CAJ | 학술논문

目的采用重复经颅磁刺激(rTMS)联合减重步行训练(BWSTT)治疗慢性不完全性脊髓损伤(SCI)的临床疗效观察.方法慢性不完全性SCI患者4例,先给予rTMS治疗后立即给予BWSTT训练.在治疗前、后以及治疗后第3周,分别进行临床功能评估.对其中2例患者进行H反射、功能性磁共振成像(fMRI)和静态平衡功能评估(BPM).结果 4例患者中有2例美国脊髓损伤协会(ASIA)运动及感觉评分、10 m步行速度提高,步行费力程度减小,身体重心摆动路径和摆动面积均减小,改变持续到治疗后第3周.2例患者的电生理评估均显示H反射最大波幅降低,H/M最大波幅比下降.治疗后,2例患者的fMRI均显示M1区激活体积增大.结论高频rTMS联合BWSTT可能改善慢性不完全性SCI患者的运动功能,提高脊髓运动神经元的兴奋性并促进大脑皮质的重塑.
목적 채용중복경로자자격(rTMS)연합감중보행훈련(BWSTT)치료만성불완전성척수손상(SCI)적림상료효관찰.방법 만성불완전성SCI환자4례,선급여rTMS치료후립즉급여BWSTT훈련.재치료전、후이급치료후제3주,분별진행림상공능평고.대기중2례환자진행H반사、공능성자공진성상(fMRI)화정태평형공능평고(BPM).결과 4례환자중유2례미국척수손상협회(ASIA)운동급감각평분、10 m보행속도제고,보행비력정도감소,신체중심파동로경화파동면적균감소,개변지속도치료후제3주.2례환자적전생리평고균현시H반사최대파폭강저,H/M최대파폭비하강.치료후,2례환자적fMRI균현시M1구격활체적증대.결론 고빈rTMS연합BWSTT가능개선만성불완전성SCI환자적운동공능,제고척수운동신경원적흥강성병촉진대뇌피질적중소.
Objective To investigate the clinical effects of repetitive transcranial magnetic stimulation (rTMS) combined with body-weight-supported treadmill training (BWSTT) on patients with incomplete spinal cord injury (SCI).Methods Four patients with chronic incomplete SCI participated in this study.They were first treated with rTMS and then BWSTT training.They were assessed with clinical measures of function.Two of the four patients were assessed in terms of their H reflex,and using functional magnetic resonance imaging (fMRI) and a balance performance monitor (BPM).Results In two of the four patients,American spinal injury association (ASIA) clinical measures of motor and sensory function improved,as did 10 m walking speed and their sense of effort.In static balance tests,the sway path and sway area of the two patients both decreased.These improvements lasted for 3 weeks after the intervention.The two patients' maximum H reflex amplitude and the H/M amplitude ratio decreased.The fMRI results showed progressive enlargement of the activation volume of the movement-related M1 region after treatment.Conclusion High-frequency rTMS combined with BWSTT may improve motor function,elevate excitability of spinal motor neurons and improve the plasticity of the cerebral cortex in chronic incomplete SCI patients.