Classic paired associative stimulation can improve synaptic plasticity,as demonstrated by animal expe riments and human clinical trials in spinal cord injury patients.Paired associative magnetic stimulation(dual-targe...Classic paired associative stimulation can improve synaptic plasticity,as demonstrated by animal expe riments and human clinical trials in spinal cord injury patients.Paired associative magnetic stimulation(dual-target peripheral and central magnetic stimulation)has been shown to promote neurologic recove ry after stroke.However,it remains unclear whether paired associative magnetic stimulation can promote recovery of lower limb motor dysfunction after spinal cord injury.We hypothesize that the curre nt caused by central and peripheral magnetic stimulation will conve rge at the synapse,which will promote synapse function and improve the motor function of the relevant muscles.Therefore,this study aimed to examine the effects of paired associative magnetic stimulation on neural circuit activation by measuring changes in motor evoked and somatosensory evoked potentials,motor and sensory function of the lower limbs,functional health and activities of daily living,and depression in patients with spinal co rd injury.We will recruit 110 thora cic spinal trauma patients treated in the Department of Spinal Cord Injury,China Rehabilitation Hospital and randomly assign them to expe rimental and control groups in a 1:1 ratio.The trial group(n=55)will be treated with paired associative magnetic stimulation and conventional rehabilitation treatment.The control group(n=55)will be treated with sham stimulation and co nventional rehabilitation treatment.Outcomes will be measured at four time points:baseline and 4,12,and 24 wee ks after the start of inte rvention(active or sham paired associative magnetic stimulation).The primary outcome measure of this trial is change in lower limb American Spinal Injury Association Impairment Scale motor function score from baseline to last follow-up.Secondary outcome measures include changes in lower limb American Spinal Injury Association sensory function sco re,motor evoked potentials,sensory evoked potentials,modified Ashwo rth scale score,Maslach Burnout Invento ry score,and Hamilton Depression Scale score over time.Motor evoked potential latency reflects corticospinal tract transmission time,while amplitude reflects recruitment ability;both measures can help elucidate the mechanism underlying the effect of paired associative magnetic stimulation on synaptic efficiency.Adve rse events will be recorded.Findings from this trial will help to indicate whether paired associative magnetic stimulation(1)promotes recove ry of lower limb sensory and motor function,reduces spasticity,and improves quality of life;(2)promotes neurologic recovery by increasing excitability of spinal cord motor neurons and stimulating synaptic plasticity;and(3)improves rehabilitation outcome in patients with spinal cord injury.Recruitment for this trial began in April 2021 and is currently ongoing.It was approved by the Ethics Committee of Yangzhi Affiliated Rehabilitation Hospital of Tongji University,China(approval No.YZ2020-018)on May 18,2020.The study protocol was registered in the Chinese Clinical Trial Registry(registration number:ChiCTR2100044794)on March 27,2021(protocol version 1.0).This trial will be completed in April 2022.展开更多
针对目前临床痉挛评定主观性大,信度与效度有待提高的问题,提出了一种新的基于牵张反射阈值的痉挛评定方法,利用关节角加速度变化判定牵张反射阈值,通过设计相应装置检验了牵张反射阈值在上肢痉挛评定中的信度与效度,并探讨了加速度变...针对目前临床痉挛评定主观性大,信度与效度有待提高的问题,提出了一种新的基于牵张反射阈值的痉挛评定方法,利用关节角加速度变化判定牵张反射阈值,通过设计相应装置检验了牵张反射阈值在上肢痉挛评定中的信度与效度,并探讨了加速度变化在上肢痉挛评定中的信度与效度.4位检查者利用改良Ashworth量表(Modified Ashworth scale,MAS)及该痉挛检测装置对招募的22例伴随有上肢痉挛症状的受试者进行了痉挛评定.将评定过程中采集的牵张反射阈值以及加速度平均变化值(Acceleration mean variance,AMV)与MAS评分进行相关性分析,显示牵张反射阈值数据与MAS评分显著相关,相关性满足(r=-0.831～-0.953,P<0.05),AMV与MAS评分相关性满足(r=0.665～0.900,P<0.05).它们重测信度分别满足(r=0.890～0.962,P<0.05)和(r=0.632～0.928,P<0.05).实验结果表明该方法及装置可为痉挛评定提供一种实用的定量分析手段.展开更多
