Name: paradigms of lower extremity electrical stimulation training after spinal cord injury
Uploaded: 2018-02-01T14:00:00.000+00:00
Duration: 8 min 7 s
Description: Watch this Scientific Journal Video about Paradigms of Lower Extremity Electrical Stimulation Training After Spinal Cord Injury at JoVE.com

我们要感谢那些花时间和精力参加以往研究的与会者。我们要感谢亨特福尔摩斯研究所和脊髓损伤服务和疾病提供环境进行临床人体研究试验。阿什拉夫·杰汉吉尔·卡齐 s Gorgey 目前由退伍军人事务部、退伍军人健康管理局、康复研究和发展处 (B7867-W) 和国防部 CDRMP (W81XWH-14-SCIRP-CTA) 提供支持。

本手稿中描述的培训协议是用 clinicaltrials.gov 标识符 (NCT01652040) 注册的。该训练计划涉及踝关节重量和 NMES。表 2中列出了所有必需的设备。研究协议和知情同意由里士满 VAMC 机构审查委员会 (irb) 和弗吉尼亚联邦大学 (VCU) irb 审查和批准。所有研究规程在开始试验之前详细地被解释了对每个参加者。
1. 参加者的征聘
<ol><li>对潜在参与者进行预筛选评估。<ol>
<li>详细说明培训协议的详细内容, 包括学习时间 (24 周)、每周时间 (每两周) 和会议时间 (NMES-RT:30 min 和非斯-45-60 分钟)。 注: NMES 在头12周进行, 其次为12周。</li>
		<li>描述对潜在参与者的医疗要求, 包括: 男性或女性与 SCI, 美国脊柱损伤分类 (ais) A, B 或 C (那些有 ais "C" 分类谁不能站立和步行), 18 到65岁, 大于1年损伤后, 身体质量指数 (BMI) ≤30公斤/米2, 电机完全或不完全 C5-L2 水平的伤害。</li>
		<li>描述对潜在参与者的医疗限制, 包括: 诊断心血管疾病, 不受控制的 II 型糖尿病或胰岛素, 无节制的高血压, 压力疮期3或更大, 泌尿道感染或症状, 骨质疏松症与 T 评分-2.5, 怀孕妇女与 SCI。</li>
	</ol>
</li>
</ol>2. NMES-RT
<ol><li>确保参与者的膀胱排空, 并测量静息血压和心率。当参加者坐在轮椅上时, 指示参与者脱掉他/她的鞋子。然后, 在小腿后面放一个枕头, 在膝盖屈曲时垫腿。将脚踝重量 (0-26 磅) 应用到参与者的脚踝 (图 1)。 注: 最初的2次会议是没有脚踝重量, 以确保参与者可以解除他/她的腿与重力。</li>
	<li>应用两个 7.5 cm x 12.7 cm 胶粘剂碳电极双边对皮肤在膝伸肌组。<ol>
<li>放置远端电极〜1/3 的距离之间的髌骨和腹股沟褶皱和内侧的股四头肌中线。将电极纵向和平行地放置在从臀部到膝关节的中线轴线 (图 2)。</li>
		<li>将近端电极侧向并毗邻腹股沟襞, 股外肌。将电极纵向和平行地置于中线轴 (图 2)。</li>
	</ol>
</li>
	<li>设置一个便携式刺激器的频率为30赫兹和双相矩形脉冲宽度450µs 和50µs 间间隔19,20,21,22,23,24 ,37,38,39。连接从刺激器到每个电极的电缆。 注: 只要电极定位正确, 电极的极性不会影响刺激模式。</li>
	<li>从右腿开始, 逐渐增加电流直到明显的可见张力在膝伸肌群中被识别。继续缓慢地坡道电流, 以唤起全膝关节延长 (最大200毫安)。允许腿保持3-5 秒, 以唤起最大的张力在激活的马达单位。</li>
	<li>逐渐减少电流, 直到它低于50% 的目标电流需要延长腿和移动腿偏心回到起始位置。记录当前所需的振幅, 以唤起整个腿部的伸展。</li>
	<li>完成单边训练, 包括每条腿的4套10次重复, 右腿和左腿交替。允许腿休息3-5 秒之间的每一个重复和3分钟之间的集合。如果参与者没有达到全膝关节伸展, 记录%range 的运动和增加时间之间的重复。 注意: 肌肉疲劳被定义为两个连续的重复与运动的范围≤25%。</li>
