scholarly journals A Controlled Clinical Study of Intensive Neurorehabilitation in Post-Surgical Dogs with Severe Acute Intervertebral Disc Extrusion

Animals ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 3034
Author(s):  
Ângela Martins ◽  
Débora Gouveia ◽  
Ana Cardoso ◽  
Carla Carvalho ◽  
Tiago Coelho ◽  
...  
Keyword(s):  
Clinical Study ◽  
Intervertebral Disc ◽  
Pain Perception ◽  
Spinal Reflex ◽  
Control Group ◽  
Locomotor Training ◽  
Significant Difference ◽  
Cord Injury ◽  
Controlled Clinical Study ◽  
Disc Extrusion

This retrospective controlled clinical study aimed to verify if intensive neurorehabilitation (INR) could improve ambulation faster than spontaneous recovery or conventional physiotherapy and provide a possible therapeutic approach in post-surgical paraplegic deep pain perception-positive (DPP+) (with absent/decreased flexor reflex) and DPP-negative (DDP−) dogs, with acute intervertebral disc extrusion. A large cohort of T10-L3 Spinal Cord Injury (SCI) dogs (n = 367) were divided into a study group (SG) (n = 262) and a control group (CG) (n = 105). The SG was based on prospective clinical cases, and the CG was created by retrospective medical records. All SG dogs performed an INR protocol by the hospitalization regime based on locomotor training, electrical stimulation, and, for DPP−, a combination with pharmacological management. All were monitored throughout the process, and measuring the outcome for DPP+ was performed by OFS and, for the DPP−, by the new Functional Neurorehabilitation Scale (FNRS-DPP−). In the SG, DPP+ dogs had an ambulation rate of 99.4% (n = 167) and, in DPP−, of 58.5% (n = 55). Moreover, in DPP+, there was a strong statistically significant difference between groups regarding ambulation (p < 0.001). The same significant difference was verified in the DPP– dogs (p = 0.007). Furthermore, a tendency toward a significant statistical difference (p = 0.058) regarding DPP recovery was demonstrated between groups. Of the 59 dogs that did not recover DPP, 22 dogs achieved spinal reflex locomotion (SRL), 37.2% within a maximum of 3 months. The progressive myelomalacia cases were 14.9% (14/94). Therefore, although it is difficult to assess the contribution of INR for recovery, the results suggested that ambulation success may be improved, mainly regarding time.

scholarly journals Risk factors associated with progressive myelomalacia in dogs with complete sensorimotor loss following intervertebral disc extrusion: a retrospective case-control study

2019 ◽  
Vol 15 (1) ◽  
Author(s):  
Aude Castel ◽  
Natasha J. Olby ◽  
Hongyu Ru ◽  
Christopher L. Mariani ◽  
Karen R. Muñana ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intervertebral Disc ◽  
Pain Perception ◽  
Case Control Study ◽  
Case Control ◽  
Control Group ◽  
Retrospective Case ◽  
Increased Risk ◽  
Control Study ◽  
Disc Extrusion

Abstract Background Progressive myelomalacia (PMM) is a usually fatal complication of acute intervertebral disc extrusion (IVDE) in dogs but its risk factors are poorly understood. The objective of this retrospective case-control study was to identify risk factors for PMM by comparing dogs with complete sensorimotor loss following IVDE that did and did not develop the disease after surgery. We also investigated whether any risk factors for PMM influenced return of ambulation. Medical records of client-owned dogs with paraplegia and loss of pain perception that underwent surgery for IVDE from 1998 to 2016, were reviewed. Dogs were categorized as PMM yes or no based on clinical progression or histopathology. Walking outcome at 6 months was established. Signalment, onset and duration of signs (categorized), steroids, non-steroidal anti-inflammatory drugs (yes or no), site of IVDE (lumbar intumescence or thoracolumbar) and longitudinal extent of IVDE were retrieved and their associations with PMM and walking outcome were examined using logistic regression. Results One hundred and ninety seven dogs were included, 45 with and 152 without PMM. A 6-month-outcome was available in 178 dogs (all 45 PMM dogs and 133 control dogs); 86 recovered walking (all in the control group). Disc extrusions at the lumbar intumescence were associated with PMM (p = 0.01, OR: 3.02, CI: 1.3–7.2). Surgery performed more than 12 h after loss of ambulation was associated with PMM (OR = 3.4; CI = 1.1–10.5, p = 0.03 for 12-24 h and OR = 4.6; CI = 1.3–16.6, p = 0.02 for the > 24 h categories when compared with the ≤12 h category). Treatment with corticosteroids was negatively associated with PMM (OR: 3.1; CI: 1.3–7.6, p = 0.01). The only variable to affect walking outcome was longitudinal extent of IVDE (OR = 2.6; CI = 1.3–5.3, p = 0.006). Conclusion Dogs with lumbar intumescence IVDE are at increased risk of PMM. Timing of surgery and corticosteroid use warrant further investigations. PMM and recovery of walking are influenced by different factors.

