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。
OBJECTIVE: To evaluate if acute intermittent hypoxia (AIH) coupled with transcutaneous spinal cord stimulation (tSCS) enhances task-specific training and leads to superior and more sustained gait improvements as compared with each of these strategies used in isolation in persons with chronic, incomplete spinal cord injury.
METHODS: Proof of concept, randomized crossover trial.
METHODS: Outpatient, rehabilitation hospital.
METHODS: 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 at self-selected velocity (SSV) and fast velocity, 6-minute walk test, timed Up and Go (TUG) and secondary outcome measures included 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 (1WK). 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 with the other 2 arms at POST and 1WK for the 6-minute walk test, fast velocity, and ankle plantarflexion torque.
CONCLUSIONS: This pilot study is the first to demonstrate that combining these 3 neuromodulation strategies leads to superior improvements in the TUG and SSV for individuals with chronic incomplete spinal cord injury and warrants further investigation.