T. R. Moshonkina

Transcutaneous electrical stimulation of the spinal cord: A noninvasive tool for the activation of stepping pattern generators in humans

A new method for the activation of spinal locomotor networks (SLN) in humans by transcutaneous electrical spinal cord stimulation (tESCS) has been described. The tESCS applied in the region of the T11-T12 vertebrae with a frequency of 5–40 Hz elicited involuntary step-like movements in healthy subjects with their legs suspended in a gravity-neutral position. The amplitude of evoked step-like movements increased with increasing tESCS frequency. The frequency of evoked step-like movements did not depend on the frequency of tESCS. It was shown that the hip, knee, and ankle joints were involved in the evoked movements. It has been suggested that tESCS activates the SPG (SLN) through in part, via the dorsal roots that enter the spinal cord. tESCS can be used as a noninvasive method in rehabilitation of spinal pathology.

Morphofunctional basis for recovery of locomotor movements in rats with completely crossed spinal cord

Treadmill training of spinalized rats creates conditions for early appearance of rhythmic locomotor movements of the hind limbs. Recovery of the movements was paralleled by an appropriate structural organization of neurons in the anterior horns of the distal compartment of the spinal cord.

Effects of Spinal Cord Electrical Stimulation in Patients with Vertebrospinal Pathology

Until now, no scientific neurophysiologic methods of diagnostics and treatment of vertebrospinal pathologies were developed. Previous study showed that electrical stimulation of lumbar segments of the spinal cord in animals with complete spinal cord transection induced a well-coordinated weight-bearing locomotion. The present comparative study of motor activity triggered by electrical epidural stimulation of one or two segments of the spinal cord in spinal patients showed that stimulation of lumbar (L2-L4) or sacral (S2) segments facilitated generation of motor patterns of muscle activity. Combination of electrical stimulation with locomotor training resulted in the appearance of stepping patterns characteristic of normal walking and tonic activity of the muscles needed for body balance maintenance.

Mechanical stimulation of the support zones of soles: The method of noninvasive activation of the stepping movement generators in humans

The effects of mechanical stimulation of the soles’ support zones in the modes of slow and fast walking (75 and 120 steps per minute) were studied using the model of supportlessness (legs suspension). 20 healthy subjects participated in the study. EMG activity of hip and shin muscles was recorded. Kinematics of leg movements was assessed with the use of videoanalysis system. In 80% of cases support stimulation was followed by leg movements, in 69% of which they had characteristics of locomotions being accompanied by the burst-like electromyographic activities. The order of involvement of leg muscles and organization of antagonistic muscles activities were analogous to those of voluntary walking. The latencies of electromyographic activity in hip and shin muscles composed 5.17 ± 1.08 and 14.01 ± 2.82 s, respectively, the frequencies of bursts differed significantly depending on stimulation frequency. In 31% of cases the electromyographical activity following the stimulation of the soles’ support zones had not burst-like but uninterrupted pattern. Its amplitude rose smoothly reaching a certain level that was subsequently maintained. Results of the study showed that soles’ support zones stimulation in the mode of locomotion could activate a locomotor generator provoking the appearance of locomotion-like activity and that effect evoked by this stimulation includes not only rhythmical but also non-rhythmical (probably postural) components of walking.

Morphofunctional characteristics of the lumbar enlargement of the spinal cord in rats

The topography of the lumbar enlargement of the spinal cord in rats was studied; an immunohistochemical method was used to determine the distribution of synaptophysin — a membrane protein of synaptic vesicles. Synaptophysin-immunoreactive structures were detected in the gray matter of all Rexed laminae, around most neurons and in the neuropil. Previously undescribed subpial synaptic contacts were detected immunohistochemically in the white matter and confirmed by electron microscopy. A non-myelinated component of the corticospinal tract, including axonal varicosities and synaptic contacts, was observed in the dorsal part of the white matter of the lumbar enlargement of the spinal cord.

Effect of locomotor training and functional electrical stimulation on postural function in children with severe cerebral palsy

Cerebral palsy (CP) considerably impairs the ability to maintain upright stance. The effects of locomotor training and functional electrical stimulation (FES) on postural control were determined in 27 children aged 6–12 years with severe CP. The severity level of the clinical manifestations of CP was classified as 3 according to the Gross Motor Function Classification System (GMFCS). All patients participated in 15 30-min mechanical therapy sessions using robot-assisted passive stepping. In 12 out of 27 children, the locomotion therapy was accompanied by FES. Stabilometry and plantography tests were performed in 23 healthy age-matched children. Postural control in children with CP differed from the stabilograms of healthy children in a forward shift of the center of pressure (COP) projection; higher values of the COP trajectory area and length, the mean amplitude of the COP oscillations, and the absence of COP response to the eyes closed condition. After treatment, the posturographic characteristics tended to normalize in relation to the values obtained in neurologically intact children. The improvement was observed in 43% of children without FES and in 75% of children in the group with FES. Analysis of plantograms revealed normalization of footprints in children who received FES. Thus, it was demonstrated that FES combined with locomotor training resulted in the improvement in vertical posture control in children with severe CP.

Effect of Combination of Non-Invasive Spinal Cord Electrical Stimulation and Serotonin Receptor Activation in Patients with Chronic Spinal Cord Lesion

We analyzed the efficiency of percutaneous electrical stimulation of the spinal cord and serotonin receptor activation in rehabilitation of paralyzed patients. Four-week course of spinal cord electrical stimulation combined with mechanotherapy produced positive shifts in the status of chronically paralyzed patients. Serotonin receptor activation potentiated the effect of spinal cord stimulation and can be regarded as an additional neurorehabilitation option.

Neurorehabilitation of patients with cerebral palsy

Cerebral palsy (CP) is one of the most common diseases that cause substantial motor disability. The review considers new methods of motor rehabilitation in children with CP in the context of modern physiology and summarizes the experimental data on their efficacy.

Response of external inspiration to the movements induced by transcutaneous spinal cord stimulation

The dynamic of the parameters of lung ventilation and gas exchange have been studied in 10 young male subjects during involuntary stepping movements induced by transcutaneous spinal cord electrical stimulation applied in the projection of T11–T12 vertebrae and during voluntary stepping movements. It has been found that the transcutaneous spinal cord stimulation inducing stepping movements leads to an increase in breathing frequency and a reduction in tidal volume. These effects may be mediated by some neurogenic factors associated with muscular activity during stepping movements, the activation of abdominal expiratory muscles, and the interaction between the stepping pattern and breathing generators.

Effects of transcutaneous electrical spinal cord stimulation on stepping patterns during walking

Effects of transcutaneous electrical spinal cord stimulation (tESCS) on the parameters of stepping movements in healthy subjects were investigated during two kinds of activity: walking on a moving treadmill belt (active treadmill) as well as pushing the treadmill belt by effort of the legs (passive treadmill). It was found that the total interference electromyogram (EMG) activity during stepping performance on a passive treadmill was 1.5–2 times higher than during stepping on an active treadmill. In addition, the amplitude of angular displacement of the hip joint and ankle was 2.5 times and 1.7 times higher, respectively, during passive vs. active treadmill, while the duration of stepping cycle decreased by 19%. Although the muscles were exposed to different load and the parameters of motion on the active and passive treadmill were different, tESCS caused an increase in the total EMG activity in 96% of cases both on the active and on the passive treadmill. In both cases, the stepping cycle period decreased by 4–43% in all subjects. These results suggest that tESCS can affect voluntary stepping patterns under conditions of different afferent control.