The Effect of Acceptance and Commitment Therapy on Psychological Flexibility and Emotional Regulation in Patients with Spinal Cord Injuries: A Randomized Controlled Trial

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Mohammad Saeed Khanjani ◽  
Javad Kazemi ◽  
Jalal Younesi ◽  
Asghar Dadkhah ◽  
Akbar Biglarian ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Emotion Regulation ◽  
Emotional Regulation ◽  
Spinal Cord Injuries ◽  
Psychological Flexibility ◽  
Control Group ◽  
Acceptance And Commitment ◽  
Significant Difference ◽  
Cord Injury ◽  
And Control

Background: Patients with spinal cord injuries suffer from some psychological problems, such as inadequate emotional regulation and flexibility for adapting to the post-injury condition. In this regard, acceptance and commitment therapy (ACT) can improve psychological flexibility and emotional regulation. Objectives: The main goal of this study was to analyze the effectiveness of ACT in improving psychological flexibility and emotional regulation in patients with spinal cord injuries. Methods: This quasi-experimental design study was based on a pretest-posttest method with a control group. The study population consisted of all patients with spinal cord injury referred to Jalaeipour Rehabilitation Center in Tehran. The study sample included 30 patients with spinal cord injury selected by the purposive sampling method. The inclusion criteria were patients aged 20 to 55 years, residing in Tehran, and with at least a high school diploma. The injury duration varied between one and five years, and the injuries were thoracic and lumbar injuries and an intermediate score of psychological flexibility and emotion regulation. The exclusion criteria were patients with cervical spinal cord injuries, as well as patients who were simultaneously receiving another psychological treatment together with the subjects who suffered from brain damage. Patients were randomly assigned to the experimental and control groups based on random numbers. There were 15 patients in each group. The intervention group received ACT during eight sessions (1.5-hour group therapy) held once a week at Jalaeipour Rehabilitation Center in Tehran (2018), while the control group received routine care. Dennis and Vander Wal’s cognitive flexibility inventory (CFI) and Gross and John’s emotion regulation questionnaire (ERQ) were completed before and one week after the intervention. The data were analyzed using multivariate analysis of covariance (MANCOVA). Results: There was a significant difference in demographic indicators between the two groups. Based on MANCOVA with the baseline score, the mean scores of psychological flexibility and emotion regulation had a significant difference regarding the results of ACT between the experimental and control groups (P < 0.05). Conclusions: According to the findings, ACT can improve psychological flexibility and emotional regulation in patients with spinal cord injuries.

scholarly journals Individual Pharmacotherapy Management (IPM) - I: a group-matched retrospective controlled clinical study on prevention of complicating delirium in the elderly trauma patients and identification of associated factors

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Luise Drewas ◽  
Hassan Ghadir ◽  
Rüdiger Neef ◽  
Karl-Stefan Delank ◽  
Ursula Wolf
Keyword(s):  
Clinical Study ◽  
Associated Factors ◽  
Intervention Group ◽  
The Elderly ◽  
Control Group ◽  
Trauma Patients ◽  
Effective Prevention ◽  
Multivariable Regression ◽  
Elderly Trauma Patients ◽  
Controlled Clinical Study

