脊髓损伤的经脊髓刺激加运动训练

实验性的：站立时提供真正的经脊柱刺激，然后进行运动训练

胸腰椎区域的经脊柱强直刺激将在站立期间以 30 赫兹的频率进行，并根据需要在站立框架或 Lokomat 中提供体重支撑 (BWS) 以确保安全。

组合产品：站立经脊柱刺激后进行机器人步态训练

15 名脊髓损伤患者将在站立期间接受 40 次每天 30 分钟的无创高频（例如 30 赫兹）经皮经脊柱刺激，然后进行 30 分钟的辅助步态机器人步态训练。 训练前后标准化的临床和神经生理学测试将用于评估感觉运动功能的恢复情况。

其他名称：

• 站立经脊柱刺激

实验性的：仰卧时提供真正的经脊柱刺激，然后进行运动训练

仰卧时，将以 30 赫兹的频率进行经脊柱强直刺激。

组合产品：卧位经脊柱刺激后进行机器人步态训练

15 名脊髓损伤患者每天将接受 40 次每次 30 分钟的无创高频（例如 30 赫兹）经皮经脊柱刺激，同时仰卧在治疗台上，然后进行 30 分钟的辅助步态机器人步态训练。 训练前后标准化的临床和神经生理学测试将用于评估感觉运动功能的恢复情况。

其他名称：

• 躺着经脊柱刺激

假比较器：站立期间进行假经脊柱刺激，然后进行运动训练

一个假手术组将在站立期间以没有感觉的强度接受经脊柱刺激。

其他：站立假经脊柱刺激后进行机器人步态训练

15 名脊髓损伤患者每天将接受 40 次每次 30 分钟的假经脊柱刺激，其站立强度为无感觉，随后进行 30 分钟的机器人步态训练。 训练前后标准化的临床和神经生理学测试将用于评估感觉运动功能的恢复情况。

其他名称：

• 机器人步态训练

Plasticity of Spinal Neuronal Networks - Homosynaptic Depression

Soleus H-reflexes following posterior tibial nerve stimulation with a 1-ms monophasic pulse were recorded with subjects seated and stimuli delivered every 1 s (1.0 Hz), 3 s (0.33 Hz), 5 s (0.2 Hz), 8 s (0.125 Hz), and 10s (0.1 Hz). Results for each interval vs 0.1 Hz shown.

Plasticity of Spinal Neuronal Networks - Presynaptic Inhibition

Presynaptic inhibition was assessed with a conditioning pulse train of 4 pulses with 9 ms duration, delivered to the CPN at the C-T intervals of 20, 60, or 100 ms. These C-T intervals were selected because the reflex inhibition produced at the intermediate C-T intervals is predominantly presynaptic. The stimulus to the CPN was delivered at 1.27 ± 0.12 (21.8 ± 10.1 mA) and 1.4 ± 0.28 (21.8 ± 10.1 mA) TA motor threshold before and after treatment, respectively. Control and conditioned soleus H-reflexes were randomly recorded across the C-T intervals tested, and 15 H-reflexes were recorded at each C-T interval. For each participant at each timepoint, amplitudes across the 15 H-reflexes per C-T interval were averaged.

Results are listed for each C-T interval, pre- and post-intervention.

Plasticity of Spinal Neuronal Networks - Reciprocal Inhigition

To assess restoration of reciprocal Ia inhibition, soleus H-reflexes were recorded following common peroneal nerve (CPN) stimulation at short conditioning-test (C-T) intervals of 0, 1, 2, 3, and 4 ms.

The stimulus to the CPN was delivered at 1.27 ± 0.12 (21.8 ± 10.1 mA) and 1.4 ± 0.28 (21.8 ± 10.1 mA) TA motor threshold before and after treatment, respectively.

Control and conditioned soleus H-reflexes were randomly recorded across the C-T intervals tested, and 15 H-reflexes were recorded at each C-T interval. For each participant at each timepoint, amplitudes across the 15 H-reflexes per C-T interval were averaged.

Results are listed for each C-T interval, pre- and post-intervention.

Plasticity of Corticospinal Networks

Neurophysiological measurements assessing changes in corticospinal excitability from the interventions by recording responses to single-pulse transcranial magnetic stimulation (TMS) at rest and during robotic-assisted stepping.

The tibialis anterior resting motor threshold (RMT) was established and corresponded to the lowest TMS maximal stimulator output that induced reproducible evoked potentials of at least ~50 µV in 4 out of 5 consecutive single TMS pulses.

RMTs (percentage of maximal stimulator output) are shown pre- and post-intervention.

Ambulatory Function

Change in 10-meter timed test (seconds required to complete 10-meter walk) between baseline and post-intervention. Fewer seconds means faster (better) gait.

Balance

Changes in Berg Balance Scale score between baseline and post-intervention. Scale scores between 0 and 56. Higher scores mean better balance.

Autonomic Function

SCIM III Bladder and Bowel management subscores Bladder subscore rated 0-15 (higher means better bladder function). Bowel subscore rated 0-10 (higher means better bowel function).