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1.
The restoration of walking function following SCI is extremely important to consumers and has stimulated a response of new treatments by scientists, the pharmaceutical industry and clinical entrepreneurs. Several of the proposed interventions: (1) the use of functional electrical stimulation (FES) and (2) locomotor training have been examined in clinical trials and recent reviews of the scientific literature. Each of these interventions is based on research of human locomotion. Therefore, the systematic study of walking function and gait in normal individuals and those with injury to the spinal cord has contributed to the identification of the impairments of walking, the development of new treatments and how they will be measured to determine effectiveness. In this context gait research applied to interventions to improve walking function is of high clinical relevance. This research helps identify walking impairments to be corrected and measures of walking function to be utilized as endpoints for clinical trials. The most common impairments following SCI diagnosed by observational gait analysis include inadequate hip extension during stance, persistent plantar flexion and hip/knee flexion during swing and foot placement at heel strike. FES has been employed as one strategy for correcting these impairments based on analysis that range from simple measures of speed, cadence and stride length to more sophisticated systems of three- dimensional video motion analysis and multichannel EMG tracings of integrated walking. A recent review of the entire FES literature identified 36 studies that merit comment and the full range of outcome measures for walking function were used from simple velocity to the video analysis of motion. In addition to measures of walking function developed for FES interventions, the first randomized multicenter clinical trial on locomotor training in subacute SCI was recently published with an extensive review of these measures. In this study outcome measures of motor strength (impairment), balance, Walking Index for SCI (WISCI), speed, 5min walk (walking capacities) and locomotor functional independence measure (L-FIM), a disability measure all showed improvement in walking function based on the strategy of the response of activity based plasticity to step training. Although the scientific basis for this intervention will be covered in other articles in this series, the evolution of clinical outcome measures of walking function continues to be important for the determination of effectiveness in clinical trials.  相似文献   

2.
Objective. The aim of the paper is to present various relatively simple functional electrical stimulation (FES) systems that affect neural circuits and reflex behavior by providing necessary peripheral input to the lower extremities of incomplete spinal cord injured (SCI) persons. Methods. The proposed FES re‐education walking systems make use of feedback information that is transmitted from the paralyzed limb to the nonparalyzed part of the patient's body. A single gait variable can be analogously transmitted to the walking subject in a form of sensory stimulation. The information about several gait variables can be first integrated and afterwards delivered to the walking subject as a single command. Conclusions. Significant improvements in the duration of the double support phase, metabolic energy expenditure, and physiologic cost index were observed when using FES‐assisted training of walking in incomplete SCI persons.  相似文献   

3.
《Neuromodulation》2003,6(2):122-127
This paper presents the use of multiple sensors for walking assessment and provision of cognitive feedback during early re‐education of incomplete spinal cord injured (SCI) humans. The paper is focused on the swing phase estimation as an important part of the Functional Electrical Stimulation (FES) gait re‐education system for incomplete spinal cord injured persons. The proposed sensory system comprises four accelerometers, one gyro placed at the shank of the paretic leg, and two goniometers placed at the knee and ankle joints, respectively. The data from the sensors are input in the mathematical algorithm applied for swing quality estimation. The output from the algorithm is a numerical value. The calculated output is divided into three levels, each defining the swing quality in terms of good, sufficient, and poor. This information is provided to the patient as an auditory signal. The patient is taught to maximize his efforts to improve the quality of walking, that is, to move the more affected leg in a way that will generate the auditory output corresponding to the level “good”. The preliminary measurements were performed in healthy subjects walking on even terrain and in an incomplete SCI person with C6 lesion during walking on the treadmill. FES in the latter case was triggered manually by a physiotherapist. The results showed that the timing of FES triggering played an important role in sensory‐supported FES‐assisted walking, that is, the auditory feedback was also a cue to the therapist controlling the FES. The swing quality estimation enabled patients to voluntarily improve their walking, consequently the intensity of FES assistance was decreased. This suggests that the use of an FES multisensor system for cognitive feedback is efficient rehabilitative method in early stage of rehabilitation of walking.  相似文献   

