPA receptors (AMPA-Rs) assembled with the GluA1 subunit, and this occurs in an NMDA receptor (NMDA-R)-independent manner. The dendrite growth promoting activity of GluA1-containing AMPA-Rs depends on its intracellular binding partner, SAP97, and SAP97's PDZ3 domain. We show here that cysteine-rich interactor of PDZ3 (CRIPT) is a bona fide SAP97 PDZ3-domain binding partner, localizes to synapses with GluA1 and SAP97 along the dendritic tree, and is a determinant of the dendritic growth of mammalian spinal cord neurons. We further show that CRIPT has a well-conserved ortholog in the nematode, Caenorhabditis elegans, and animals lacking CRIPT display decreased dendrite branching of the well-studied PVD neuron in vivo. The lack of CRIPT leads to a selective defect in touch perception, and this is rescued by expression of wild-type (WT) human CRIPT (hCRIPT) in the nervous system. This work brings new light into the molecular machinery that drives dendritic growth during development and may prove relevant to the promotion of nervous system plasticity following insult.
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Shimizu Y, Kadone H, Kubota S, Suzuki K, Abe T, Ueno T, Soma Y, Sankai Y, Hada Y, Yamazaki M. Voluntary Ambulation by Upper Limb-Triggered HAL® in Patients with Complete Quadri/Paraplegia Due to Chronic Spinal Cord Injury. Front Neurosci 2017; 11:649. [PMID: 29209163 PMCID: PMC5702458 DOI: 10.3389/fnins.2017.00649] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/08/2017] [Indexed: 12/24/2022] Open
Abstract
Patients with complete paraplegia after spinal cord injury (SCI) are unable to stand or walk on their own. Standing exercise decreases the risk of decubitus ulcers, osteoporosis, and joint deformities in patients with SCI. Conventional gait training for complete paraplegia requires excessive upper limb usage for weight bearing and is difficult in cases of complete quadriplegia. The purpose of this study was to describe voluntary ambulation triggered by upper limb activity using the Hybrid Assistive Limb® (HAL) in patients with complete quadri/paraplegia after chronic SCI. Four patients (3 men, 1 woman) were enrolled in this study. The mean patient age ± standard deviation was 37.2 ± 17.8 (range, 20–67) years. Clinical evaluation before intervention revealed the following findings: case 1, neurological level C6, American Spinal Cord Injury Association impairment scale (AIS) grade B; case 2, T6, AIS A; case 3, T10 AIS A; and case 4, T11, AIS A. The HAL intervention consisted of 10 sessions. Each HAL session lasted 60–90 min. The HAL electrodes for hip and knee flexion-extension were placed on the anterior and posterior sides of the upper limbs contralaterally corresponding to each of the lower limbs. Surface electromyography (EMG) was used to evaluate muscle activity of the tensor fascia lata and quadriceps femoris (Quad) in synchronization with a Vicon motion capture system. The modified Ashworth scale (mAs) score was also evaluated before and after each session. All participants completed all 10 sessions. Cases 1, 2, and 3 demonstrated significant decreases in mAs score after the sessions compared to pre-session measurements. In all cases, EMG before the intervention showed no apparent activation in either Quad. However, gait phase dependent activity of the lower limb muscles was seen during voluntarily triggered ambulation driven by upper limb muscle activities. In cases 3 and 4, active contraction in both Quads was observed after intervention. These findings suggest that upper-limb-triggered HAL ambulation is a safe and feasible option for rehabilitation in patients with complete quadri/paraplegia caused by chronic SCI.