	<li>尝试每四套, 但如果参与者经历肌肉疲劳, 结束目前的设置, 并继续训练相反的腿。如果在连续2次训练中没有肌肉疲劳的情况下实现全膝关节伸展, 接下来的一周训练中增加2磅的踝关节重量。</li>
</ol>3。
<ol><li>测量参与者的静息血压和心率。将参与者放在非斯测力计自行车 (材料表) 前面, 坐在他/她的个人电源或手动轮椅上 (图 3a,图 3b)。</li>
	<li>用粘接碳电极对膝关节伸肌、膝屈肌腱和臀鲆肌肉组进行双边。<ol>
<li>对于膝伸, 将远端电极 (7.5 x 12.7 厘米) 放在皮肤上 1/3, 髌骨与腹股沟襞之间的距离, 股内侧肌。在股外肌 (图 4a) 上, 将近端电极侧向并毗邻腹股沟襞。</li>
		<li>对于膝肌, 将远端电极 (7.5 x 10 厘米) 放在腘窝上方2-3 厘米的皮肤上。将近端电极20厘米以上的腘窝 (图 4b)。为了防止远端电极的移动, 请使用弹性包装来保护电极的位置 (图 3a)。</li>
		<li>对于臀肌, 指示参加者向前倾向测力计。放置两个电极 (5 x 9 厘米) 平行和在肌肉腹部的大部分;允许〜两个手指宽度的电极之间的分离。</li>
	</ol>
</li>
	<li>与参与者坐在他/她的轮椅和中心在前面的测力计, 连接的电缆从刺激到每个12电极。检查测力计的正面和背面以确保参与者正确居中。</li>
	<li>确保参与者的轮椅被锁定, 并将参与者的脚 (穿着网球鞋) 轻轻地放在踏板内 (图 6)。使用包裹在织物覆盖物上的松紧带将小腿固定在测力计上。将参与者的脚固定在每个花瓣上的两个交叉松紧带和魔术贴上 (图 5)。</li>
	<li>在把腿捆到测力计后, 被动地移动腿部, 观察自行车的运动规律。如果腿太压缩或伸, 调整自行车的高度, 并通过被动地移动腿重新检查位置。</li>
	<li>使用位于测力计底部的两个可伸缩钩将参与者的轮椅固定到测力计。将挂钩连接到轮椅下面的稳定结构 (图 5)。在轮椅的轮子下面放置两个木制的断裂, 以防止在骑车期间任何椅子的移动。</li>
	<li>将刺激频率设置为33.3 赫兹, 脉冲持续时间为350µs, 电流振幅为140、100、100毫安, 分别为膝伸肌、膝屈肌腱和臀鲆肌肉组。</li>
	<li>设置循环参数如下: 目标转速为每分钟40-45 转 (RPM);可调马达扭矩从 10 Nm 开始;运动阶段 i、II 和 III. 的1.0、1.5 和 2.0 Nm 的阻力</li>
	<li>设置间隔训练参数, 如下所示: 3 分钟"预热" 阶段;三10分钟的运动阶段(刺激);每个练习阶段后的2分钟休眠阶段;和3分钟"冷却" 阶段。</li>
	<li>根据损伤程度 (高于或低于 T4), 测量血压和心率每2至5分钟, 以防止发生任何症状的自主反射。</li>
	<li>如果血压保持升高, 停止测力计, 并指示参与者无效他/她的膀胱或休息, 如果他们已经失效。此外, 检查, 以确保参加者正确就位, 以减少任何压力点, 并检查鞋或任何皮带是不是过于收紧。每2分钟严密监测血压。如血压恢复, 恢复训练;如果血压保持未, 结束会议, 并指示参与者看到他/她的初级保健医生。 注意: 这是至关重要的, 以确保参与者持续服用他们的血压药物, 如果有的话, 并使他们的膀胱在非斯循环之前无效。</li>
	<li>记录参与者的心率, 速度, 功率, 距离, 阻力和% 的刺激, 每年三十年代。</li>
	<li>如果参加者完成了整个演习没有疲劳 (速度 < 18 RPM 在积极循环), 减少伺服马达扭矩协助 1 Nm 以下会话, 否则保持所有参数相同。</li>
	<li>如果参加者完成两次运动训练, 而不疲劳或在运动阶段使用伺服马达协助, 在每个练习阶段增加 0.5 Nm 的阻力。</li>
</ol>

作者没有什么可透露的。

目前的研究展示了两种不同的电刺激模式。一个范例的重点是实施逐步加载到训练有素的肌肉, 以唤起骨骼肌肥大和其他范例主要是为了提高有氧能力的心脏代谢表现。这项研究确保比较两种范式, 并强调各自的利弊。
NMES-RT 被证明是有效的恢复肌肉大小和唤起肥厚的人急性和慢性 SCI19,20,21</su...