Abstract Background Delirium is one of the most frequent complications in hospitalized elderly patients with additional costs such as prolongation of hospital stays and institutionalization, with risk of reduced functional recovery, long-term cognitive impairment, and increased morbidity and mortality. We analyzed the effect of individual pharmacotherapy management (IPM) in the University Hospital Halle in geriatric trauma patients on complicating delirium and aimed to identify associated factors. Methods In a retrospective controlled clinical study of 404 hospitalized trauma patients ≥70 years we compared the IPM intervention group (IG) with a control group (CG) before IPM implementation. Delirium was recorded from the hospital discharge letter. The medication review and data records included baseline data, all medications, diagnoses, electrocardiogram (ECG), laboratory and vital parameters during hospitalization. The IPM internist and the senior trauma physician guaranteed personnel and structural continuity in the implementation of the interdisciplinary patient rounds. Results There was a highly matched congruence between CG and IG in terms of age, gender, residency, BMI, most diagnoses, and injury patterns to compare the two groups. The total number of medications per patient was 11.1 ± 4.9 (CG) versus 10.4 ± 3.6 (IG). Our targeted IPM focus on 6 frontline aspects with reduction of antipsychotics, anticholinergic burden, benzodiazepines, serotonergic opioids, elimination of pharmacokinetic and pharmacodynamic drug interactions and overdosage reduced complicating delirium from 5% to almost zero at 0.5%. The association of IPM with a significant 10-fold reduction, OR = 0.09 [95% CI 0.01–0.7], in univariable regression, maintained of clinical relevance in multivariable regression OR = 0.1 [95% CI 0.01–1.1]. Factors most strongly associated with complicating delirium in univariable regression were cognitive dysfunction, nursing home residency, muscle relaxants, antiparkinsonian agents, xanthines, transient disorientation documented in the fall risk scale, antibiotic-requiring infections, antifungals, antipsychotics, and intensive care stay, the two latter maintaining significance in multivariable regression. Conclusions IPM is associated with a highly effective prevention of complicating delirium in the elderly trauma patients. For patient safety it should be integrated as an essential preventative contribution. The associated factors help identify patients at risk.

scholarly journals ‘Vidangadi Lauha’ for Obese Type 2 Diabetes mellitus; Randomized controlled clinical study

2021 ◽  
Author(s):  
Punam Khobarkar ◽  
Jayant Gulhane ◽  
Amit Nakanekar
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Clinical Study ◽  
Targeted Treatment ◽  
High Density Lipoproteins ◽  
Control Group ◽  
Randomized Controlled ◽  
Controlled Clinical Study

Abstract Type 2 Diabetes mellitus in obese persons is becoming threatening disease due to increasing prevalence of its microvascular and macro vascular complications. A multi targeted treatment can be considered better over single targeted treatment; in view of multiple pathways involved in pathogenesis of diabetes and its complications. This open labelled randomized controlled clinical Study was aimed to evaluate clinical efficacy of ‘Vidangadi Lauha’(An Ayurveda formulation) in comparison with metformin for obese type II diabetes mellitus. Participants were divided into two groups. Trial group received Vidangadi Lauha 5gm BID and control group received tablet metformin 500mg BID for duration of 3 months. Among 550 screened participants 120 participants were eligible, out of them 100 participants were enrolled and randomized by computer generated method, out of them 80 patients (40 in each group) completed the trial. Both the treatments were equally effective in reducing blood sugar fasting(F), post meal(PM) glycated Haemoglobin (HbA1C) and Body Mass Index (BMI). Vidangadi Lauha is more effective in reducing Ayurvedic Symptoms, waist hip ratio and cholesterol as compared to Metformin. High Density Lipoproteins (HDL) were improved by minor clinical difference in both the groups. Both the treatment does not have statistically significant effect in reducing Low Density Lipoproteins (LDL).

Treatment of fresh thoracolumbar vertebral burst fracture based on intraoperative CT scan

2020 ◽  
Author(s):  
yuwei li ◽  
wei cui ◽  
Peng Zhou ◽  
Cheng Li ◽  
Wei Xiao ◽  
...  
Keyword(s):  
Treatment Group ◽  
Ct Scan ◽  
Cobb Angle ◽  
Dura Mater ◽  
Spinal Canal ◽  
Control Group ◽  
Intraoperative Ct ◽  
Bleeding Volume ◽  
Significant Difference ◽  
Cord Injury