4.
脑脊液内细胞移植治疗脊髓损伤   总被引:1,自引:0,他引:1  
经脑脊液进行细胞移植治疗脊髓损伤具有较大的临床应用前景.有关研究显示,经脑脊液进行的细胞移植方法安全、方便,对病人的损伤小,适用于治疗中枢神经系统多发疾病.但是经脑脊液移植的细胞能否促进中枢神经系统轴突再生和脊髓神经功能修复仍存在争议,其作用机制、移植时间以及移植细胞种类方面还需要进一步研究.本文对经脑脊液细胞移植方法用于治疗脊髓损伤进行综述,探讨此方法对脊髓损伤后中枢神经系统内轴突再生及功能修复的促进作用.  相似文献   

5.
The purpose of this study was to evaluate the effects of spinal cord injury (SCI) and functional electrical stimulation (FES) of paralyzed muscles on type IV collagen content and proteins involving its degradation, which is initiated by matrix metalloproteinase (MMP)-2 and -9 and regulated by their tissue inhibitors (TIMPs)-2 and -1. Ten SCI subjects participated in an 18-month program of functional electrical stimulation (FES) of their leg muscles. Needle biopsies were taken from the vastus lateralis muscle before and at various times during the training period, and from able-bodied controls. Type IV collagen concentration was unaltered. ProMMP-2 level of SCI subjects before the training period tended to be higher than able-bodied controls and was significantly above the control level after FES. MMP-9 concentration was unchanged. The results suggest accelerated type IV collagen turnover in skeletal muscle of SCI individuals especially after FES as a part of adaptive process of the muscle.  相似文献   

6.
Objective. To investigate the effect of interval training supported by Functional Electrical Stimulation (FES) on ambulation ability in complete spinal cord injury (SCI). Methods. We trained four men with sensorimotor‐complete (ASIA A) SCI, who achieved gait through FES of the quadriceps femoris, gluteus maximus, and common peroneal nerve on each side on a motorized treadmill. Training involved progressive interval walking exercise, consisting of periods of activity followed by equal periods of rest, repeated until muscle fatigue. We used time to muscle fatigue during continuous treadmill ambulation as the primary outcome measure. We also recorded the patterns of incremental stimulation for all training and testing sessions. Results. All subjects increased their ambulation capacity; however, the responses varied from subject to subject. Some subjects increased the total distance walked by as much as 300% with progressive improvement over the entire training period; however, others made more modest gains and appeared to reach a performance plateau within a few training sessions. Conclusions. FES‐supported interval training offers a useful and effective strategy for strength‐endurance improvement in the large muscle groups of the lower limb in motor‐complete SCI. We believe that this training protocol offers a viable alternative to that of continuous walking training in people with SCI using FES to aid ambulation.  相似文献   

7.
The aim of this study was to investigate the use of functional electrical stimulation (FES) as a means of pressure sore prevention in seated spinal cord injured (SCI) subjects. Nine SCI subjects took part in tests in which electrical stimulation was applied to the quadriceps with the lower legs restrained. Ischial pressures were measured during periods of quiet sitting and FES application. A strain gauged lever arm was used to measure the knee moment during quadriceps stimulation. The average pressure drop at the right and left buttocks was 44 mmHg and 27 mmHg respectively. In general the greatest reductions occurred in subjects with larger knee moments; however, there was no direct relationship between the pressure reduction obtained and the quadriceps strength. This form of FES may be useful as a prophylactic aid in the management of pressure sores in SCI subjects.  相似文献   