据估计, 大约有28.2万人在美国目前生活在脊髓损伤 (SCI)1。平均每年有大约1.7万新的案件, 主要由机动车车祸、暴力行为和体育活动造成,1。SCI 导致部分或全部的神经传导中断, 在伤害水平的范围内和低于2, 导致亚损感觉和/或马达损耗。损伤后, 骨骼肌肉的活动在损伤水平之下大大减少, 导致精益质量的迅速下降和伴随的异位脂肪组织的浸润, 或肌肉脂肪 (IMF)。研究表明, 下肢骨骼肌在受伤后的头几周内会出现明显的萎缩, 在第一年的最后一个3,4。一旦6周后受伤, 与年龄和体重匹配的残疾身体的控制, 完全 SCI 的个人经历了18-46% 下降的亚损肌肉大小。24周后受伤, 骨骼肌横断面面积 (CSA) 可低至30至 50%3。Gorgey 和达德利表明, 骨骼肌继续萎缩43% 的原始大小4.5 月后受伤, 并指出三倍的货币基金组织的人与残疾健全的控制相比,4。新陈代谢活性精益质量的损失导致基础代谢率的降低 (BMR)2,6, 该值占总每日能源支出的∼65-70%;这样减少在 BMR 可能导致有害能量失衡和增加肥胖在伤害以后2,7,8,910,18。肥胖症与慢性继发性疾病的发展有关, 包括高血压、II 型糖尿病 (T2DM) 和心血管病2,10,11,12,13,14,15,16,17,18. 此外, SCI 的人可能患有营养不良和依赖高脂肪饮食。膳食脂肪摄入量可能占29到34% 的脂肪的人与 sci, 这很可能是一个因素解释日益增加的肥胖和在 sci 人口中不断上升的流行率12,13。
神经肌肉电刺激诱发抗性训练 (NMES) 是为了诱导瘫痪骨骼肌肥大而设计的19,20,21,22,23, 24。在每周两次的 NMES 十二周后, 整个大腿、膝伸肌和膝屈肌群的骨骼肌 CSA 分别增加了28%、35% 和 16%, 各22。达德利et al。显示, 8 周两次-每周 NMES-RT 恢复膝伸肌大小, 以75% 的原始大小在六周后受伤的19。此外, 茉莉et al。使用相同的协议, 并注意到35% 和39% 增加的右和左直肌肌肉后12周 NMES RT20。
功能性电刺激-下肢循环 (非斯) 是一种常见的康复技术, 用于锻炼下肢肌肉组后 SCI25,26。不同于 NMES, 非斯依赖于刺激6肌肉群, 这可能导致增加肥大和改善在代谢配置文件10,25,26,27, 28. Dolbow et al。发现, 在 SCI27的个体中, 总的身体精益质量在56月后增加了18.5%。在十二月的三次每周的非斯, 一个60岁的女性截瘫经历了7.7% 的增加总身体精益质量和4.1% 增加腿部瘦肉质量28。在 SCI10、25、26之后, 功能性电刺激 (非斯) 的常规使用与代谢条件的危险因素的改善有关。
理想的电刺激训练的候选人将有电机完全或不完全的伤害, 与完整的外周运动神经元和有限的下肢感觉。目前的手稿, 描述了一个组合的方法, 使用 NMES RT 和非斯, 旨在改善的结果, 电刺激训练的人与慢性 SCI。NMES 的过程中使用踝关节重量将概述, 同时突出的关键步骤的协议和整体利益的干预提供给人慢性 SCI。第二个目的是描述代谢的过程, 旨在最大限度地提高干预的整体效果。以前的工作证实了我们的理性, 联合训练协议可能唤起更大的结果后24周的电刺激训练20,21,22,23,24 ,25,26,31,32,33,34,35,36。

