背景:脊髓损伤(SCI)后,大量幸存者患有严重的运动功能障碍(MD)。虽然损伤部位在脊髓,初级运动皮层(M1)的兴奋性显着降低,尤其是在下肢(LE)区域。不幸的是,M1LE区域靶向重复经颅磁刺激(rTMS)在SCI患者中并未实现显着的运动改善。最近的研究报告说,具有SCl的个体中的M1手区域包含组成代码(神经活动的运动编码成分),该代码将来自上肢(UE)和LE的匹配运动联系起来。然而,双侧M1手区兴奋性与整体功能恢复之间的相关性未知.
目的:阐明SCI后双侧M1手区兴奋性的变化及其与运动恢复的相关性,我们的目标是指定用于SCI运动康复的rTMS的治疗参数。
方法:本研究是一项为期12个月的前瞻性队列研究。将评估参与者的神经生理学和整体功能状态。主要结果包括单脉冲和配对脉冲TMS。第二个结果包括功能性近红外光谱(fNIRS)测量。整体功能状态包括总运动评分,修改后的Ashworth量表评分,亚洲减值量表等级,脊髓独立性测量和改良Barthel指数。数据将记录在1个月的疾病持续时间的SCI患者,2个月,4个月,6个月和12个月。匹配的健康对照将在招募后的相同时间段内进行测量。
结论:本研究首次分析双侧M1手区兴奋性变化对SCI后整体功能恢复(包括运动功能和日常生活活动)的评价和预测作用,将进一步拓展传统的M1占优理论,优化目前rTMS治疗,探索SCI患者的脑机界面设计。
背景:ChiCTR2300068831。
BACKGROUND: After spinal cord injury (SCI), a large number of survivors suffer from severe motor dysfunction (MD). Although the injury site is in the spinal cord, excitability significantly decreases in the primary motor cortex (M1), especially in the lower extremity (LE) area. Unfortunately, M1 LE area-targeted repetitive transcranial magnetic stimulation (rTMS) has not achieved significant motor improvement in individuals with SCI. A recent
study reported that the M1 hand area in individuals with SCl contains a compositional code (the movement-coding component of neural activity) that links matching movements from the upper extremities (UE) and the LE. However, the correlation between bilateral M1 hand area excitability and overall functional recovery is unknown.
OBJECTIVE: To clarify the changes in the excitability of the bilateral M1 hand area after SCI and its correlation with motor recovery, we aim to specify the therapeutic parameters of rTMS for SCI motor rehabilitation.
METHODS: This
study is a 12-month prospective cohort
study. The neurophysiological and overall functional status of the participants will be assessed. The primary outcomes included single-pulse and paired-pulse TMS. The second outcome included functional near-infrared spectroscopy (fNIRS) measurements. Overall functional status included total motor score, modified Ashworth scale score, ASIA Impairment Scale grade, spinal cord independence measure and modified Barthel index. The data will be recorded for individuals with SCI at disease durations of 1 month, 2 months, 4 months, 6 months and 12 months. The matched healthy controls will be measured during the same period of time after recruitment.
CONCLUSIONS: The present
study is the first to analyze the role of bilateral M1 hand area excitability changes in the evaluation and prediction of overall functional recovery (including motor function and activities of daily living) after SCI, which will further expand the traditional theory of the predominant role of M1, optimize the current rTMS treatment, and explore the brain-computer interface design for individuals with SCI.
BACKGROUND: ChiCTR2300068831.