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Affiliation(s)
- Yukiyo Shimizu
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Hideki Kadone
- Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Tsukuba, Japan
| | - Shigeki Kubota
- Division of Regenerative Medicine for Musculoskeletal System, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kenji Suzuki
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Tetsuya Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomoyuki Ueno
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yuichiro Soma
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yoshiyuki Sankai
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Warabi T, Furuyama H, Sugai E, Kato M, Yanagisawa N. Gait bradykinesia in Parkinson's disease: a change in the motor program which controls the synergy of gait. Exp Brain Res 2017; 236:43-57. [PMID: 29080098 DOI: 10.1007/s00221-017-5106-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 10/10/2017] [Indexed: 11/28/2022]
Abstract
This study examined how gait bradykinesia is changed by the motor programming in Parkinson's disease. Thirty-five idiopathic Parkinson's disease patients and nine age-matched healthy subjects participated in this study. After the patients fixated on a visual-fixation target (conditioning-stimulus), the voluntary-gait was triggered by a visual on-stimulus. While the subject walked on a level floor, soleus, tibialis anterior EMG latencies, and the y-axis-vector of the sole-floor reaction force were examined. Three paradigms were used to distinguish between the off-/on-latencies. The gap-task: the visual-fixation target was turned off; 200 ms before the on-stimulus was engaged (resulting in a 200 ms-gap). EMG latency was not influenced by the visual-fixation target. The overlap-task: the on-stimulus was turned on during the visual-fixation target presentation (200 ms-overlap). The no-gap-task: the fixation target was turned off and the on-stimulus was turned on simultaneously. The onset of EMG pause following the tonic soleus EMG was defined as the off-latency of posture (termination). The onset of the tibialis anterior EMG burst was defined as the on-latency of gait (initiation). In the gap-task, the on-latency was unchanged in all of the subjects. In Parkinson's disease, the visual-fixation target prolonged both the off-/on-latencies in the overlap-task. In all tasks, the off-latency was prolonged and the off-/on-latencies were unsynchronized, which changed the synergic movement to a slow, short-step-gait. The synergy of gait was regulated by two independent sensory-motor programs of the off- and on-latency levels. In Parkinson's disease, the delayed gait initiation was due to the difficulty in terminating the sensory-motor program which controls the subject's fixation. The dynamic gait bradykinesia was involved in the difficulty (long off-latency) in terminating the motor program of the prior posture/movement.
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Affiliation(s)
- Tateo Warabi
- Clinical Brain Research Laboratory, Department of Neurology, Sapporo Yamanoue Hospital, Toyokura Memorial Hall, Yamanote 6-9-1-1, Nishi-ku, Sapporo, Hokkaido, 063-0006, Japan.
| | - Hiroyasu Furuyama
- Clinical Brain Research Laboratory, Department of Neurology, Sapporo Yamanoue Hospital, Toyokura Memorial Hall, Yamanote 6-9-1-1, Nishi-ku, Sapporo, Hokkaido, 063-0006, Japan
| | - Eri Sugai
- Clinical Brain Research Laboratory, Department of Neurology, Sapporo Yamanoue Hospital, Toyokura Memorial Hall, Yamanote 6-9-1-1, Nishi-ku, Sapporo, Hokkaido, 063-0006, Japan
| | - Masamichi Kato
- Clinical Brain Research Laboratory, Department of Neurology, Sapporo Yamanoue Hospital, Toyokura Memorial Hall, Yamanote 6-9-1-1, Nishi-ku, Sapporo, Hokkaido, 063-0006, Japan
| | - Nobuo Yanagisawa
- Department of Neurology, School of Medicine, Shinshu University, Matsumoto, Japan
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Rejc E, Angeli CA, Atkinson D, Harkema SJ. Motor recovery after activity-based training with spinal cord epidural stimulation in a chronic motor complete paraplegic. Sci Rep 2017; 7:13476. [PMID: 29074997 PMCID: PMC5658385 DOI: 10.1038/s41598-017-14003-w] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/05/2017] [Indexed: 11/17/2022] Open
Abstract
The prognosis for recovery of motor function in motor complete spinal cord injured (SCI) individuals is poor. Our research team has demonstrated that lumbosacral spinal cord epidural stimulation (scES) and activity-based training can progressively promote the recovery of volitional leg movements and standing in individuals with chronic clinically complete SCI. However, scES was required to perform these motor tasks. Herein, we show the progressive recovery of voluntary leg movement and standing without scES in an individual with chronic, motor complete SCI throughout 3.7 years of activity-based interventions utilizing scES configurations customized for the different motor tasks that were specifically trained (standing, stepping, volitional leg movement). In particular, this report details the ongoing neural adaptations that allowed a functional progression from no volitional muscle activation to a refined, task-specific activation pattern and movement generation during volitional attempts without scES. Similarly, we observed the re-emergence of muscle activation patterns sufficient for standing with independent knee and hip extension. These findings highlight the recovery potential of the human nervous system after chronic clinically motor complete SCI.
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Affiliation(s)
- Enrico Rejc
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.,Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Claudia A Angeli
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.,Frazier Rehab Institute, Louisville, Kentucky, USA
| | - Darryn Atkinson
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.,Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Susan J Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA. .,Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA. .,Frazier Rehab Institute, Louisville, Kentucky, USA.
