神經肌肉特性與脊髓損傷後之改變

The Changes of Neuromuscular Properties Following Spinal Cord Injury

謝宗勳(Tsung-Hsun Hsieh) ； 高煜昇(Yu-Sheng Kao) ； 劉宇菁(Yu-Ching Liu) ； 陳貞吟(Chen-Yin Chen) ； 李言貞(Yen-Chen Li) ； 張雅如(Ya-Ju Chang)

《物理治療》 41卷3期 (2016/09) Pp. 211-222

https://doi.org/10.6215/FJPT.PTS1457063155

摘要

背景與目的：脊髓神經迴路與肌肉特性會在脊髓損傷後產生動態性的改變，進而產生痙攣。這些變化並不是受傷初期即發生，而是逐漸改變而來。然而，過去研究對脊髓神經肌肉的適應的瞭解則相當有限，因此研究中樞神經損傷後之神經迴路與肌肉特性之時程變化對於發展相對應之復健方式顯得格外重要。方法：本研究收取20個健康受試者與31名受傷時間不同的脊髓損傷患者，評估健康人與脊髓損傷患者之H反射活化後抑制、交替抑制、運動神經元興奮性與肌肉疲乏指數之適應程度。使用線性迴歸分析與單因子變異數分析，瞭解脊髓損傷後神經肌肉適應性隨時間之改變，以及與健康人之差異。結果：本研究觀察到活化後抑制隨著脊髓損傷受傷時間增加而逐漸減少的現象。交替抑制隨受傷時間的增長而出現逐漸消失的現象。運動神經元興奮性在脊髓損傷後會逐漸的上升，疲勞指數則在受傷後疲勞指數會快速的下降。結論：本研究發現在脊髓損傷後，神經迴路與肌肉特性會隨著受傷時間而逐漸適應改變，此結果將可被當為在受傷後不同階段處理脊髓損傷患者之痙攣症狀的一個重要指標。

關鍵字

脊髓損傷 ； 活化後抑制 ； 交替抑制 ； 疲勞指數

並列摘要

Background and purpose: After spinal cord injury (SCI), the spinal circuits and muscle characteristics show dramatic changes in parallel to the development of spasticity. These changes do not occur instantaneously, but instead undergo a series of adaptations with time post injury. However, the understanding of spinal neuromuscular adaptation following spinal cord injury is quite limited. Therefore, to develop the novel rehabilitation approaches, it is particularly important to understand the time-course changes of spinal circuits and muscle characteristics following spinal cord injury. Methods: We recruited 20 healthy subjects and 31 individuals with SCI for the testing of adaptation in post activation depression of H reflexes (PAD), reciprocal inhibition (RI), motor neuron excitability, and fatigue index. Regression analysis and One way analysis of variance were used to analyze the time-course adaptations and the differences between healthy and SCI subjects. Results: We found that the PAD and RI in patients with spinal cord injury were gradually reduced with time. The motor neuron excitability revealed gradually increased and fatigue index sharply decreased after spinal cord injury, respectively. Conclusion: In this study, the progressive adaptations of spinal circuit and muscle characteristics were observed after spinal cord injury. These parameters can be as important indicators for the evaluation and management of spasticity in patients with different stages of spinal cord injury.

並列關鍵字

Spinal cord injury ； Post activation depression of H-reflex ； Reciprocal inhibition ； Fatigue index