<table><tbody><tr><td>adhesive carbon electrodes (2 of each)</td><td>Physio Tech (Richmond, VA, USA 23233)</td><td>PT3X5&lt;br/&gt; PALS3X4&lt;br/&gt; E7300</td><td>7.5&#039; x 12.7&#039;&lt;br/&gt; 7.5&#039; x 10&#039;&lt;br/&gt; 5&#039; x 9&#039;</td></tr><tr><td>TheraTouch 4.7 stimulator</td><td>Richmar (Chattanooga, TN, USA 37406)</td><td>400-082</td><td>41.28&#039; x 39.37&#039; x 17.78&#039; (8.91 kg)&lt;br/&gt; power: 110 VAC at 60 Hz / 220VAC at 50 Hz&lt;br/&gt; power consumption: 110 Watts</td></tr><tr><td>Red &amp;amp; White Lead Cords (2)</td><td>Richmar (Chattanooga, TN, USA 37406)</td><td>A1717</td><td>2.0 m</td></tr><tr><td>RT300-SL FES Ergometer</td><td>Restorative Therapies, Inc. (Baltimore, MD, USA 21231)</td><td>RT300-SL</td><td>80&#039; x 49&#039; x 92-103&#039; (39 kg)&lt;br/&gt; 16 channel&lt;br/&gt; speed: 15 &amp;ndash; 55 rev/min</td></tr><tr><td>elastic NuStim wraps (2)</td><td>Fabrifoam (Exton, PA, USA 19341)</td><td>PP108666</td><td>36&quot;</td></tr><tr><td>wooden wheelchair break (2)</td><td>n/a</td><td>n/a</td><td>n/a</td></tr><tr><td>pillow/cushion</td><td>n/a</td><td>n/a</td><td>standard</td></tr><tr><td>ankle weights</td><td>n/a</td><td>n/a</td><td>2-26 lb.</td></tr></tbody></table>

paradigms of lower extremity electrical stimulation training after spinal cord injury

骨骼肌萎缩、肥胖增加和体力活动减少是脊髓损伤后观察到的重要改变, 与许多代谢的健康后果有关。这些变化有可能增加发展慢性二级疾病的风险, 并影响 SCI 人的生活质量. 表面神经肌肉电刺激诱发抗性训练 (NMES) 是一种策略减轻骨骼肌萎缩的过程, 减少异位肥胖, 提高胰岛素敏感性, 增强线粒体能力。然而, NMES 仅限于单个肌肉群。累及下肢多个肌肉群, 可以最大限度地提高训练的健康效益。功能性电刺激-下肢循环 (非斯) 允许激活6肌肉群, 这可能会唤起更大的新陈代谢和心血管适应。对刺激参数的适当了解是提高电刺激训练效果的关键. 在康复过程中采用长期使用 NMES 的策略可以保持肌肉骨骼系统, 是临床试验的先决条件, 旨在恢复受伤后步行。目前的手稿提出了一个组合的协议使用 NMES 前的非斯-RT。我们推测, 在骑车前12周的肌肉会有能力产生更大的能量, 循环抵抗更高的阻力, 并导致更多的人适应 SCI。

22参加者的踝关节重量逐渐增加, 超过16周的 NMES (图 6a)。参与者举起的平均重量是19.6 ±6.5 磅 (右腿) 和20±6磅 (左腿) [8-24 磅]。在整个试验中, 右腿和左脚的电流振幅波动 (图 6b)。
一个人的进展与电机完成 SCI 在12周的非斯培训后, 在表 1中突出显示。结果表明, 在12周的训?...

Watch this Scientific Journal Video about Paradigms of Lower Extremity Electrical Stimulation Training After Spinal Cord Injury at JoVE.com

Paradigms of Lower Extremity Electrical Stimulation Training After Spinal Cord Injury

脊髓损伤是一种创伤性的疾病, 可能导致慢性次生代谢紊乱的风险增高。在这里, 我们提出了一个协议使用表面神经肌肉电刺激-阻力训练结合功能性电刺激-下肢循环作为一种策略, 以改善这些医疗问题的一些。

脊髓损伤后下肢电刺激训练的模式

Skeletal muscle atrophy, increased adiposity and reduced physical activity are key changes observed after spinal cord injury (SCI) and are associated with ...

paradigms-lower-extremity-electrical-stimulation-training-after

Research

JoVE Journal

Behavior

12.6K 次观看.  Hunter Holmes McGuire VAMC. 脊髓损伤是一种创伤性的疾病, 可能导致慢性次生代谢紊乱的风险增高。在这里, 我们提出了一个协议使用表面神经肌肉电刺激-阻力训练结合功能性电刺激-下肢循环作为一种策略, 以改善这些医疗问题的一些。

视频: Paradigms of Lower Extremity Electrical Stimulation Training After Spinal Cord Injury