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Gant KL, Nagle KG, Cowan RE, Field-Fote EC, Nash MS, Kressler J, Thomas CK, Castellanos M, Widerström-Noga E, Anderson KD. Body System Effects of a Multi-Modal Training Program Targeting Chronic, Motor Complete Thoracic Spinal Cord Injury. J Neurotrauma 2017; 35:411-423. [PMID: 28795657 DOI: 10.1089/neu.2017.5105] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The safety and efficacy of pharmacological and cellular transplantation strategies are currently being evaluated in people with spinal cord injury (SCI). In studies of people with chronic SCIs, it is thought that functional recovery will be best achieved when drug or cell therapies are combined with rehabilitation protocols. However, any functional recovery attributed to the therapy may be confounded by the conditioned state of the body and by training-induced effects on neuroplasticity. For this reason, we sought to investigate the effects of a multi-modal training program on several body systems. The training program included body-weight-supported treadmill training for locomotion, circuit resistance training for upper body conditioning, functional electrical stimulation for activation of sublesional muscles, and wheelchair skills training for overall mobility. Eight participants with chronic, thoracic-level, motor-complete SCI completed the 12-week training program. After 12 weeks, upper extremity muscular strength improved significantly for all participants, and some participants experienced improvements in function, which may be explained by increased strength. Neurological function did not change. Changes in pain and spasticity were highly variable between participants. This is the first demonstration of the effect of this combination of four training modalities. However, balancing participant and study-site burden with capturing meaningful outcome measures is also an important consideration.
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Affiliation(s)
- Katie L Gant
- 1 The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine , Miami, Florida.,2 The Department of Neurological Surgery, The University of Miami Miller School of Medicine , Miami, Florida
| | | | - Rachel E Cowan
- 1 The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine , Miami, Florida.,2 The Department of Neurological Surgery, The University of Miami Miller School of Medicine , Miami, Florida
| | - Edelle C Field-Fote
- 5 Shepherd Center , Atlanta, Georgia .,6 Division of Physical Therapy, Emory University School of Medicine , Atlanta, Georgia .,7 Georgia Institute of Technology , Atlanta, Georgia
| | - Mark S Nash
- 1 The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine , Miami, Florida.,2 The Department of Neurological Surgery, The University of Miami Miller School of Medicine , Miami, Florida.,3 The Department of Physical Medicine and Rehabilitation, The University of Miami Miller School of Medicine , Miami, Florida
| | - Jochen Kressler
- 8 The Department of Exercise and Nutritional Sciences, San Diego State University , San Diego, California
| | - Christine K Thomas
- 1 The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine , Miami, Florida.,2 The Department of Neurological Surgery, The University of Miami Miller School of Medicine , Miami, Florida
| | - Mabelin Castellanos
- 1 The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine , Miami, Florida.,2 The Department of Neurological Surgery, The University of Miami Miller School of Medicine , Miami, Florida
| | - Eva Widerström-Noga
- 1 The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine , Miami, Florida.,2 The Department of Neurological Surgery, The University of Miami Miller School of Medicine , Miami, Florida.,9 Bruce W. Carter Department of Veterans Affairs Medical Center , Miami, Florida
| | - Kimberly D Anderson
- 1 The Miami Project to Cure Paralysis, The University of Miami Miller School of Medicine , Miami, Florida.,2 The Department of Neurological Surgery, The University of Miami Miller School of Medicine , Miami, Florida
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Amira A S. Effect of Robotic Assisted Gait Training on functional and psychological improvement in patients with Incomplete Spinal Cord Injury. ACTA ACUST UNITED AC 2017. [DOI: 10.17352/2455-5487.000053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Schrafl-Altermatt M, Dietz V, Bolliger M. Effect of Locomotor Training on Exhaustion of Leg Muscle Activity in Chronic Complete Spinal Cord Injury. J Neurotrauma 2017; 34:2375-2378. [PMID: 27736315 DOI: 10.1089/neu.2016.4627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of this study was to evaluate the effect of a continuous locomotor training on leg muscle electromyographic (EMG) exhaustion during assisted stepping movements in a patient with motor complete spinal cord injury (SCI). EMG exhaustion and loss of potentials starts to develop in untrained patients at ∼6 months after injury. In the trained patient examined in this study, exhaustion was also observed but occurred with a delay of several months. In contrast to an untrained patient, no more EMG exhaustion was observed in the very chronic stage. At this time (12 years after injury) a basic locomotor pattern of leg muscle activity of reduced amplitude could still be elicited, but it was resistant to exhaustion and unchanged in amplitude after 12 min of assisted stepping. It is suggested that fatigue-resistant motor units prevail at this stage and can still be activated during stepping as a result of the training.
