The objective of this study was to evaluate the biomechanical, neural, and functional outcomes during a 10-min treadmill stepping trial before and after two independent interventions with neuromuscular electrical stimulation (ES) in an individual with spinal cord injury (SCI). In this longitudinal study, a 34-year-old male with sensory- and motor-complete SCI (C5/C6) underwent two consecutive interventions: 61 h of supine lower limb ES (ES-alone) followed by 51 h of ES combined with stand training (ST) using an overhead body-weight support (BWS) system (ST + ES). In post ES-alone (unloaded), compared to baseline, the majority (∼60%) of lower extremity muscles decreased their peak surface electromyography (sEMG) amplitude, while in post ST + ES (loaded), compared to post ES-alone, there was a restoration in muscle activation that endured the continuous 10-min stepping. Temporal α-motor neuron activity patterns were observed for the SCI participant. In post ST + ES, there were increases in spinal activity patterns during mid-stance at spinal levels L5–S2 for the right and left limbs. Moreover, in post ES-alone, trunk stability increased with excursions from the midline of the base-of-support (50%) to the left (44.2%; Baseline: 54.2%) and right (66.4%; baseline: 77.5%). The least amount of trunk excursion observed post ST + ES, from midline to left (43%; AB: 22%) and right (64%; AB: 64%). Overall, in post ES-alone, there were gains in trunk independence with a decrease in lower limb muscle activation, whereas in post ST + ES, there were gains in trunk independence and increased muscle activation in both bilateral trunk muscles as well as lower limb muscles during the treadmill stepping paradigm. The results of the study illustrate the importance of loading during the stimulation for neural and mechanical gains.

中文翻译：

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多肌肉电刺激和站立训练对 SCI 患者踏步的影响

本研究的目的是评估脊髓损伤 (SCI) 患者在两次独立的神经肌肉电刺激 (ES) 干预前后 10 分钟跑步机踏步试验期间的生物力学、神经和功能结果。在这项纵向研究中，一名患有感觉和运动完全性 SCI (C5/C6) 的 34 岁男性连续接受了两次干预：61 小时仰卧下肢 ES（单独 ES），然后是 51 小时 ES 联合使用头顶负重支撑 (BWS) 系统 (ST + ES) 进行站立训练 (ST)。在单独使用 ES 后（无负荷）中，与基线相比，大多数 (~60%) 下肢肌肉降低了它们的峰值表面肌电图 (sEMG) 幅度，而在 ST + ES 后（负荷）中，与单独使用 ES 后相比, 经过连续 10 分钟的踏步，肌肉激活得到了恢复。观察到 SCI 参与者的时间α-运动神经元活动模式。在 ST + ES 后，右侧和左侧肢体在 L5-S2 脊柱水平的中间站立期间脊柱活动模式增加。此外，在单独使用 ES 后，躯干稳定性随着从支撑基底中线 (50%) 向左侧 (44.2%；基线：54.2%) 和右侧 (66.4%；基线：77.5%) 的偏移而增加. ST + ES 后观察到的躯干偏移量最少，从中线到左侧（43%；AB：22%）和右侧（64%；AB：64%）。总体而言，在单独使用 ES 后，躯干独立性增加，下肢肌肉激活减少，而在 ST + ES 后，在跑步机步进范式期间，躯干独立性和双侧躯干肌肉以及下肢肌肉的肌肉活动增加。研究结果说明了在刺激过程中负荷对神经和机械增益的重要性。