Treating Low Back Pain in Failed Back Surgery Patients with Multicolumn-lead Spinal Cord Stimulation

Failed back surgery syndrome (FBSS) refers to persistent, chronic pain following spinal surgery. Spinal cord stimulation with dorsal epidural leads can be used to treat back and leg pain in FBSS patients. This paper presents a detailed protocol for using spinal cord stimulation with surgical leads in FBSS patients. In our department, with the patient under general anesthesia, we place the lead in the epidural space by means of a small laminectomy at the 10th thoracic level. Placement of the lead is followed by a 1 month trial period with an externalized lead. If pain relief is greater than 50% at the end of this 1 month stimulation trial (required by Belgian reimbursement criteria), an internal pulse generator is then placed under the skin and connected to the lead in a second surgical procedure. We have demonstrated that using this technique in rigorously selected FBSS patients can significantly improve back pain, leg pain, patient activity, and quality of life for a sustained period of time.

This paper presents a method that uses spinal cord stimulation with a multicolumn lead to treat neuropathic low back pain in failed back surgery patients.

多列铅脊髓刺激术后腰痛的治疗

Failed back surgery syndrome (FBSS) refers to persistent, chronic pain following spinal surgery. Spinal cord stimulation with dorsal epidural leads can be ...

科研

行为学

Breathing-controlled Electrical Stimulation (BreEStim) for Management of Neuropathic Pain and Spasticity

Electrical stimulation (EStim) refers to the application of electrical current to muscles or nerves in order to achieve functional and therapeutic goals. It has been extensively used in various clinical settings. Based upon recent discoveries related to the systemic effects of voluntary breathing and intrinsic physiological interactions among systems during voluntary breathing, a new EStim protocol, Breathing-controlled Electrical Stimulation (BreEStim), has been developed to augment the effects of electrical stimulation. In BreEStim, a single-pulse electrical stimulus is triggered and delivered to the target area when the airflow rate of an isolated voluntary inspiration reaches the threshold. BreEStim integrates intrinsic physiological interactions that are activated during voluntary breathing and has demonstrated excellent clinical efficacy. Two representative applications of BreEStim are reported with detailed protocols: management of post-stroke finger flexor spasticity and neuropathic pain in spinal cord injury.

Breathing-controlled Electrical Stimulation BreEStim for Management of Neuropathic Pain and Spasticity

The purpose is to present a new method, breathing-control electrical stimulation (BreEStim) for management of neuropathic pain and spasticity.

呼吸控制电气的刺激（BreEStim）的神经性疼痛和痉挛的管理

Electrical stimulation (EStim) refers to the application of electrical current to muscles or nerves in order to achieve functional and therapeutic goals. ...

医学

Training Persons with Spinal Cord Injury to Ambulate Using a Powered Exoskeleton

Powered exoskeletons have become available for overground ambulation in persons with paralyses due to spinal cord injury (SCI) who have intact upper extremity function and are able to maintain upright balance using forearm crutches. To ambulate in an exoskeleton, the user must acquire the ability to maintain balance while standing, sitting and appropriate weight shifting with each step. This can be a challenging task for those with deficits in sensation and proprioception in their lower extremities. This manuscript describes screening criteria and a training program developed at the James J. Peters VA Medical Center, Bronx, NY to teach users the skills needed to utilize these devices in institutional, home or community environments. Before training can begin, potential users are screened for appropriate range of motion of the hip, knee and ankle joints. Persons with SCI are at an increased risk of sustaining lower extremity fractures, even with minimal strain or trauma, therefore a bone mineral density assessment is performed to reduce the risk of fracture. Also, as part of screening, a physical examination is performed in order to identify additional health-related contraindications. 
Once the person has successfully passed all screening requirements, they are cleared to begin the training program. The device is properly adjusted to fit the user. A series of static and dynamic balance tasks are taught and performed by the user before learning to walk. The person is taught to ambulate in various environments ranging from indoor level surfaces to outdoors over uneven or changing surfaces. Once skilled enough to be a candidate for home use with the exoskeleton, the user is then required to designate a companion-walker who will train alongside them. Together, the pair must demonstrate the ability to perform various advanced tasks in order to be permitted to use the exoskeleton in their home/community environment.

Training a person with paralysis to ambulate using a powered exoskeleton may present challenges. The goals are to present the candidate selection criteria and the training procedures for exoskeletal-assisted walking and other mobility skills that can be progressed as the participant's skill level improves.