Abstract ObjectiveTo evaluate the value of intraoperative CT scanning in the treatment of fresh thoracolumbar burst fractures .MethodThe data of patients with thoracolumbar fractures from January 2008 to January 2015 were analyzed retrospectively,79 cases were treatment group which were treated with intraoperative CT scan and decompression mode was determined according to CT scan results during the period from October 2012 to January 2015; 82 patients as the observation group were treated without intraoperative CT scan and direct laminectomy were performed during the period from January 2008 to October 2012. In the treatment group, it is no further decompression of the spinal canal when the CT showed a reduction of the fracture block into the spinal canal, If the intraoperative CT showed that the fractures still occupied the spinal dura mater according to the three-dimensional CT information, The position and the size of the fracture of the spinal canal were determined, and the unilateral laminectomy was performed corresponding to the position of the lamina and intervertebral ligamentum flavum. The operative time, bleeding volume, neurological function, height of the anterior vertebral compression and Cobb angle were compared between the two groups.ResultIn the treatment group, CT scan showed 48 cases (60.8%) entered the spinal canal fracture completely or basically reset .31 cases (39.2%) still occupied the spinal canal compression spinal dura mater. There were significant differences in the operation time and bleeding volume between the two groups. The treatment group was less than the control group. There was no infection, secondary spinal cord injury, loose fixation and other complications. There was no difference in the ASIA classification before and after operation. The anterior vertebral height and COBB angle of the two groups were significantly improved compared with those before operation. There was no significant difference between the two groups in the postoperative height and COBB angle, but after 2 years the difference was statistically significant between the two groups, to retain the rear ligament complex treatment group was significantly better than the control group.ConclusionPatients of thoracolumbar vertebral fracture in hyperextension position combined with internal fixation can achieve good correction effect. Orthopedic postoperative CT scan and according to the results of the scan precision treatment can simplify the operation, there was no difference in clinical efficacy compared with total laminectomy, but some patients avoid the spinal canal decompression and part were treated by small fenestration laminectomy decompression, which is conducive to the protection of spinouts ligament complex integrity.

scholarly journals Experimental and Preliminary Clinical Study of Real-Time Registration in Liver Tumors During Respiratory Motion Based on a Multimodality Image Navigation System

2019 ◽  
Vol 18 ◽  
pp. 153303381985776
Author(s):  
Chao Ren ◽  
Shi-rong Liu ◽  
Wen-bo Wu ◽  
Xiao-ling Yu ◽  
Zhi-gang Cheng ◽  
...  
Keyword(s):  
Clinical Study ◽  
Real Time ◽  
Respiratory Motion ◽  
Liver Tumors ◽  
The Body ◽  
Respiratory Monitoring ◽  
Control Group ◽  
Registration Errors ◽  
Significant Difference ◽  
Monitoring Module

Purpose: To develop a fusion imaging system that combines ultrasound and computed tomography for real-time tumor tracking and to validate the accuracy of performing registration via this approach during a specific breathing phase. Materials and Methods: The initial part of the experimental study was performed using iodized oil injection in pig livers and was focused on determining the accuracy of registration. Eight points (A1-4 and B1-4) at different positions and with different target sizes were selected as target points. During respiratory motion, we used our self-designed system to perform the procedure either with (experimental group, E) or without (control group, C) the respiratory monitoring module. The registration errors were then compared between the 2 groups and within group E. The second part of this study was designed as a preliminary clinical study and was performed in 18 patients. Screening was performed to determine the combination of points on the body surface that provided the highest sensitivity to respiratory motion. Registration was performed either with (group E) or without (group C) the respiratory monitoring module. Registration errors were compared between the 2 groups. Results: In part 1 of this study, there were fewer registration errors at each point in group E than at the corresponding points in group C ( P < .01). In group E, there were more registration errors at points A1 and B1 than at the other points ( P < .05). There was no significant difference in registration errors among the remaining points. During part 2 of the study, there was a significant difference in the registration errors between the 2 groups ( P < .01). Conclusions: Real-time fusion registration is feasible and can be accurately performed during respiratory motions when using this system.

scholarly journals Is isometrics effective on pain perception, functional mobility and anxiety of geriatric clients with osteoarthritis at Pathanamthitta District, Kerala

2019 ◽  
pp. 14
Author(s):  
M.D. Nisha
Keyword(s):  
Pain Perception ◽  
Rating Scale ◽  
Functional Mobility ◽  
Control Group ◽  
Control Group Design ◽  
Point Rating Scale ◽  
Significant Difference ◽  
Quasi Experimental ◽  
Global Statistics ◽  
Level Of Significance