8.
Spinal cord injury (SCI) is a devastating neurological trauma that is prevalent predominantly in young individuals. Several interventions in the areas of neuroregeneration, pharmacology and rehabilitation engineering/neuroscience are currently under investigation for restoring function after SCI. In this paper, we focus on the use of neuroprosthetic devices for restoring standing and ambulation as well as improving general health and wellness after SCI. Four neuroprosthetic approaches are discussed along with their demonstrated advantages and their future needs for improved clinical applicability. We first introduce surface functional electrical stimulation (FES) devices for restoring ambulation and highlight the importance of these devices for facilitating exercise activities and systemic physiological activation. Implanted muscle-based FES devices for restoring standing and walking that are currently undergoing clinical trials are then presented. The use of implanted peripheral nerve intraneural arrays of multi-site microelectrodes for providing fine and graded control of force during sit-to-stand maneuvers is subsequently demonstrated. Finally, intraspinal microstimulation (ISMS) of the lumbosacral spinal cord for restoring standing and walking is introduced and its results to date are presented. We conclude with a general discussion of the common needs of the neuroprosthetic devices presented in this paper and the improvements that may be incorporated in the future to advance their clinical utility and user satisfaction.  相似文献   

9.
The ability to detect physiological changes associated with treatments to effect axonal regeneration, or novel rehabilitation strategies, for spinal cord injury will be challenging using the widely employed American Spinal Injuries Association (ASIA) impairment scales (AIS) for sensory and motor function. Despite many revisions to the AIS standard neurological assessment, there remains a perceived need for more sensitive, quantitative and objective outcome measures. The purpose of Stage 1 of the Clinical Initiative was to develop these tools and then, in Stage 2 to test them for reliability against natural recovery and treatments expected to produce functional improvements in those with complete or incomplete spinal cord injury (SCI). Here we review aspects of the progress made by four teams involved in Stage 2. The strategies employed by the individual teams were (1) application of repetitive transcranial magnetic stimulation (rTMS) to the motor cortex in stable (chronic) SCI with intent to induce functional improvement of upper limb function, (2) a tele-rehabilitation approach using functional electrical stimulation to provide hand opening and grip allowing incomplete SCI subjects to deploy an instrumented manipulandum for hand and arm exercises and to play computer games, (3) weight-assisted treadmill walking therapy (WAT) comparing outcomes in acute and chronic groups of incomplete SCI patients receiving robotic assisted treadmill therapy, and (4) longitudinal monitoring of the natural progress of recovery in incomplete SCI subjects using motor tests for the lower extremity to investigate strength and coordination.  相似文献   

10.
Spinal cord injury (SCI) is a devastating disease that leads to permanent disability of victims for which no suitable therapeutic intervention has been achieved so far. Thus, exploration of novel therapeutic agents and nano-drug delivery to enhance neuroprotection after SCI is the need of the hour. Previous research on SCI is largely focused to improve neurological manifestations of the disease while ignoring spinal cord pathological changes. Recent studies from our laboratory have shown that pathological recovery of SCI appears to be well correlated with the improvement of sensory motor functions. Thus, efforts should be made to reduce or minimize spinal cord cell pathology to achieve functional and cellular recovery to enhance the quality of lives of the victims. While treating spinal cord disease, recovery of both neuronal and non-neuronal cells, e.g., endothelia and glial cells are also necessary to maintain a healthy spinal cord function after trauma. This review focuses effects of novel therapeutic strategies on the role of spinal cord microvascular reactions and endothelia cell functions, i.e., blood–spinal cord barrier (BSCB) in SCI and repair mechanisms. Thus, new therapeutic approach to minimize spinal cord pathology after trauma using antibodies to various neurotransmitters and/or drug delivery to the cord directly by topical application to maintain strong localized effects on the injured cells are discussed. In addition, the use of nanowired drugs to affect remote areas of the cord after their application on the injured spinal cord in thwarting the injury process rapidly and to enhance the neuroprotective effects of the parent compounds are also described in the light of current knowledge and our own investigations. It appears that local treatment with new therapeutic agents and nanowired drugs after SCI are needed to enhance neurorepair leading to improved spinal cord cellular functions and the sensory motor performances.  相似文献   

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