Recovery of lower-limb function after spinal cord injury (SCI) is dependent on the extent of remaining neural transmission in the corticospinal pathway. The aim of this proof-of-concept pilot study was to explore the effects of long-term paired associative stimulation (PAS) on leg muscle strength and walking in people with SCI. Five individuals with traumatic incomplete chronic tetraplegia (>34 months post-injury, motor incomplete, 3 females, mean age 60 years) with no contraindications to transcranial magnetic stimulation (TMS) received PAS to one or both legs for 2 months (28 sessions in total, 5 times a week for the first 2 weeks and 3 times a week thereafter). The participants were evaluated with the Manual Muscle Test (MMT), AIS motor and sensory examination, Modified Asworth Scale (MAS), and the Spinal Cord Independence Measure (SCIM) prior to the intervention, after 1 and 2 months of PAS, and after a 1-month follow-up. The study was registered at clinicaltrials.gov (NCT03459885). During the intervention, MMT scores and AIS motor scores increased significantly (p = 0.014 and p = 0.033, respectively). Improvements were stable in follow-up. AIS sensory scores, MAS, and SCIM were not modified significantly. MMT score prior to intervention was a good predictor of changes in walking speed ( R adj 2 = 0.962). The results of this proof-of-concept pilot study justify a larger trial on the effect of long-term PAS on leg muscle strength and walking in people with chronic incomplete SCI.

中文翻译：

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长期配对联想刺激对慢性四肢瘫痪患者腿部肌肉和步行强度的影响：一项概念验证的试验研究。

脊髓损伤（SCI）后下肢功能的恢复取决于皮质脊髓途径中剩余神经传递的程度。这项概念验证性试验研究的目的是探讨长期配对联想刺激（PAS）对SCI患者腿部肌肉力量和行走的影响。五名外伤性不完全性慢性四肢瘫痪（受伤后> 34个月，运动不全，3名女性，平均年龄60岁），无经颅磁刺激（TMS）禁忌症的患者接受了PAS于双腿或双腿接受为期2个月的治疗（共28次）总计，前2周每周5次，此后每周3次）。通过手动肌肉测试（MMT），AIS运动和感觉检查，改良的Asworth量表（MAS）对参与者进行评估，干预前，PAS 1和2个月后以及1个月的随访后进行脊髓独立性测量（SCIM）。该研究已在Clinicaltrials.gov（NCT03459885）上注册。在干预期间，MMT评分和AIS运动评分显着增加（分别为p = 0.014和p = 0.033）。随访中病情稳定。AIS感官评分，MAS和SCIM没有明显改变。干预前的MMT评分可以很好地预测步行速度的变化（R adj 2 = 0.962）。这项概念验证性试验研究的结果证明了一项长期的PAS对慢性SCI不完全的人的腿部肌肉力量和行走的影响的大型试验是正确的。在干预期间，MMT评分和AIS运动评分显着增加（分别为p = 0.014和p = 0.033）。随访中病情稳定。AIS感官评分，MAS和SCIM没有明显改变。干预前的MMT评分可以很好地预测步行速度的变化（R adj 2 = 0.962）。这项概念验证性试验研究的结果证明了一项长期的PAS对慢性SCI不完全的人的腿部肌肉力量和行走的影响的大型试验是正确的。在干预期间，MMT评分和AIS运动评分显着提高（分别为p = 0.014和p = 0.033）。随访中病情稳定。AIS感官评分，MAS和SCIM没有明显改变。干预前的MMT评分可以很好地预测步行速度的变化（R adj 2 = 0.962）。这项概念验证性试验研究的结果证明了一项长期的PAS对慢性SCI不完全的人的腿部肌肉力量和行走的影响的大型试验是正确的。