Background: Osteoarthritis is a major cause of many medical conditions and disability in people above 50’s and leads to reduced activity in older people. Global statistics revels that over 100 million people worldwide suffers from Osteoarthritis. Materials and methods: A quasi experimental pretest - posttest control group design was used. 200 geriatric clients with osteoarthritis residing in selected geriatric homes at Pathanamthitta were selected and assessed by using a Numerical Pain Intensity Scale, an Observational check list and a three point rating scale for pain, functional mobility and anxiety. Results: There was a significant difference between the mean pain score( t = 10.758 p = 0.01, df – 198), functional mobility ( t = 7.73 p = 0.01, df – 198) and anxiety (t = 7.665 ,df –198, p=0.01in experimental and control group after intervention ( t = 10.758 p = 0.01, df – 198).Statistically no significant association was found between pain, functional mobility and anxiety with variables such as gender, religion, marital status, number of children’s and duration of stay.The pain and anxiety correlation value was ‘r’ = 0.89. The functional mobility and anxiety correlation value was ‘r’ = 0.80. The functional mobility and pain correlation value was ‘r’ = 0.83. It shows that statistically positive correlation is present between the geriatric clients’ pain and anxiety, functional mobility and anxiety and functional mobility and pain at p<0.05% level of significance. Conclusion: Exercise is one of the best methods to treat Osteoarthritis. This study proved that isometric exercises are beneficial to improve the functional mobility of joints in old age people. When the mobility increases, intensity of joint pain decreases.

scholarly journals An Evaluation of the Effect of Therapeutic Ultrasound on Healing of Mandibular Fracture

2015 ◽  
Vol 8 (4) ◽  
pp. 299-306 ◽  
Author(s):  
Kiran Patel ◽  
Sanjeev Kumar ◽  
Nishtha Kathiriya ◽  
Sonal Madan ◽  
Ankit Shah ◽  
...  
Keyword(s):  
Pain Perception ◽  
Mandibular Fracture ◽  
Periodontal Pocket ◽  
Control Group ◽  
Mandibular Fractures ◽  
Study Group ◽  
Pulsed Ultrasound ◽  
Pocket Depth ◽  
Significant Difference ◽  
Experimental Group

The mandible is the most frequently fractured bone in maxillofacial trauma, the treatment of which consists of reduction and fixation of dislocated fragments by open or closed approach. Innovative techniques toward reducing the period of the postoperative intermaxillary fixation (IMF) are being researched. A relatively unknown treatment that may have an effect on fracture healing is ultrasound. Recent clinical trials have shown that low-intensity pulsed ultrasound (LIPUS) has a positive effect on bone healing. The aim of this study was to evaluate the effect of LIPUS on healing by its application in fresh, minimally displaced or undisplaced mandibular fracture in young and healthy individuals. A total of 28 healthy patients were selected randomly from the outpatient department needing treatment of mandibular fractures. They were then randomly allocated to either of the following two groups—experimental group and study group. After IMF, patients in experimental group received pulsed ultrasound signals with frequency of 1 MHz, with temporal and spatial intensity of 1.5 W/cm2, pulsed wave for 5 minutes on every alternate day for 24 days, whereas patients in control group received no therapy except IMF. Radiographic density at the fracture zone was assessed from the radiograph by Emago (Emago, Amsterdam, Netherlands) Image Analysis software before IMF then at 1st to 5th weeks post-IMF. The amount of clinical mobility between fracture fragments was assessed by digital manipulation of fractured fragment with the help of periodontal pocket depth measuring probe in millimeters at pre-IMF and after 3 weeks. Pain was objectively measured using a visual analogue scale at weekly interval. The data collected were subjected to unpaired “ t“ test. The experimental group showed significant improvement in radiographic density compared with control group at 3- and 5-week interval; pain perception was significantly reduced in experimental group compared with study group in the subsequent weeks. No significant difference was found in clinical mobility between fracture fragments at 3-week interval. The present study provides a basis for application of therapeutic controlled ultrasound as an effective treatment modality to accelerate healing of fresh, minimally displaced mandibular fracture.

Bone Marrow Transplantation or G-CSF Treatment Can Accelerate Recovery of Injured Spinal Cord in Mice.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4181-4181
Author(s):  
Damianos Sotiropoulos ◽  
Eleni Siotou ◽  
Evangelia Athanasiou ◽  
Christos Kalpouzos ◽  
Panayotis Kaloyannidis ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Bone Marrow ◽  
Bone Marrow Cells ◽  
Control Group ◽  
Significant Difference ◽  
Cord Injury ◽  
Group A ◽  
B Mice ◽  
The Mean ◽  
Group B