训练脊髓损伤者走动使用动力服

Powered exoskeletons have become available for overground ambulation in persons with paralyses due to spinal cord injury (SCI) who have intact upper ...

生物工程

Standing Neurophysiological Assessment of Lower Extremity Muscles Post-Stroke

Transcranial magnetic stimulation (TMS) is a common tool used to measure the behavior of motor circuits in healthy and neurologically impaired populations. TMS is used extensively to study motor control and the response to neurorehabilitation of the upper extremities. However, TMS has been less utilized in the study of lower extremity postural and walking-specific motor control. The limited use and the additional methodological challenges of lower extremity TMS assessments have contributed to the lack of consistency in lower extremity TMS procedures within the literature. Inspired by the decreased ability to record lower extremity TMS motor evoked potentials (MEP), this methodological report details steps to enable post-stroke TMS assessments in a standing posture. The standing posture allows for the activation of the neuromuscular system, reflecting a state more akin to the system's state during postural and walking tasks. Using dual-top force plates, we instructed participants to equally distribute their weight between their paretic and non-paretic legs. Visual feedback of the participants' weight distribution was provided. Using image guidance software, we delivered single TMS pulses via a double-cone coil to the participants' lesioned and non-lesioned hemispheres and measured the corticomotor response of the paretic and non-paretic tibialis anterior and soleus muscles. Performing assessments in the standing position increased the TMS response rate and allowed for the use of the lower stimulation intensities compared to the standard sitting/resting position. Utilization of this TMS protocol can provide a common approach to assess the lower extremity corticomotor response post-stroke when the neurorehabilitation of postural and gait impairments are of interest.

This protocol describes the process for performing a neurophysiological assessment of the lower extremity muscles, tibialis anterior and soleus, in a standing position using TMS in people post-stroke. This position provides a greater probability of eliciting a post-stroke TMS response and allows for the use of reduced stimulator power during neurophysiological assessments.

中风后下肢肌肉的站立神经生理学评估

Transcranial magnetic stimulation (TMS) is a common tool used to measure the behavior of motor circuits in healthy and neurologically impaired ...

Quantifying Arms and Legs Contributions during Repetitive Electrically-Assisted Sit-To-Stand Exercise in Paraplegics: A Pilot Study

Execution of Sit-to-Stand (SitTS) in incomplete spinal cord injury (SCI) patients involves motor function in both upper and lower extremities. The use of arm support, in particular, is a significant assistive factor while executing SitTS movement in SCI population. In addition, the application of functional electrical stimulation (FES) onto quadriceps and gluteus maximus muscles is one of the prescribed management for incomplete SCI to improve muscle action for simple lower limb movements. However, the relative contribution of upper and lower extremities during SitTS has not been thoroughly investigated. Two motor incomplete SCI paraplegics performed repetitive SitTS to fatigue exercise challenge. Their performance was investigated as a mixed-method case-control study comparing SitTS with and without the assistance of FES. Three sets of SitTS tests were completed with 5-min resting period allocated in between sets, with mechanomyography (MMG) sensors attached over the rectus femoris muscles bilaterally. The exercise was separated into 2 sessions; Day 1 for voluntary SitTS and Day 2 for FES-assisted SitTS. Questionnaires were conducted after every session to gather the participants&#39; input about their repetitive SitTS experience. The analysis confirmed that a SitTS cycle could be divided into three phases; Phase 1 (Preparation to stand), Phase 2 (Seat-off), and Phase 3 (Initiation of hip extension), which contributed to 23% &#177; 7%, 16% &#177; 4% and 61% &#177; 6% of the SitTS cycle, respectively. The contribution of arms and legs during SitTS movement varied in different participants based on their legs&#39; Medical Research Council (MRC) muscle grade. In particular, the applied arm forces start to increase clearly when the leg forces start to decline during standing. This finding is supported by the significantly reduced MMG signal indicating leg muscle fatigue and their reported feeling of tiredness.

Arms contribution in Sit-To-Stand (SitTS) is determined by the legs' muscle condition. Several compensating strategies were discovered in efforts to achieve complete SitTS cycles. These findings triangulate the spinal cord injury (SCI) persons' biomechanical measures with their subjective feeling of load borne by both their limbs throughout the SitTS approaches.

量化截瘫患者重复性电动辅助坐立锻炼期间手臂和腿部的贡献:一项试点研究

Execution of Sit-to-Stand (SitTS) in incomplete spinal cord injury (SCI) patients involves motor function in both upper and lower extremities. The use of ...