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Affiliation(s)
| | - Volker Dietz
- Spinal Injury Center, Balgrist University Hospital , Zürich, Switzerland
| | - Marc Bolliger
- Spinal Injury Center, Balgrist University Hospital , Zürich, Switzerland
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Sacheli LM, Zapparoli L, De Santis C, Preti M, Pelosi C, Ursino N, Zerbi A, Banfi G, Paulesu E. Mental steps: Differential activation of internal pacemakers in motor imagery and in mental imitation of gait. Hum Brain Mapp 2017; 38:5195-5216. [PMID: 28731517 DOI: 10.1002/hbm.23725] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/30/2017] [Accepted: 07/03/2017] [Indexed: 12/30/2022] Open
Abstract
Gait imagery and gait observation can boost the recovery of locomotion dysfunctions; yet, a neurologically justified rationale for their clinical application is lacking as much as a direct comparison of their neural correlates. Using functional magnetic resonance imaging, we measured the neural correlates of explicit motor imagery of gait during observation of in-motion videos shot in a park with a steady cam (Virtual Walking task). In a 2 × 2 factorial design, we assessed the modulatory effect of gait observation and of foot movement execution on the neural correlates of the Virtual Walking task: in half of the trials, the participants were asked to mentally imitate a human model shown while walking along the same route (mental imitation condition); moreover, for half of all the trials, the participants also performed rhythmic ankle dorsiflexion as a proxy for stepping movements. We found that, beyond the areas associated with the execution of lower limb movements (the paracentral lobule, the supplementary motor area, and the cerebellum), gait imagery also recruited dorsal premotor and posterior parietal areas known to contribute to the adaptation of walking patterns to environmental cues. When compared with mental imitation, motor imagery recruited a more extensive network, including a brainstem area compatible with the human mesencephalic locomotor region (MLR). Reduced activation of the MLR in mental imitation indicates that this more visually guided task poses less demand on subcortical structures crucial for internally generated gait patterns. This finding may explain why patients with subcortical degeneration benefit from rehabilitation protocols based on gait observation. Hum Brain Mapp 38:5195-5216, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Lucia Maria Sacheli
- Department of Psychology and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy.,IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, Milan, 20161, Italy
| | - Laura Zapparoli
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, Milan, 20161, Italy
| | - Carlo De Santis
- Department of Psychology and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy
| | - Matteo Preti
- Department of Psychology and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy
| | - Catia Pelosi
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, Milan, 20161, Italy
| | - Nicola Ursino
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, Milan, 20161, Italy
| | - Alberto Zerbi
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, Milan, 20161, Italy
| | - Giuseppe Banfi
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, Milan, 20161, Italy.,University Vita e Salute San Raffaele, Milan, Italy
| | - Eraldo Paulesu
- Department of Psychology and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, 20126, Italy.,IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, Milan, 20161, Italy
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Repeat Exposure to Leg Swing Perturbations During Treadmill Training Induces Long-Term Retention of Increased Step Length in Human SCI: A Pilot Randomized Controlled Study. Am J Phys Med Rehabil 2017; 95:911-920. [PMID: 27149587 DOI: 10.1097/phm.0000000000000517] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether repeat exposure to force perturbations during treadmill training can induce long-term retention of improved step length and overall improvements in locomotor function in persons with spinal cord injury. DESIGN Fourteen patients with spinal cord injury were recruited and randomly assigned to swing resistance or swing assistance training groups. A controlled swing resistance or assistance force, for resistance or assistance training groups, respectively, was applied to both legs through a cable-driven robotic system during treadmill training. Each participant trained 3 times per week for 6 weeks. Step length, walking speed, 6-minute walking distance, and other clinical assessments were evaluated before and after 6 weeks of training and 8 weeks after the end of training. RESULTS A significant increase in step length was observed after 6 weeks of resistance training (P = 0.04). Step length tended to increase after assistance treadmill training, but the change was not significant (P = 0.18). The changes in step length and functional gains had no significant difference between 2 groups. CONCLUSIONS Repeat exposure to swing resistance during treadmill training may induce a prolonged retention of increased step length, although it remains unclear whether swing resistance versus assistance is more effective in inducing increased step length.