基金the National Key Research and Development Program of China,No.2020YFC2004202(to DSX)the National Natural Science Foundation of China(General Program),Nos.81772453,81974358(to DSX)Scientific Research Project of Yangzhi Rehabilitation Hospital Affliated to Tongji University,No.KYPY202006(to TTS)。
文摘Classic paired associative stimulation can improve synaptic plasticity,as demonstrated by animal expe riments and human clinical trials in spinal cord injury patients.Paired associative magnetic stimulation(dual-target peripheral and central magnetic stimulation)has been shown to promote neurologic recove ry after stroke.However,it remains unclear whether paired associative magnetic stimulation can promote recovery of lower limb motor dysfunction after spinal cord injury.We hypothesize that the curre nt caused by central and peripheral magnetic stimulation will conve rge at the synapse,which will promote synapse function and improve the motor function of the relevant muscles.Therefore,this study aimed to examine the effects of paired associative magnetic stimulation on neural circuit activation by measuring changes in motor evoked and somatosensory evoked potentials,motor and sensory function of the lower limbs,functional health and activities of daily living,and depression in patients with spinal co rd injury.We will recruit 110 thora cic spinal trauma patients treated in the Department of Spinal Cord Injury,China Rehabilitation Hospital and randomly assign them to expe rimental and control groups in a 1:1 ratio.The trial group(n=55)will be treated with paired associative magnetic stimulation and conventional rehabilitation treatment.The control group(n=55)will be treated with sham stimulation and co nventional rehabilitation treatment.Outcomes will be measured at four time points:baseline and 4,12,and 24 wee ks after the start of inte rvention(active or sham paired associative magnetic stimulation).The primary outcome measure of this trial is change in lower limb American Spinal Injury Association Impairment Scale motor function score from baseline to last follow-up.Secondary outcome measures include changes in lower limb American Spinal Injury Association sensory function sco re,motor evoked potentials,sensory evoked potentials,modified Ashwo rth scale score,Maslach Burnout Invento ry score,and Hamilton Depression Scale score over time.Motor evoked potential latency reflects corticospinal tract transmission time,while amplitude reflects recruitment ability;both measures can help elucidate the mechanism underlying the effect of paired associative magnetic stimulation on synaptic efficiency.Adve rse events will be recorded.Findings from this trial will help to indicate whether paired associative magnetic stimulation(1)promotes recove ry of lower limb sensory and motor function,reduces spasticity,and improves quality of life;(2)promotes neurologic recovery by increasing excitability of spinal cord motor neurons and stimulating synaptic plasticity;and(3)improves rehabilitation outcome in patients with spinal cord injury.Recruitment for this trial began in April 2021 and is currently ongoing.It was approved by the Ethics Committee of Yangzhi Affiliated Rehabilitation Hospital of Tongji University,China(approval No.YZ2020-018)on May 18,2020.The study protocol was registered in the Chinese Clinical Trial Registry(registration number:ChiCTR2100044794)on March 27,2021(protocol version 1.0).This trial will be completed in April 2022.
文摘针对目前临床痉挛评定主观性大,信度与效度有待提高的问题,提出了一种新的基于牵张反射阈值的痉挛评定方法,利用关节角加速度变化判定牵张反射阈值,通过设计相应装置检验了牵张反射阈值在上肢痉挛评定中的信度与效度,并探讨了加速度变化在上肢痉挛评定中的信度与效度.4位检查者利用改良Ashworth量表(Modified Ashworth scale,MAS)及该痉挛检测装置对招募的22例伴随有上肢痉挛症状的受试者进行了痉挛评定.将评定过程中采集的牵张反射阈值以及加速度平均变化值(Acceleration mean variance,AMV)与MAS评分进行相关性分析,显示牵张反射阈值数据与MAS评分显著相关,相关性满足(r=-0.831～-0.953,P<0.05),AMV与MAS评分相关性满足(r=0.665～0.900,P<0.05).它们重测信度分别满足(r=0.890～0.962,P<0.05)和(r=0.632～0.928,P<0.05).实验结果表明该方法及装置可为痉挛评定提供一种实用的定量分析手段.
