Background: Quality of life measurements indicate that independent performance of activities of daily living, such as reaching to manipulate objects, is a high priority of individuals living with motor impairments due to spinal cord injury (SCI). In a small number of research participants with SCI, electrical stimulation applied to the dorsal epidural surface of the spinal cord, termed epidural spinal electrical stimulation (ES), has been shown to improve motor functions, such as standing and stepping. However, the impact of ES on seated reaching performance, as well as the approach to identifying stimulation parameters that improve reaching ability, have yet to be described. Objective: Herein, we characterize the effects of ES on seated reaching performance in two participants with chronic, complete loss of motor and sensory functions below thoracic-level SCI. Additionally, we report the effects of delivering stimulation to discrete cathode/anode locations on a 16-contact electrode array spanning the lumbosacral spinal segments on reach distance while participants were seated on a mat and/or in their wheelchair. Methods: Two males with mid-thoracic SCI due to trauma, each of which occurred more than 3 years prior to study participation, were enrolled in a clinical trial at Mayo Clinic, Rochester, MN, USA. Reaching performance was assessed, with and without ES, at several time points throughout the study using the modified functional reach test (mFRT). Altogether, participant 1 performed 1,164 reach tests over 26-time points. Participant 2 performed 480 reach tests over 17-time points. Results: Median reach distances during ES were higher for both participants compared to without ES. Forward reach distances were greater than lateral reach distances in all environments, mat or wheelchair, for both participants. Stimulation delivered in the caudal region of the array resulted in improved forward reach distance compared to stimulation in the rostral region. For both participants, when stimulation was turned off, no significant changes in reach distance were observed throughout the study. Conclusion: ES enhanced seated reaching-performance of individuals with chronic SCI. Additionally, electrode configurations delivering stimulation in caudal regions of the lumbosacral spinal segments may improve reaching ability compared to rostral regions.

中文翻译：

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腰骶脊髓的硬膜外电刺激可改善两个严重胸脊髓损伤人在坐姿伸直过程中的躯干稳定性

背景：生活质量测量表明，日常生活活动的独立表现，例如伸手去操作物体，是因脊髓损伤 (SCI) 而患有运动障碍的个体的重中之重。在少数患有 SCI 的研究参与者中，应用于脊髓背侧硬膜外表面的电刺激，称为硬膜外脊髓电刺激 (ES)，已被证明可以改善运动功能，例如站立和迈步。然而，ES 对坐姿到达性能的影响，以及识别提高到达能力的刺激参数的方法，还有待描述。目的：在此，我们描述了 ES 对两名慢性、在胸水平 SCI 以下完全丧失运动和感觉功能。此外，我们报告了当参与者坐在垫子上和/或坐在轮椅上时，将刺激传递到跨越腰骶脊髓节段的 16 触点电极阵列上的离散阴极/阳极位置的影响。方法：两名因外伤而患有中胸 SCI 的男性在美国明尼苏达州罗彻斯特市梅奥诊所参加了一项临床试验，他们均在参与研究前 3 年以上发生。在整个研究的几个时间点，使用改良的功能范围测试 (mFRT) 评估了有和没有 ES 的达到性能。总共，参与者 1 在 26 个时间点进行了 1,164 次到达测试。参与者 2 在 17 个时间点上进行了 480 次到达测试。结果：与没有 ES 的情况相比，两个参与者在 ES 期间的平均可达距离更高。在所有环境中，无论是垫子还是轮椅，两名参与者的前伸距离都大于侧伸距离。与嘴部区域的刺激相比，阵列尾部区域的刺激导致前伸距离的改善。对于这两个参与者，当关闭刺激时，在整个研究过程中都没有观察到到达距离的显着变化。结论：ES 增强了慢性 SCI 患者的坐姿伸手能力。此外，与嘴部区域相比，在腰骶段的尾部区域提供刺激的电极配置可以提高到达能力。在所有环境中，无论是垫子还是轮椅，两名参与者的前伸距离都大于侧伸距离。与嘴部区域的刺激相比，阵列尾部区域的刺激导致前伸距离的改善。对于这两个参与者，当关闭刺激时，在整个研究过程中都没有观察到到达距离的显着变化。结论：ES 增强了慢性 SCI 患者的坐姿伸手能力。此外，与嘴部区域相比，在腰骶段的尾部区域提供刺激的电极配置可以提高到达能力。在所有环境中，无论是垫子还是轮椅，两名参与者的前伸距离都大于侧伸距离。与嘴部区域的刺激相比，阵列尾部区域的刺激导致前伸距离的改善。对于这两个参与者，当关闭刺激时，在整个研究过程中都没有观察到到达距离的显着变化。结论：ES 增强了慢性 SCI 患者的坐姿伸手能力。此外，与嘴部区域相比，在腰骶段的尾部区域提供刺激的电极配置可以提高到达能力。与嘴部区域的刺激相比，阵列尾部区域的刺激导致前伸距离的改善。对于这两个参与者，当关闭刺激时，在整个研究过程中都没有观察到到达距离的显着变化。结论：ES 增强了慢性 SCI 患者的坐姿伸手能力。此外，与嘴部区域相比，在腰骶段的尾部区域提供刺激的电极配置可以提高到达能力。与嘴部区域的刺激相比，阵列尾部区域的刺激导致前伸距离的改善。对于这两个参与者，当关闭刺激时，在整个研究过程中都没有观察到到达距离的显着变化。结论：ES 增强了慢性 SCI 患者的坐姿伸手能力。此外，与嘴部区域相比，在腰骶段的尾部区域提供刺激的电极配置可以提高到达能力。