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Baniasad M, Farahmand F, Arazpour M, Zohoor H. Role and Significance of Trunk and Upper Extremity Muscles in Walker-Assisted Paraplegic Gait: A Case Study. Top Spinal Cord Inj Rehabil 2017; 24:18-27. [PMID: 29434457 DOI: 10.1310/sci16-00061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background and Purpose: Understanding the role and significance of trunk and upper extremity muscles in paraplegic gait can help in designing more effective assistive devices for these patients and also provides valuable information for improving muscle strengthening programs. Methods: In a patient with a spinal cord injury (SCI) who could walk independently (rating scale of ambulatory capacity, 9) with the aid of bilateral ankle-foot orthosis and a walker, the kinematics, kinetics and electromyographic (EMG) activities of 16 muscles from the trunk and upper and lower extremities were recorded during gait. The onset, cessation, and duration of the EMG signal were associated with the 4 phases of each step, distinguished based on the kinematics results. Results: It was found that the reciprocating activation pattern of the quadratus lumborum, latissimus dorsi, pectoralis major, and lower trapezius is responsible for trunk extension during the balance adjustment phase, leg unload and foot clearance creation during the leg raising phase, and propulsion force generation during the leg swing phase. Conclusion: The continuous activation of the rectus abdominis and erector spinae within the gait cycle helps stabilize the thorax and acts in reverse, that is, fixes the proximal joint and moves the distal limb. The shoulder girdle muscles contribute to the leg's unloading and then smooth landing during leg raising and leg swing phases, respectively.
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Affiliation(s)
- Mina Baniasad
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
| | - Farzam Farahmand
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
| | - Mokhtar Arazpour
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hassan Zohoor
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
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Piazza S, Serrano-Muñoz D, Gómez-Soriano J, Torricelli D, Segura-Fragosa A, Pons JL, Taylor J. Afferent electrical stimulation during cycling improves spinal processing of sensorimotor function after incomplete spinal cord injury. NeuroRehabilitation 2017; 40:429-437. [DOI: 10.3233/nre-161430] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Stefano Piazza
- Neural Rehabilitation Group, Cajal Institute, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Diego Serrano-Muñoz
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos, Toledo, Spain
| | - Julio Gómez-Soriano
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos, Toledo, Spain
- Toledo Physiotherapy Research Group, Nursing and Physiotherapy School, Castilla La Mancha University, Toledo, Spain
| | - Diego Torricelli
- Neural Rehabilitation Group, Cajal Institute, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | | | - José Luis Pons
- Neural Rehabilitation Group, Cajal Institute, Consejo Superior de Investigaciones Científicas, Madrid, Spain
- Tecnológico de Monterrey, Mexico
| | - Julian Taylor
- Sensorimotor Function Group, Hospital Nacional de Parapléjicos, Toledo, Spain
- Stoke Mandeville Spinal Research, National Spinal Injuries Centre, Aylesbury, UK
- Harris Manchester College, University of Oxford, Oxford, UK
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Grasmücke D, Zieriacks A, Jansen O, Fisahn C, Sczesny-Kaiser M, Wessling M, Meindl RC, Schildhauer TA, Aach M. Against the odds: what to expect in rehabilitation of chronic spinal cord injury with a neurologically controlled Hybrid Assistive Limb exoskeleton. A subgroup analysis of 55 patients according to age and lesion level. Neurosurg Focus 2017; 42:E15. [DOI: 10.3171/2017.2.focus171] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
