Abstract：
OBJECTIVE: To evaluate if acute intermittent hypoxia (AIH) coupled with transcutaneous spinal cord stimulation (tSCS) enhance task-specific training and lead to superior and more sustained gait improvements as compared to each of these strategies used in isolation in persons with chronic, incomplete spinal cord injury (SCI).
METHODS: Proof of concept, randomized crossover trial SETTING: Outpatient, rehabilitation hospital INTERVENTIONS: Ten participants completed 3 intervention arms: 1) AIH, tSCS, and gait training (AIH + tSCS), 2) tSCS plus gait training (SHAM AIH + tSCS), and 3) gait training alone (SHAM + SHAM). Each arm consisted of 5 consecutive days of intervention with a minimum of a 4-week washout between arms. The order of arms was randomized. The study took place from December 3, 2020 to January 4, 2023.
METHODS: 10-meter walk test (10MWT) at self-selected velocity (SSV) and fast velocity (FV), 6-minute walk test (6MWT), Timed Up and Go (TUG) SECONDARY OUTCOME MEASURES: Isometric ankle plantarflexion and dorsiflexion torque RESULTS: TUG improvements were 3.44 seconds (95% CI: 1.24-5.65) significantly greater in the AIH + tSCS arm than the SHAM AIH + tSCS arm at post-intervention (POST) and 3.31 seconds (95% CI: 1.03-5.58) greater than the SHAM + SHAM arm at 1-week follow up. SSV was 0.08 m/s (95% CI: 0.02-0.14) significantly greater following the AIH + tSCS arm than the SHAM AIH + tSCS at POST. Although not significant, the AIH + tSCS arm also demonstrated the greatest average improvements compared to the other two arms at POST and 1WK for the 6MWT, FV, and ankle plantarflexion torque.
CONCLUSIONS: This pilot study is the first to demonstrate that combining these three neuromodulation strategies leads to superior improvements in the TUG and SSV for individuals with chronic incomplete SCI and warrants further investigation.
METHODS: Proof of concept, randomized crossover trial SETTING: Outpatient, rehabilitation hospital INTERVENTIONS: Ten participants completed 3 intervention arms: 1) AIH, tSCS, and gait training (AIH + tSCS), 2) tSCS plus gait training (SHAM AIH + tSCS), and 3) gait training alone (SHAM + SHAM). Each arm consisted of 5 consecutive days of intervention with a minimum of a 4-week washout between arms. The order of arms was randomized. The study took place from December 3, 2020 to January 4, 2023.
METHODS: 10-meter walk test (10MWT) at self-selected velocity (SSV) and fast velocity (FV), 6-minute walk test (6MWT), Timed Up and Go (TUG) SECONDARY OUTCOME MEASURES: Isometric ankle plantarflexion and dorsiflexion torque RESULTS: TUG improvements were 3.44 seconds (95% CI: 1.24-5.65) significantly greater in the AIH + tSCS arm than the SHAM AIH + tSCS arm at post-intervention (POST) and 3.31 seconds (95% CI: 1.03-5.58) greater than the SHAM + SHAM arm at 1-week follow up. SSV was 0.08 m/s (95% CI: 0.02-0.14) significantly greater following the AIH + tSCS arm than the SHAM AIH + tSCS at POST. Although not significant, the AIH + tSCS arm also demonstrated the greatest average improvements compared to the other two arms at POST and 1WK for the 6MWT, FV, and ankle plantarflexion torque.
CONCLUSIONS: This pilot study is the first to demonstrate that combining these three neuromodulation strategies leads to superior improvements in the TUG and SSV for individuals with chronic incomplete SCI and warrants further investigation.
摘要：
目的：评估急性间歇性缺氧（AIH）联合经皮脊髓刺激（tSCS）是否可以增强特定任务的训练，并与单独使用的每种策略相比，可以改善更持久的步态。不完全性脊髓损伤（SCI）。
方法：概念证明，随机交叉试验设置：门诊，康复医院干预：十名参与者完成了3个干预组：1）AIH，tSCS,和步态训练（AIH+tSCS），2)tSCS加步态训练(SHAMAIH+tSCS),和3)单独的步态训练(SHAM+SHAM)。每个手臂由连续5天的干预组成，手臂之间至少有4周的冲洗时间。武器的顺序是随机的。该研究于2020年12月3日至2023年1月4日进行。
方法：在自选速度（SSV）和快速速度（FV）下进行10米步行测试（10MWT），6分钟步行测试（6MWT），定时上升和前进（TUG）二级结果指标：等距踝关节前屈和背屈扭矩结果：AIH+tSCS组的TUG改善为3.44秒（95％CI：1.24-5.65）明显大于SHAMAIH+tSCS组干预后（POST）和SHAM-1周随访时的3.31秒（95％CI：1.03-5.58）。AIHtSCS臂后的SSV为0.08m/s（95％CI：0.02-0.14），明显高于SHAMAIHtSCS。虽然不重要，在6MWT的POST和1WK下，AIH+tSCS臂与其他两个臂相比也表现出最大的平均改进，FV,和踝关节足底屈扭矩。
结论：这项初步研究首次证明，结合这三种神经调节策略可以改善慢性不完全SCI患者的TUG和SSV，值得进一步研究。
方法：概念证明，随机交叉试验设置：门诊，康复医院干预：十名参与者完成了3个干预组：1）AIH，tSCS,和步态训练（AIH+tSCS），2)tSCS加步态训练(SHAMAIH+tSCS),和3)单独的步态训练(SHAM+SHAM)。每个手臂由连续5天的干预组成，手臂之间至少有4周的冲洗时间。武器的顺序是随机的。该研究于2020年12月3日至2023年1月4日进行。
方法：在自选速度（SSV）和快速速度（FV）下进行10米步行测试（10MWT），6分钟步行测试（6MWT），定时上升和前进（TUG）二级结果指标：等距踝关节前屈和背屈扭矩结果：AIH+tSCS组的TUG改善为3.44秒（95％CI：1.24-5.65）明显大于SHAMAIH+tSCS组干预后（POST）和SHAM-1周随访时的3.31秒（95％CI：1.03-5.58）。AIHtSCS臂后的SSV为0.08m/s（95％CI：0.02-0.14），明显高于SHAMAIHtSCS。虽然不重要，在6MWT的POST和1WK下，AIH+tSCS臂与其他两个臂相比也表现出最大的平均改进，FV,和踝关节足底屈扭矩。
结论：这项初步研究首次证明，结合这三种神经调节策略可以改善慢性不完全SCI患者的TUG和SSV，值得进一步研究。