Abstract Mice, unlike rats and humans, have a self recovery mechanism of spinal cord injury. Whether the hematopoietic system is involved in this mechanism is under investigation. In this study we tested whether bone marrow cells transplanted or mobilized by a growth factor in mice with spinal cord injury, can accelerate the recovery. C57bl/6 female mice 10 to 12 weeks of age underwent spinal cord incision in an open operation. The injury was performed as a complete transection including the dura mater and the whole circumference of the cord at the T10-T11 intervertebral space with a micro scalpel (No 11). Group A mice received 200μg/kg/day G-CSF subcutaneously for 7 days, starting 24 hours after operation. Group B mice received 106 light density bone marrow cells from C576bl/6 donor mice intravenously 24 hours after operation. Control group mice received no treatment. Histological evaluation was performed at 48 hours, 1 week, 3 weeks and 5 weeks postoperatively. Paraffin embedded longitudinal samples of spinal cord were cut as serial sections. Spinal cord damage was estimated by measuring the maximum diameter of the area of axonal damage and disruption of astrocytic network using immunostaining for neurofilaments and GFAP. Antibodies against CD68 were applied to identify macrophage aggregations. All measurements were performed by morphometric photo analysis. The volume of fibroblastic infiltration was estimated using a grading system (0–7), based on Van Gieson stain for connective tissue. Functional deficits and recovery over time were evaluated by testing hind limb reflex and coordinated motor function (Kuhn and Wrathal functional tests, modified by Seki et al, 2002). All tests have been videotaped. Outcome scores at 48 hours, 1 week, 3 weeks and 5 weeks postoperatively for the control group, group A and group B mice were analyzed with the Mann-Whitney U test. 48 hours post operatively all mice in all groups were paralyzed in both hind limbs. Gradual improvement was observed in all groups. At week 3 there was a significant difference between the mean scores of functional tests for both treated groups (A and B) compared with the mean scores of the control group. Statistically significant difference (p&lt;0,05) was observed in 5 out of 7 tests for group A and in 3 out of 7 tests for group B. Same difference between Group A mice and control group mice was observed by 5 weeks, while group B had no statistically significant difference. No animal in any of the groups had a complete recovery 5 weeks postoperatively. Spinal cord in control group mice showed a gradually increase of fibroblastic infiltration until 5 week which entirely separated the two ends of the cord. In group A and group B mice a significant decrease of fibroblastic infiltration was observed at week 5 compared with week 3. Macrophage aggregations were evident at weeks 1 and 5 but not at week 3 in all groups. In conclusion our results indicate that light density bone marrow transplanted cells or G-CSF treatment can accelerate spinal cord injured mice recovery. It is possible that this is associated with a decrease in fibroblastic infiltration of spinal cord. Macrophage aggregation may also play an important role in the mechanism of recovery in mice, while in rats a different reaction including cavitation and delayed demyelination prohibits neurological recovery.

scholarly journals Corticospinal Reorganization after Locomotor Training in a Person with Motor Incomplete Paraplegia

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Nupur Hajela ◽  
Chaithanya K. Mummidisetty ◽  
Andrew C. Smith ◽  
Maria Knikou
Keyword(s):  
Spinal Cord ◽  
Primary Motor Cortex ◽  
Motor Evoked Potential ◽  
Gait Training ◽  
Spinal Reflex ◽  
Locomotor Training ◽  
Human Spinal Cord ◽  
Flexion Reflex ◽  
Cord Injury ◽  
Before And After

Activity-dependent plasticity as a result of reorganization of neural circuits is a fundamental characteristic of the central nervous system that occurs simultaneously in multiple sites. In this study, we established the effects of subthreshold transcranial magnetic stimulation (TMS) over the primary motor cortex region on the tibialis anterior (TA) long-latency flexion reflex. Neurophysiological tests were conducted before and after robotic gait training in one person with a motor incomplete spinal cord injury (SCI) while at rest and during robotic-assisted stepping. The TA flexion reflex was evoked following nonnociceptive sural nerve stimulation and was conditioned by TMS at 0.9 TA motor evoked potential resting threshold at conditioning-test intervals that ranged from 70 to 130 ms. Subthreshold TMS induced a significant facilitation on the TA flexion reflex before training, which was reversed to depression after training with the subject seated at rest. During stepping, corticospinal facilitation of the flexion reflex at early and midstance phases before training was replaced with depression at early and midswing followed by facilitation at late swing after training. These results constitute the first neurophysiologic evidence that locomotor training reorganizes the cortical control of spinal interneuronal circuits that generate patterned motor activity, modifying spinal reflex function, in the chronic lesioned human spinal cord.

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