工程学

A Human-machine-interface Integrating Low-cost Sensors with a Neuromuscular Electrical Stimulation System for Post-stroke Balance Rehabilitation

A stroke is caused when an artery carrying blood from heart to an area in the brain bursts or a clot obstructs the blood flow to brain thereby preventing delivery of oxygen and nutrients. About half of the stroke survivors are left with some degree of disability. Innovative methodologies for restorative neurorehabilitation are urgently required to reduce long-term disability. The ability of the nervous system to reorganize its structure, function and connections as a response to intrinsic or extrinsic stimuli is called neuroplasticity. Neuroplasticity is involved in post-stroke functional disturbances, but also in rehabilitation. Beneficial neuroplastic changes may be facilitated with non-invasive electrotherapy, such as neuromuscular electrical stimulation (NMES) and sensory electrical stimulation (SES). NMES involves coordinated electrical stimulation of motor nerves and muscles to activate them with continuous short pulses of electrical current while SES involves stimulation of sensory nerves with electrical current resulting in sensations that vary from barely perceivable to highly unpleasant. Here, active cortical participation in rehabilitation procedures may be facilitated by driving the non-invasive electrotherapy with biosignals (electromyogram (EMG), electroencephalogram (EEG), electrooculogram (EOG)) that represent simultaneous active perception and volitional effort. To achieve this in a resource-poor setting, e.g., in low- and middle-income countries, we present a low-cost human-machine-interface (HMI) by leveraging recent advances in off-the-shelf video game sensor technology. In this paper, we discuss the open-source software interface that integrates low-cost off-the-shelf sensors for visual-auditory biofeedback with non-invasive electrotherapy to assist postural control during balance rehabilitation. We demonstrate the proof-of-concept on healthy volunteers.

A novel low-cost human-machine interface for interactive post-stroke balance rehabilitation system is presented in this article. The system integrates off-the-shelf low-cost sensors towards volitionally driven electrotherapy paradigm. The proof-of-concept software interface is demonstrated on healthy volunteers.

人机界面集成的低成本传感器，具有神经肌肉电刺激系统中风后康复平衡

A stroke is caused when an artery carrying blood from heart to an area in the brain bursts or a clot obstructs the blood flow to brain thereby preventing ...

神经科学

Activity-based Training on a Treadmill with Spinal Cord Injured Wistar Rats

Spinal cord injury (SCI) results in lasting deficits that include both mobility and a multitude of autonomic-related dysfunctions. Locomotor training (LT) on a treadmill is widely used as a rehabilitation tool in the SCI population with many benefits and improvements to daily life. We utilize this method of activity-based task-specific training (ABT) in rodents after SCI to both elucidate the mechanisms behind such improvements and to enhance and improve upon existing clinical rehabilitation protocols. Our current goal is to determine the mechanisms underlying ABT-induced improvements in urinary, bowel, and sexual function in SCI rats after a moderate to severe level of contusion. After securing each individual animal in a custom-made adjustable vest, they are secured to a versatile body weight support mechanism, lowered to a modified three-lane treadmill and assisted in step-training for 58 minutes, once a day for 10 weeks. This setup allows for the training of both quadrupedal and forelimb-only animals, alongside two different non-trained groups. Quadrupedal-trained animals with body weight support are aided by a technician present to assist in stepping with proper hind limb placement as necessary, while forelimb-only trained animals are raised at the caudal end to ensure no hind limb contact with the treadmill and no weight-bearing. One non-trained SCI group of animals is placed in a harness and rests next to the treadmill, while the other control SCI group remains in its home cage in the training room nearby. This paradigm allows for the training of multiple SCI animals at once, thus making it more time-efficient in addition to ensuring that our pre-clinical animal model mimics the clinical representation as close as possible, particularly with respect to the body weight support with manual assistance.

This protocol demonstrates our model of activity-based locomotor treadmill training for rats with spinal cord injury (SCI). Included is both quadrupedal and forelimb-only groups, in addition to two distinct types of non-trained control groups. Investigators are able to assess training effects on SCI rats using this protocol.

脊髓损伤 wistar 大鼠跑步机的作业训练

Spinal cord injury (SCI) results in lasting deficits that include both mobility and a multitude of autonomic-related dysfunctions. Locomotor training (LT) ...