ObjectiveAge and lesion level are believed to represent outcome predictors in rehabilitation of patients with chronic spinal cord injury (SCI). The Hybrid Assistive Limb (HAL) exoskeleton enables patients to perform a voluntary controlled gait pattern via an electromyography-triggered neuromuscular feedback system, and has been introduced as a temporary gait training tool in patients with SCI. The aim of this prospective pre- and postintervention study was to examine functional outcomes as a function of age and lesion level in patients with chronic incomplete SCI (iSCI) or chronic complete SCI (cSCI) with zones of partial preservation (ZPP) by using the HAL as a temporary training tool.MethodsFifty-five participants with chronic iSCI or cSCI (mean time since injury 6.85 ± 5.12 years) were classified according to the American Spinal Injury Association (ASIA) Impairment Scale (AIS) and divided by age (< 50 or ≥ 50 years), independent of lesion level, and also into 4 homogeneous groups according to lesion level. The subgroups were as follows: Subgroup 1, tetraplegic iSCI (n = 13) (C2–8, AIS C [n = 8] and AIS D [n = 5]); Subgroup 2, paraplegic iSCI with spastic motor behavior (n = 15) (T2–12, AIS C [n = 8] and AIS D [n = 7]); Subgroup 3, paraplegic cSCI with complete motor paraplegia and absence of spastic motor behavior (n = 18) (T11–L4 [AIS A], and ZPP from L-3 to S-1); and Subgroup 4, paraplegic iSCI with absence of spastic motor behavior (n = 9) (T12–L3, AIS C [n = 8] and AIS D [n = 1]). The training paradigm consisted of 12 weeks of HAL-assisted treadmill training (5 times/week). Baseline status was documented prior to intervention by using the AIS grade, Walking Index for SCI II (WISCI II) score, the 10-meter walk test (10MWT), and the 6-minute walk test (6MinWT). Training effects were assessed after 6 and 12 weeks of therapy, without HAL assistance.ResultsOverall, a time reduction of 47% in the 10MWT, self-selected speed (10MWTsss) (< 50 years = 56% vs ≥ 50 years = 37%) and an increase of 50% in the 6MinWT were documented. The WISCI II scores showed a mean gain of 1.69 levels. At the end of the study, 24 of 55 patients (43.6%) were less dependent on walking aids. Age had a nonsignificant negative influence on the 10MWTsss. Despite a few nonsignificant subgroup differences, participants improved across all tests. Namely, patients with iSCI who had spastic motor behavior improved to a nonsignificant, lesser extent in the 6MinWT.ConclusionsThe HAL-assisted treadmill training leads to functional improvements in chronic iSCI or cSCI, both in and out of the exoskeleton. An improvement of approximately 50% in the 10MWTsss and in gait endurance (6MinWT) can be expected from such training. The influences of SCI lesion level and age on functional outcome were nonsignificant in the present study. Older age (≥ 50 years) may be associated with smaller improvements in the 10MWTsss. An iSCI in paraplegic patients with spastic motor behavior may be a nonsignificant negative predictor in gait endurance improvements.Clinical trial registration no.: DRKS00010250 (https://drks-neu.uniklinik-freiburg.de/drks_web/setLocale_DE.do)
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Affiliation(s)
| | | | | | - Christian Fisahn
- 2Department of General and Trauma Surgery, and
- 3Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington
| | | | - Martin Wessling
- 5Department of Tumour and Revision Surgery, Orthopaedic Hospital Volmarstein, Wetter, Germany; and
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Dietz V, Schwab ME. From the Rodent Spinal Cord Injury Model to Human Application: Promises and Challenges. J Neurotrauma 2017; 34:1826-1830. [DOI: 10.1089/neu.2016.4513] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Volker Dietz
- Spinal Cord Injury Center, University Hospital Balgrist, Zürich, Switzerland
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Giesser B, Beres-Jones J, Budovitch A, Herlihy E, Harkema S. Locomotor training using body weight support on a treadmill improves mobility in persons with multiple sclerosis: a pilot study. Mult Scler 2017; 13:224-31. [PMID: 17450642 DOI: 10.1177/1352458506070663] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Rationale The purpose of this protocol was to investigate the potential benefits and tolerability of locomotor training using body weight support on a treadmill (LTBWST) in persons with multiple sclerosis (MS). Methods Four persons with primarily spinal cord MS and severely impaired ambulation (Expanded Disability Status Scale score 7.0–7.5) were enrolled in LTBWST. Subjects completed an average of 40 training sessions over several months. Results Subjects showed improvement in muscle strength, spasticity, endurance, balance, walking speed, and quality of life at the end of the training sessions, and could tolerate training without fatigue or other adverse effects. Conclusions LTBWST is well tolerated by persons with MS and may produce improvements in parameters related to functional mobility. Multiple Sclerosis 2007; 13: 224–231. http://msj.sagepub.com
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Affiliation(s)
- Barbara Giesser
- Department of Neurology, UCLA School of Medicine, Los Angeles, CA 90095, USA.
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