Article

Locomotor behavior is controlled by specific neural circuits called central
pattern generators primarily located at the lumbosacral spinal cord. These
locomotor-related neuronal circuits have a high level of automaticity; that is,
they can produce a "stepping" movement pattern also seen on electromyography
(EMG) in the absence of supraspinal and/or peripheral afferent inputs. These
circuits can be modulated by epidural spinal-cord stimulation and/or
pharmacological intervention. Such interventions have been used to neuromodulate
the neuronal circuits in patients with motor-complete spinal-cord injury (SCI) to
facilitate postural and locomotor adjustments and to regain voluntary motor
control. Here, we describe a novel non-invasive stimulation strategy of painless
transcutaneous electrical enabling motor control (pcEmc) to neuromodulate the
physiological state of the spinal cord. The technique can facilitate a stepping
performance in non-injured subjects with legs placed in a gravity-neutral
position. The stepping movements were induced more effectively with multi-site
than single-site spinal-cord stimulation. From these results, a multielectrode
surface array technology was developed. Our preliminary data indicate that use of
the multielectrode surface array can fine-tune the control of the locomotor
behavior. As well, the pcEmc strategy combined with exoskeleton technology is
effective for improving motor function in paralyzed patients with SCI. The
potential impact of using pcEmc to neuromodulate the spinal circuitry has
significant implications for furthering our understanding of the mechanisms
controlling locomotion and for rehabilitating sensorimotor function even after
severe SCI.
CI - Copyright (c) 2015 Elsevier Masson SAS. All rights reserved.

Langue : ANGLAIS