Structured Motor Rehabilitation After Selective Nerve Transfers

After severe nerve injuries, selective nerve transfers provide an opportunity to restore motor and sensory function. Functional recovery depends both on the successful re-innervation of the targets in the periphery and on the motor re-learning process entailing cortical plasticity. While there is an increasing number of methods to improve rehabilitation, their routine implementation in a clinical setting remains a challenge due to their complexity and long duration. Therefore, recommendations for rehabilitation strategies are presented with the aim of guiding medical doctors and therapists through the long-lasting rehabilitation process and providing step-by-step instructions for supporting motor re-learning.
Directly after nerve transfer surgery, no motor function is present, and therapy should focus on promoting activity in the sensory-motor cortex areas of the paralyzed body part. After about two to six months (depending on the severity and modality of injury, the distance of nerve regeneration and many other factors), the first motor activity can be detected via electromyography (EMG). Within this phase of rehabilitation, multimodal feedback is used to re-learn the motor function. This is especially critical after nerve transfers, as muscle activation patterns change due to the altered neural connection. Finally, muscle strength should be sufficient to overcome gravity/resistance of antagonistic muscles and joint stiffness, and more functional tasks can be implemented in rehabilitation.

Here, we present a protocol for the motor rehabilitation of patients with severe nerve injuries and selective nerve transfer surgery. It aims at restoring the motor function proposing several stages in patient education, early-stage therapy after surgery and interventions for rehabilitation after successful re-innervation of the nerve&#8217;s target.

选择性神经转移后的结构化运动康复

After severe nerve injuries, selective nerve transfers provide an opportunity to restore motor and sensory function. Functional recovery depends both on ...

Implantation and Control of Wireless, Battery-free Systems for Peripheral Nerve Interfacing

Peripheral nerve interfaces are frequently used in experimental neuroscience and regenerative medicine for a wide variety of applications. Such interfaces can be sensors, actuators, or both. Traditional methods of peripheral nerve interfacing must either tether to an external system or rely on battery power that limits the time frame for operation. With recent developments of wireless, battery-free, and fully implantable peripheral nerve interfaces, a new class of devices can offer capabilities that match or exceed those of their wired or battery-powered precursors. This paper describes methods to (i) surgically implant and (ii) wirelessly power and control this system in adult rats. The sciatic and phrenic nerve models were selected as examples to highlight the versatility of this approach. The paper shows how the peripheral nerve interface can evoke compound muscle action potentials (CMAPs), deliver a therapeutic electrical stimulation protocol, and incorporate a conduit for the repair of peripheral nerve injury. Such devices offer expanded treatment options for single-dose or repeated dose therapeutic stimulation and can be adapted to a variety of nerve locations.

This is a protocol for the surgical implantation and operation of a wirelessly powered interface for peripheral nerves. We demonstrate the utility of this approach with examples from nerve stimulators placed on either the rat sciatic or phrenic nerve.

用于周围神经接口的无线、无电池系统的植入和控制

Peripheral nerve interfaces are frequently used in experimental neuroscience and regenerative medicine for a wide variety of applications. Such interfaces ...

Therapy Interventions for Upper Limb Amputees Undergoing Selective Nerve Transfers

Targeted Muscle Reinnervation (TMR) improves the biological control interface for myoelectric prostheses after above-elbow amputation. Selective activation of muscle units is made possible by surgically re-routing nerves, yielding a high number of independent myoelectric control signals. However, this intervention requires careful patient selection and specific rehabilitation therapy. Here a rehabilitation protocol is presented for high-level upper limb amputees undergoing TMR, based on an expert Delphi study. Interventions before surgery include detailed patient assessment and general measures for pain control, muscle endurance and strength, balance, and range of motion of the remaining joints. After surgery, additional therapeutic interventions focus on edema control and scar treatment and the selective activation of cortical areas responsible for upper limb control. Following successful&#160;reinnervation of target muscles, surface electromyographic (sEMG) biofeedback is used to train the activation of the novel muscular units. Later on, a table-top prosthesis may provide the first experience of prosthetic control. After fitting the actual prosthesis, training includes repetitive drills without objects, object manipulation, and finally, activities of daily living. Ultimately, regular patient appointments and functional assessments allow tracking prosthetic function and enabling early interventions if malfunctioning.

This work presents a protocol to enhance prosthetic function after selective nerve transfer surgery. Rehabilitation interventions include patient information and selection, support of wound healing, cortical re-activation of sensory-motor areas of the upper limb, training of selective muscle activation, prosthetic handling in daily life, and regular follow-up assessments.